Fig. 1

Schematic overview of the CDSS. Legend The CDSS generates a report for each patient daily, in which all the rules of the CDSS are assessed. All rules receive either a red or green outcome, with red alerts requiring action and attention, and they are evaluated by the pharmacist. The pharmacist then assesses whether action is needed for the healthcare provider and communicates this. The CDSS runs daily, and all rules/alerts are once again categorized as red or green. When a red alert remains red, we define it as an “unresolved” alert, and if the rule turns green, we define it as a “resolved” alert. We evaluated the rules and outcomes for the first 7 days of admission