i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s 8 2 ( 2 0 1 3 ) 980–986 journa l h omepage: www.ijmijournal.com Junior doctors’ prescribing work after-hours and the impact of computerized decision support Samantha L. Jaensch a,b , Melissa T. Baysari b,c,* , Richard O. Day a,b , Johanna I. Westbrook d a Faculty of Medicine, University of New South Wales, Sydney, Australia b Department of Clinical Pharmacology & Toxicology, St. Vincent’s Hospital, Sydney, Australia c Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia d Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia a r t i c l e i n f o Article history: Received 14 October 2012 Received in revised form 5 March 2013 Accepted 30 June 2013 Keywords: CPOE CDSS Transcribing Junior doctors Alerts a b s t r a c t Background and objective: computerized provider order entry (CPOE) systems with integrated decision support (DS) can reduce prescribing errors, but their impact may vary depending on the clinical setting. This study aimed to assess the impact of partial implementation of CPOE on junior doctors’ prescribing work after-hours and to examine differences in junior doctors’ use of DS during transcribing and their own prescribing tasks. Methods: Twelve junior doctors at a 350-bed teaching hospital in Sydney, Australia were shadowed between 16:30 and 22:30 over eight weeks for 65 h. CPOE was available on all wards except for the emergency department (ED). All medication tasks, computerized alerts, prescriber responses, and uses of reference material were recorded. Results: Of 306 medication orders entered into the CPOE, 78.4% were transcribed from paper ED charts. A total of 113 alerts were triggered, most (78%) were read but only 6 (5%) resulted in prescribers changing an order. Reference material was accessed three times more frequently when junior doctors made their own prescribing decisions than when they transcribed other doctors’ orders, but a similar proportion of alerts was read during decision-making and transcribing tasks. Conclusion: Junior doctors spent most of their after-hours prescribing time transcribing other doctors’ orders. This is a new task brought about by partial CPOE implementation. Junior doctors read computerized alerts and used online reference material to support their decision-making. However they rarely made changes to a medication order following alert generation, suggesting the alert information was often not clinically relevant. © 2013 Elsevier Ireland Ltd. All rights reserved. 1. Background and objective Computerized provider order entry (CPOE) systems have been shown to reduce prescribing errors, even more so when they ∗ Corresponding author at: Department of Clinical Pharmacology & Toxicology, Therapeutics Centre, Level 2, Xavier Building, St. Vincent’s Hospital, Darlinghurst, NSW 2010, Australia. Tel.: +61 2 8382 2043; fax: +61 2 8382 2724. E-mail address: m.baysari@unsw.edu.au (M.T. Baysari). include clinical decision support (DS) [1–3]. While DS varies between settings, it typically comprises access to clinical refer- ence material, pre-written orders and real-time drug alerts [4]. DS can facilitate decision-making if it provides relevant infor- mation to the decision-maker at the time of prescribing [5,6]. 1386-5056/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijmedinf.2013.06.014