The cycle start coordination checklist

Before the calendar goes out

• Get the protocol and start day confirmed in writingA verbal in the hallway is how start days drift. Good looks like a written protocol note with the intended start date and the planned gonadotropin dose, initialed by the physician before you build anything.
• Confirm baseline labs and antral follicle count are resultedDo not print a calendar against pending results. Check estradiol, the baseline scan and any cyst finding are back and reviewed, because a suppressed baseline changes the start day and wastes the calendar you just built.
• Verify the medication benefit with the specialty pharmacy, not the medical planInjectables usually sit with the pharmacy benefit. Good looks like a named pharmacy, a confirmed prior authorization status and a patient responsibility figure you would be willing to repeat back on a recorded call.
• Confirm the shipment arrived and what is actually in the boxAsk the patient to read the labels aloud or send a photo. Substitutions and short fills are common enough that discovering one on day one of stimulation is an avoidable evening.
• Identify who is giving the injections and include that personIf a partner or a friend is drawing up doses, she needs the same calendar. Good looks like both people able to see the current schedule rather than one relaying it to the other at nine at night.

Building the medication calendar

• Write every dose in the units marked on the pen or vialTranslate the order into what the patient physically sees. If the pen dials in units, write units, and never leave the patient converting between the order language and the device in her hand.
• Put mixing steps next to the drug that needs mixingReconstitution instructions in a separate handout get lost by day four. Good looks like the mixing note attached to the same calendar row as the dose, so it is unavoidable at the moment she needs it.
• State a time window for each injection and name the time zoneEvening is not an instruction. Give a window such as between six and eight in the evening, name the time zone, and say what to do if she misses it rather than leaving her to improvise.
• Mark which monitoring dates are fixed and which get set day by dayPatients plan work around this. Good looks like the known appointments dated and the provisional ones flagged clearly as depending on how she responds, so nobody assumes a date that was never promised.
• Leave the trigger row visible but empty until it is decidedShowing the row from day one teaches her that the trigger has an exact time and that she will receive it. It also stops her assuming a date from the average cycle length she read online.
• Add refrigeration, travel and disposal notes as one blockOne short block at the end covering what goes in the fridge, how to travel with medication and where sharps go. Scattering these across the calendar means they get read once and forgotten.

Monitoring mornings and dose changes

• Give an arrival window and the lab cutoff, not a vague morningYour estradiol turnaround dictates everything downstream. Tell her the window and say plainly that arriving after the cutoff pushes her results to the afternoon, which pushes her dose instruction late.
• Set a promise time for the results call and hold itGood looks like telling every patient she will hear by a stated hour, then clearing the board by that hour. An unkept promise time generates more inbound calls than no promise at all.
• Send dose changes in writing with the unchanged drugs listed tooStating only what changed invites her to guess about the rest. List all active medications with tonight numbers, so the message is a complete instruction rather than an amendment.
• Require an acknowledgment back before you close the boardA confirmation tied to the specific dose and date, not a general reply. Good looks like an unconfirmed list you can see at a glance, sorted by how near the injection window is.
• Escalate anything unconfirmed by your cutoff to a live callSet a clinic wide cutoff, commonly late afternoon. Past it, somebody dials, and the call is logged against the cycle so the next coordinator on the board knows it happened.
• Record every dose change against the cycle the same dayDo not batch documentation to the end of the week. Good looks like the instruction, the timestamp and the acknowledgment sitting together, which is what you will want if the cycle is later reviewed.

Trigger night and retrieval prep

• State the trigger time to the minute with the date and time zoneNine thirty is not enough. Good looks like the full date, the exact clock time, the drug, the dose and a note that timing matters more here than anywhere else in the cycle.
• Have a second person read the trigger instruction before it goes outA thirty second read by another coordinator catches transposed digits and wrong dates. Make it a standing rule rather than something reserved for complicated cases.
• Confirm the patient repeated the time back in her own wordsAn acknowledgment tap plus a spoken readback on a first cycle. Good looks like her saying the date and time unprompted, not agreeing with the time you just said to her.
• Send NPO, arrival time and ride requirements as one messageThree separate messages produce three chances to miss one. Combine them, and state the arrival time as a clock time rather than as an interval before the procedure.
• Check the confirmation board before you leave for the nightThe last action of a trigger day is looking at who has not acknowledged. Good looks like an empty unconfirmed list, or a documented call for every name still on it.