Within the last few years, multiple companies in the hospital pharmacy industry have developed technologies to make temperature monitoring simpler, more accurate, and less time consuming. There is rarely a perfect technological solution, though, and as the systems differ, weighing the pros and cons of competing temperature monitoring systems to determine which best suits an organization’s needs is a vital step in product selection.
Hays Medical Center is a rural, regional referral center for northwest Kansas that is licensed for 199 beds and also monitors temperatures in 11 remote clinics. During a recent inspection, we were questioned on our process for monitoring the temperature of the refrigerators at our clinics during weekends when staff are not working. At the time, we relied on pharmacy staff to physically check individual refrigerator temperature readings, and with the clinics closed on weekends, those checks simply did not occur. Recognizing that our lack of an automated temperature monitoring system made it difficult to maintain compliance with TJC PC.17.10, this inquiry led our facility to reevaluate and improve temperature monitoring methods. As with many projects of this nature, we encountered a few pitfalls that could have potentially derailed, or at least complicated, the project. Steering clear of these impediments will help facilities implement temperature monitoring seamlessly.
Vetting the Available Products
When deciding which system would best suit the needs of our facility, the first step was to create a multidepartmental task force to analyze the available products. A similar task force should include not only the individuals who are going to set up and install the product, but also end users. Including our nurses and nursing managers up front was vital to a smooth operational transition after the installation was completed.
As a member of this task force, I was asked to attend the ASHP Midyear convention and collect information on some of the available temperature monitoring products. This proved to be a fortuitous decision, because I was able to evaluate several systems in a short period of time. As it turns out, we discovered a system at the convention that provided more functionality than the one we were initially considering. Because the new system was compatible with our facility’s existing WiFi, we could avoid the additional expense and time required to purchase and install 900-Mhz transmitting units. All of our remote clinics are also WiFi-enabled, so there would be no additional cost to expand the system’s reach. Taking the extra step to fully review as many options as possible made a big difference for us, as the product originally under consideration would not have provided the best coverage in the long run.
Determining Your Needs
Every hospital has different needs and technological capabilities, so review the details of how each system would work within your workflow. For example, the types of sensors vary in how they record temperature and at what range. Determining the necessary temperature range your drug products require is important to ensuring cost-effectiveness and maximum usefulness. Also, contact your IT department to verify that any external clinics use the same network as the main facility. Taking care of these details initially will save time and avoid potential difficulties later.
Rolling Out the Installation
In an attempt to save on installation costs, the temperature monitoring task force decided to assign responsibility for programming and installing the components of the system to the in-house IT and engineering departments, with no on-site help from the vendor. Looking back, not having the vendor on site for implementation was unwise. The cost associated with installing and programming the equipment was not significant when compared to the actual hardware cost, and paying the extra amount for the vendor’s expertise would have reduced delays. Our in-house team ended up doing a fantastic job, but the installation did add to their already long list of daily duties, as they had to familiarize themselves with this new equipment.
One of the first challenges our in-house team faced during installation was programming the transmitters. Instead of having the transmitters act as data transfer devices only, they were initially programmed to sound an alarm and flash when the temperature went out of range. These alarms and lights were quite bothersome to nearby staff. Because we had not fully tested the initial temperature parameters in a real-world setting, simple tasks resulted in alarms that were not indicative of problems. As a result, we then programmed the transmitters to better serve our workflow and data collection needs.
After completing the live trial run with a small number of transmitters, we were ready to embark on the facility-wide installation. This process proved quite complex as multiple probes and transmitters were installed in all the refrigerators in the main facility, as well as in all of the remote clinics. At this point it was discovered that not all of the refrigerators were equipped to handle the monitoring probes, and holes had to be drilled in some units in order for the probe lead to be inserted.
Developing Policies and Procedures
Once installed, the system appeared ready to be activated, but we soon discovered other issues that needed to be addressed first. We originally developed the policy and procedure document for the temperature monitoring system prior to the actual installation. Given the alterations that were made during installation, we had to make corresponding changes to that document. Proper SOPs are important to ensure all staff members understand their roles in working with technology, including temperature monitoring equipment.
We initially employed an early-stage alert if temperatures were rising or declining faster than expected. After testing this option in the pilot stage, staff ultimately decided to disable this feature, due to the daily auto-defrost cycles in many of our refrigerators, which triggered this alert regularly. As pharmacy only wanted to be alerted if the temperature was out of range and an action was required, these early alerts created confusion. In the end, we chose to keep the alerts as simple as possible to minimize staff interruptions while still providing vital oversight of medication temperatures.
When determining who would be responsible for receiving and responding to alerts, we initially used a communication center that received all the alerts and then contacted the appropriate person or department for resolution. Pharmacy was to be notified of any alerts triggered in refrigerators containing medications, and facilities management was notified for refrigerators containing nutrition products only. It was decided that facilities management and security would go to both on-campus and off-campus clinics to address after-hour alerts. The pharmacy department worked with the external clinics and acquired all contact information necessary to ensure efficient handling of off-site and after-hour alerts.
After using the communication center as an intermediary for a period of time, we felt the process could be simplified by eliminating the middleman. As a solution, our IT department created a pop-up alert, generated through the temperature monitoring system, that would display on the main computer in the pharmacy. This provides immediate notification to the central pharmacy any time a refrigerator is out of range. We determined this would be the most efficient method since the central pharmacy is staffed around the clock. It also eliminated email, cell phone, and pager notifications to people not in the facility or off work at the time of the alert.
Post-implementation, the greatest concern was ensuring all staff members were properly trained on the system. Our goal was for all users to feel comfortable navigating through the software and responding to alerts. Our probe vendor offered training on the new system, which proved valuable. We were careful not to rush this step, as we believed that allowing adequate time for training would help prevent inefficient responses to alerts and unnecessary service calls moving forward. Also, certain staff members were designated as superusers, who took on the responsibility of assisting others when questions about the system arose. As a result of this comprehensive training, staff were able to recognize both the time savings and the improved medication safety provided by the automated temperature monitoring system, and were excited about the new technology.
Safety and Efficiency Gains
Once we were up and running, the benefits of automated temperature monitoring were quickly evident. The system is easy to navigate, and the learning curve for using the technology was manageable for all users. Eliminating manual tasks, such as recording individual refrigerator and freezer temperatures, compiling the data, and maintaining paper logs has improved our efficiency. The biggest benefit of the system, however, is the improved medication safety provided by the monitoring equipment. We are now confident that refrigerated drugs are being stored and maintained consistently at the proper temperature, mitigating the risk of compromising these temperature-sensitive drugs.
When we were recording refrigerator temperatures manually, it took a significant amount of time to compile and send the monthly temperature reports to the state department of health for review. With the new system, this task is now executed easily and quickly. In addition, temperature monitoring is a relatively inexpensive technology that can greatly improve the practice and safety of hospital pharmacy.
Willy Cadoret, PharmD, is the pharmacy supervisor at Hays Medical Center in Hays, Kansas. He graduated from Washburn University with a BA in chemistry in 1998, and received his doctor of pharmacy degree from the University of Kansas in 2002. Willy’s professional interests include researching new pharmacy technology and creating effective processes for implementation.
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