Table 2 Summary of pharmacists’ approaches to promote the appropriate use of medicines using CDSSs when auditing prescriptions

Bhardwaja et al. [46]

A system warned pharmacists when the dosage exceeded kidney function-based values when dispensing renally excreted drugs

The rates of dosage errors in the intervention and control groups were 33% and 49%, respectively, and those in the intervention group were significantly lower (p < 0.001)

Díaz et al. [47]

A system allowed pharmacists in a tertiary teaching hospital to identify patients with reduced kidney function and medications that may require dosage modifications based on kidney function

The rate of appropriate prescriptions based on kidney function increased significantly from 65 to 86% before and after the intervention, respectively (p < 0.001)

Niedrig et al [48]

A system prospectively identified metformin prescriptions when the estimated glomerular filtration rate was less than 60 mL/min in a tertiary care hospital. The system sent real-time electronic alerts to clinical pharmacologists and pharmacists, who verified the case in electronic medical records and, if necessary, confirmed the dose with the prescriber

Clinical pharmacologists and pharmacists who received electronic alerts contacted the prescriber to request reduction or discontinuation of metformin in 240 patients. This suggestion was accepted in 191 patients

Vogel et al. [49]

An outpatient system alerted pharmacists when they dispense prescriptions for medications that require kidney dose adjustment or are contraindicated at certain kidney function thresholds

The rate of dosage errors was 0.36%

Ishikawa et al. [42]

A system automatically printed a DOAC check sheet including the information on dosages according to kidney function and cut-off values ​​for contraindications due to kidney function when DOACs were prescribed to hospitalized patients

The number of inquiries from pharmacists to physicians regarding DOAC prescriptions, such as dosage, before the use of the DOAC check sheet, was four out of 642 prescriptions (0.6%), but after its introduction, this number increased significantly to 21 out of 905 prescriptions (2.3%) (p = 0.0089)

Sonoda et al. [43]

An in-hospital PCS for hospitalized patients involved: (1) adding the label “renal” before the name of renally excreted drugs on the prescription; (2) adding the patient’s estimated kidney function level on the prescription; and (3) using a check sheet for the dosages based on kidney function for the target drugs. When a hospital prescription included the target drug, a check sheet based on the patient’s kidney function was automatically printed

The overall dosage error rate for the four target drugs was 26% before PCS implementation, which decreased significantly to 3% after PCS implementation (p < 0.001)