Oregon Health & Science University Hospital and Clinics Provider’s Orders - PO9031 - Adult Ambulatory Infusion Order - Epoetin alfa-epbx (RETACRIT) Injection Maintenance for Oncology Patients

Q: What are the activation requirements for this provider order set?

All orders must be marked in ink with a checkmark to be active.

Q: What indications can be selected for maintenance dosing of epoetin alfa-epbx?

The form supports chemotherapy-induced anemia and symptomatic anemia associated with myelodysplastic syndrome (MDS), with specific documentation requirements for each.

Q: How are patients switched from epoetin alfa-epbx to darbepoetin alfa?

Orders for epoetin alfa-epbx are converted to darbepoetin alfa using equivalent therapeutic interchange dosing tables. Providers can use epoetin alfa-epbx only with a specified reason.

Oct 13, 2026

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Oregon Health & Science University Hospital and Clinics Provider’s Orders define an adult ambulatory infusion maintenance regimen for epoetin alfa-epbx (RETACRIT) in oncology patients. The order set includes required ink checkmark activation, patient identification fields, allergy/diagnosis placeholders, and treatment start and follow-up rules with a 365-day expiration. It specifies indications for chemotherapy-induced anemia or MDS-related symptomatic anemia, ESA interchange conversion to darbepoetin alfa, monitoring labs and treatment parameters, and nursing and other operational instructions including vascular access maintenance.

LanguageEnglish

CategoryForms

FormatPDF

Pages4

Reading Time2 min

AccessFree to download

Provider’s Orders

Adult Ambulatory Infusion Order

Indications and Ordering Guidelines

Treatment Parameters and Monitoring Labs

Nursing and Other Orders

ESA Conversion and Dosing Tables

Medication and Dosing Regimens

| | Oregon Health & Science University Hospital and Clinics Provider’s Orders
*PO9031*
ADULT AMBULATORY INFUSION ORDER
Epoetin alfa-epbx (RETACRIT) Injection Maintenance for Oncology Patients
Page 1 of 4
PO9031 | ACCOUNT NO.
MED. REC. NO.
NAME
BIRTHDATE
Patient Identification | | --- | --- | --- | | ALL ORDERS MUST BE MARKED IN INK WITH A CHECKMARK ( 􀀹 ) TO BE ACTIVE. | | | Weight: kg Height: cm Allergies: Diagnosis Code: Treatment Start Date: Patient to follow up with provider on date: **This plan will expire after 365 days at which time a new order will need to be placed** **This order set is for MAINTENANCE DOSING ONLY. Patients should have received first dose via the INITIATION order set with either chemotherapy-induced anemia or myelodysplastic syndrome selected as indications** INDICATION: (Must check one) 􀂅 Chemotherapy-induced anemia 􀂅 Symptomatic anemia associated with myelodysplastic syndrome (MDS) GUIDELINES FOR ORDERING 1. Send FACE SHEET and H&P or most recent chart note. 2. OHSU’s formulary erythropoiesis stimulating agent (ESA) is darbepoetin alfa (ARANESP) . All orders for epoetin alfa-epbx (RETACRIT) will be converted to darbepoetin alfa using equivalent therapeutic interchange dosing listed in the table below. Providers who prefer to use epoetin alfa-epbx must specify a reason for its use. REASON FOR EPOETIN USE: 3. Patients receiving concurrent treatment with Iron Sucrose (VENOFER) and/or Vitamin B12 cannot receive ESA treatment on the same day. Patients may be on prophylactic oral iron supplementation concurrent with ESA treatment as long as supplementation for the prevention of iron deficiency is necessary due to ESA therapy alone. 4. Serum ferritin and transferrin saturation (TSAT) must be performed every month during initial (ESA) treatment and at least every 3 months during stable ESA treatment (serum ferritin greater than 100 ng/mL, and TSAT greater than or equal to 20%) . Therapy with epoetin alfa-epbx may continue only if hemoglobin DOES NOT equal or exceed 11 g/dL. 5. For patients with chemotherapy-induced anemia: The medical record must document the provider’s rationale for determining the anemia is "chemotherapy-induced." Anemia must be secondary tomyelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma, or lymphocytic leukemia. Treatment should be limited to the 8 weeks following myelosuppressive chemotherapy. 6. For patients with symptomatic anemia from MDS: The patient must be symptomatic and his/her life expectancy must be >3 months. The medical record must display documentation that a bone marrow biopsy has been reviewed by a provider and is consistent with the diagnosis of MDS. The marrow blast count must be <5% | | Oregon Health & Science University Hospital and Clinics Provider’s Orders
ADULT AMBULATORY INFUSION ORDER
Epoetin alfa-epbx (RETACRIT) Injection Maintenance for Oncology Patients
Page 2 of 4 | ACCOUNT NO.
MED. REC. NO.
NAME
BIRTHDATE
Patient Identification | | --- | --- | --- | | ALL ORDERS MUST BE MARKED IN INK WITH A CHECKMARK ( 􀀹 ) TO BE ACTIVE. | | | LABS: 􀂅 Hemoglobin & Hematocrit, Routine, ONCE, (weekly) or every (visit)(days)(weeks)(months)– Circle One 􀂅 CMP, Routine, ONCE, (weekly) or every (visit)(days)(weeks)(months)– Circle One 􀂅 Ferritin (serum), Routine, ONCE, every 12 weeks 􀂅 Iron and TIBC (serum), Routine, ONCE, every 12 weeks 􀂅 Labs already drawn. Date: (Must have been drawn at least 14 days after the last dose) NURSING ORDERS: 1. Patients receiving concurrent treatment with Iron Sucrose (VENOFER) and/or Vitamin B12 cannot receive ESA treatment on the same day. 2. TREATMENT PARAMETERS – Hold treatment and call provider if hemoglobin is greater than or equal to 11, serum ferritin is less than or equal to 100 ng/mL, transferrin saturation is less than 20% or if blood pressure is greater than 180 systolic or 100 diast

FAQs

What are the activation requirements for this provider order set?

All orders must be marked in ink with a checkmark to be active.

What indications can be selected for maintenance dosing of epoetin alfa-epbx?

The form supports chemotherapy-induced anemia and symptomatic anemia associated with myelodysplastic syndrome (MDS), with specific documentation requirements for each.

How are patients switched from epoetin alfa-epbx to darbepoetin alfa?

Orders for epoetin alfa-epbx are converted to darbepoetin alfa using equivalent therapeutic interchange dosing tables. Providers can use epoetin alfa-epbx only with a specified reason.

Oct 13, 2026

Upload by I feel Different