IV Compatibility Study Sparks Discussion on Data Accuracy and Clinical Decision Support
A recently published study in the European Journal of Clinical Pharmacology has highlighted the potential of electronic tools to support the detection of intravenous (IV) drug incompatibilities in clinical practice. A subsequent correspondence from the editor of King Guide has raised important questions regarding the accuracy of some of the data used in the study, prompting a broader discussion about validation, reference standards, and the role of clinical decision-support systems in medication safety. [link.springer.com], [e-Harvis a...ature Link]
Original Study Evaluates e-Harvis Compared to Established References
In June 2026, Ammor and colleagues published Detection of Intravenous Drug Physicochemical Incompatibilities in Clinical Practice: e-Harvis Compared to Reference Tools in the European Journal of Clinical Pharmacology. The study evaluated e-Harvis, an electronic resource designed to identify physicochemical incompatibilities among intravenously administered medications, and compared its performance with established compatibility references used by pharmacists and healthcare professionals. [link.springer.com]
Study Findings Challenged by Respected Editor of King Guide
On September 7, 2026, Dr. Patrick N. Catania, editor of King Guide to Parenteral Admixtures since 1993, published a correspondence titled e-Harvis and Detection of IV Incompatibilities, expressing concerns regarding the methodology and data interpretation used in the original publication. [e-Harvis a...ature Link]
According to Dr. Catania, the process used to identify compatible and incompatible drug combinations was not sufficiently robust to accurately reflect information contained in several widely used compatibility resources, including the ASHP Handbook on Injectable Drugs, King Guide to Parenteral Admixtures, and Stabilis. His rebuttal to the study finds potential that the study may have incorrectly represented the content and reliability of these reference tools. [e-Harvis a...ature Link]
Dr. Catania’s analysis presents several examples in which compatibility assessments reported within the study's supplementary materials allegedly differed from information long contained in the referenced databases. Examples cited include reports of "Unknown" compatibility status for specific drug-fluid or drug-drug combinations. [e-Harvis a...ature Link]
Importance of Data Validation
A central theme of the rebuttal is the need for rigorous validation when comparing emerging digital tools against established drug compatibility references. Dr. Catania noted that even limited review of the supplementary data identified discrepancies that warrant re-examination of the study's methodology, findings and conclusions.
The discussion underscores the challenges involved in aggregating and interpreting compatibility information from multiple resources. Differences in terminology, nomenclature, data structure, and evidence interpretation can create complexities when developing electronic decision-support platforms intended for real-world clinical use. [e-Harvis a...ature Link]
Implications for Pharmacy Practice
While the original study highlights the promise of technology-enabled compatibility screening, Dr. Catania’s rebuttal serves as a reminder that clinical decision-support systems must be subjected to continuous validation and quality assurance by experienced pracitioners.
References
Ammor et al. Detection of intravenous drug physicochemical incompatibilities in clinical practice: e-Harvis compared to reference tools. European Journal of Clinical Pharmacology. 2026. [link.springer.com]
Catania PN. e-Harvis and detection of IV incompatibilities. European Journal of Clinical Pharmacology. 2026;82:244. Published September 7, 2026. [e-Harvis a...ature Link]