• administration, intravenous
• medical informatics
• medication systems, hospital
• safety
• pharmacy service, hospital

According to the 2018 China National Adverse Drug Reaction (ADR) Monitoring Report, intravenous medications accounted for 60.0% of the reported ADRs.1 Over-reliance and improper administration of intravenous infusions are a severe health problem in China. A 2019 study reveals that 89.2% of patients received intravenous medications at a large Chinese academic hospital, and 11.4% of these prescriptions were inappropriate, ranging from improper diluents to contraindicated administrations.2 Over the past two decades, hospitals have been exploring ways to address intravenous medication safety in China. Efforts are focused on building hospital information systems and pharmacy intravenous admixture services (PIVAS), targeting the entire intravenous medication use process: prescribing, order review, compounding and administration. This letter aimed to provide a brief update on several key intravenous medication safety initiatives in China.

PIVAS has been constructed in Chinese hospitals since 1999 to reduce patient morbidity and mortality caused by intravenous compounding, and PIVAS now exists in more than 1100 hospitals. Intravenous admixtures are compounded by PIVAS centres after prescription order review. However, the percentage of hospitals with PIVAS is still meagre at 3.3%. Further investment in PIVAS is urgently needed.

Leveraging information technology is critical in medication safety. Intravenous therapies are the responsibility of all clinicians involved in the practice. Two notable advances are the development of an intravenous prescription early warning and assessment system (IPEWAS) by the Xiangya Hospital Central South University,3 and the PIVAS Clinical Decision Support Intelligent Sequence Annotation (PCISA) system developed by the Hefei Binhu Hospital.4 The IPEWAS has separate interfaces for physicians, pharmacists and nurses, and a management interface serving as a central repository for intravenous infusion therapy. The system can provide clinical decision support to physician prescribing, pharmacist verification and nursing administration of intravenous medications. For example, the nursing interface offers instructions on the rate and route of administration, and whether special precautions are needed, such as light protection and extravasation management.3 This platform has demonstrated its value in curbing the frequency of inappropriate administration of intravenous medications at the hospital.3 A hospitalised patient may receive multiple intravenous infusions throughout the day, and the administration sequence may affect efficacy and safety.4 Improper sequences may lead to physical changes of compounded admixtures (ie, turbidity and precipitation) and unnecessary tubing flushes in between incompatible infusions. Both pharmacokinetics and pharmacodynamics may affect the infusion sequences of intravenous medications, and eight infusion factors are considered in building the infusion knowledge database (table 1). The module contains all hospital formulary intravenous medications, and the PCISA performs sequence analyses for a given patient when multiple intravenous medications are prescribed. The PCISA is efficient in sequence analysis and leads to rational use of intravenous medications.5 The PCISA extends the functions of IPEWAS. The integration of these systems and full application in Chinese hospitals may effectively enhance the safety of intravenous therapies for a patient during the entire medication use process.