Table 4 Examples of (organisation) team level awareness and computerised provider order entry (CPOE) limitations

Doctors with doctors

Difficult to identify ‘where the patient is at’ [whole regimen view]

....you do have to then plough through a fair bit of information to figure out where they’re at. So I’m at the mercy of the quality of the input of the previous doctor [...] If they put in [...] for example, “had day 72 coming on the 14th [of this month] for day 86,” then it places me exactly where they’re at. [...] if they put that in it makes my life easy. If they put in, “See again next scheduled visit”, I don’t know what that next scheduled visit is. And for my patients I might know, [...] I will see other people’s patients [...] I have to then come up to speed with what that particular patient is on. (id1)

Difficult to identify [patient specific] changes to prescriptions

I know the things that make my life easier, so I will document these things whenever I see them. And some of the fellows that see them in clinic, because they were more recently registrars and recognise this issue, will do the same. So they will document clearly their medication list, and the changes that they’ve made. (id20)

Doctors with nurses

Difficult to identify ‘where the patient is at’ [exact place in the protocol (a PDF file)]

Nurse 1: [...] when the fellows are ordering the chemo [...] it does help if they are actually very specific on where this kid is up to, like, exactly what cycle and everything they are up to.

Nurse 2: ‘Course two, cycle three, page 59’.

Nurse 1: The more specific they [doctors] are, the easier it is for us to find it, yeah. (id8–12)

Automatically calculated doses may not be feasible to administer

[as a doctor] I make sure that the dose isn’t something that’s ridiculous and going to be really hard for [nurses] to give. (id5)

Automatically calculated times of doses may not be convenient (safe?)

I make sure that [nurses] can recognise if they need to give it now or if they can give it at a later date, like [...] the midnight doses. [...] whether the times that are coming up are convenient. (id5)

Fluid charts may not get automatically filled-in

... just things like being aware that if they [the doctors] don’t fill out things like durations and infuse over times correctly, it makes it much harder for the nurses to then complete their fluid balance charts correctly, because they’ve got to manually pull everything in, whereas if the doctors order it correctly it all prepopulates beautifully for them. (id13)

Nurses with nurses

Difficult to identify ‘where the patient is at’ [exact place in the protocol (a PDF file)]

Nurse 1: To find the bit you actually want for the chemo you are giving, you might have to scroll through multiple pages if you are the first [nurse] to kind of ... find that cycle of chemo.

Nurse 2: Once you found it we write it down [for the next nurse]. (id8–12)

Doctors with Pharmacy

Automatically calculated doses may not be feasible to dispense

So not prescribing a dose that’s 1.62 mg because no pharmacist is ever going to be able to draw that up ... (id13)

Pharmacy staff access to CPOE orders not sufficient for timely dispensing

We owe it to the pharmacy to give them as much notice as possible and the minimum [lead] time we have most recently put in is 48 h. So the pharmacy has to know at least 48 h before, we’re going to give the drug... (id2)