Background:
· Temperature sensitive vaccines and medications are subject to precise temperature monitoring from the time of their manufacturing to their delivery to hospitals, with the capability to demonstrate temperature compliance on a 24/7 basis.
· Upon receipt by hospitals, no such regulations exist, and the drug “Cold Chain” can become vulnerable to spoilage that results in millions of dollars of medications and vaccines that are thrown out; or worse, not detected and administered to patients.
Current Medication and Vaccine Management Practices in Hospitals
· Studies have indicated that 30% to 40%, of temperature sensitive vaccines and medications are stored by hospitals outside of the stated ranges required to maintain their maximum effectiveness. These studies have found that while the typical recommended storage range for refrigerated medications is between 2ºC to 8ºC, they are often exposed to temperatures ranging from -1ºC to 15ºC.
· Temperature failure points can exist in a variety of hospital locations and departments:
Ø For example, an instance was noted in which temperature sensitive and expensive drugs were left on a loading dock in 30ºC weather for more than 2 hours. These drugs were likely spoiled, yet, also likely administered to patients because temperature logging did not occur during that period.
Ø In Nursing, pharmaceuticals are routinely stored in common “bar fridges” that are not well insulated, and cycle in a manner that produces ‘spiky’ temperatures. Temperatures in these fridges are typically monitored by manual processes using Min/Max thermometers. There is no requirement for regular temperature calibrations and manual logs are vulnerable to abuse.
Ø Beyond calibration issues, Min/Max thermometers do not indicate the duration of “out-of-range” conditions, thus leading to drugs being thrown out, when they were not necessarily out “out-of-range” long enough to render them ineffective.
Solutions
· Recent changes in monitoring technology now provide integrated, cost effective and easily installed solutions to address these issues, as well as cross-departmental monitoring. For example, The Scarborough Hospital installed a wireless monitoring solution that identified 30% of their medication fridges as being out range; within 2 weeks they eliminated their non-compliance.
Recommendations
· In the short term, hospitals can take immediate action to address temperature non-compliance issues, and to identify the magnitude of their medication and vaccine storage issues through temperature mapping and storage studies.
ü Temperature storage studies can be quickly completed to identify the temperature profiles of each medication and vaccine fridge, and the range of temperatures to which the medications and vaccines are being exposed.
ü This is a low cost option and can quickly identify the magnitude of the problem for taking immediate corrective action.
· In the longer term, hospitals can install temperature monitoring solutions that make use of wireless technologies that can be quickly and inexpensively installed, and provide 24/7 temperature visibility; as well as out-of-range temperature notifications for immediate corrective action.