Fig. 1

Checkpoints to prevent overdosage of renally excreted drugs and avoid the inappropriate use of nephrotoxic drugs. Before renally excreted drugs or nephrotoxic drugs are administered to a patient, there are two checkpoints. First, physicians prescribe the drugs using the electronic physician order entry system. If the dosage is inadequate, a CDSS alert is sent to physicians, and they modify the dosages of drugs as necessary. Second, pharmacists check the dosages of drugs taking into account kidney function. If the dosage is inadequate, a CDSS alert is sent to pharmacists, and they discuss the dosages with the prescriber and dispense drugs. Then, the drug is administered to a patient. If a decreased kidney function or acute kidney injury occurs during drug administration, a CDSS alert is sent to physicians or pharmacists. Physicians consider changing the dosages or discontinuing the administration of drugs or pharmacists suggest it for physicians. CDSS: clinical decision support system