Hospital pharmacies are moving quickly to automate their temperature monitoring, given the efficiency gains and relatively low implementation costs for such systems. However, upon automating temperature monitoring, many facilities are confronted with the realization that the refrigerators being monitored are performing on a subpar level. At this point, the value of implementing medical grade refrigerators becomes apparent. These more sophisticated refrigerators maintain tighter temperature control, require fewer hours to maintain, and are more durable than non-medical grade refrigerators. In addition, once installed, medical grade refrigerators save on repair costs and time.
Challenges in Refrigeration Storage
One of the greatest benefits of medical grade refrigerators is their ability to maintain a tight temperature range, averting the large temperature fluctuations sometimes seen in regular refrigerators. A slight adjustment to a non-medical grade unit can send the temperature rising too high or falling too low. Following adjustments, staff often finds that the refrigerator never maintains proper temperature again. It is not unusual for ice, which acts as an insulator, to build up within these refrigerators, resulting in slow but steady temperature increases. Frequent defrosting is the only solution to this problem. Because a defrost cycle is built into the programming of medical grade refrigerators, ice buildup is never an issue. When large quantities of room temperature IV bags are delivered to a non-medical grade refrigerator, for example, it can take up to 12 hours for the temperature to return to the correct range. Medical grade refrigerators are built with sufficient insulation and powerful compressors that ensure the temperature will return to its setting quickly.
Inadvertent adjustments to the thermostat dial in non-medical grade refrigerators are not uncommon when personnel are retrieving medications. These accidents then lead to out-of-range alerts. Medical grade refrigerators avoid this problem, as the temperature controls are located outside of the unit. In addition, multiple steps are required to adjust the controls, thus ensuring that only an authorized individual would be able to complete the process.
During busy periods on a unit, a refrigerator is opened and closed often to retrieve medications. Flimsy door seals in non-medical grade refrigerators can begin to malfunction as a result of constant use. As air leaks into the refrigerator through the seals, maintaining proper temperature becomes difficult. However, the stainless steel cabinet and heavy-duty seals of medical grade refrigerators are durable, have been designed for the hospital environment, and are able to withstand a high volume of use.
When a non-medical grade refrigerator goes out of range, pharmacy technicians must respond to the alert. If pharmacy cannot adjust the refrigerator correctly, a maintenance technician is then called. Thus, staff spends an extraordinary amount of time monitoring, checking, adjusting, repairing, and documenting corrective actions. The use of medical grade refrigerators can save labor and time, since the correct temperature is maintained, precluding the need for pharmacy to respond to constant alerts. And since the components of medical grade refrigerators are more durable than non-medical grade refrigerators, maintenance receives fewer calls requesting repair.
When a malfunction occurs in a non-medical grade refrigerator, the entire unit must be removed and repaired. The medications it houses are transferred temporarily to another nursing unit’s refrigerator. The obvious problem with this scenario is that when two nursing units share the same refrigerator, overcrowding can ensue, leading to medication picking complications and potential errors. As medical grade refrigerators generally require less maintenance, this risk for medication error is minimized.
Evaluating the Options
Depending on the size of the facility and the budget allowance, there are many features to consider when deciding which refrigerator is the best fit. Factors that should be reviewed include:
Teamwork and timing are critical to successfully switch to medical grade refrigerators. At the University of California Davis Medical Center, we first scheduled a meeting with pharmacy, maintenance, and engineering and did a walk-through of the staging area to determine how the refrigerators would be configured and what electrical sources would be used. After the new refrigerators were delivered to the staging area, engineering and pharmacy examined and tested them. As some were to be attached to automated dispensing cabinets (ADCs), the pharmacy technicians and the ADC vendor applied the necessary door brackets and hardware to enable use. At this point, maintenance helped pharmacy move the new refrigerators to the nursing units. Pharmacy should accompany maintenance throughout the move process to ensure the units are delivered to the correct locations, and then transfer the medications and appropriate labeling to the new refrigerators.
Implementation Challenges Overall, our implementation progressed smoothly. However, in hindsight, there are a few processes that, had they been in place, would have ensured a more efficient implementation.
Implementing medical grade refrigerators requires cooperation and teamwork from multiple departments, but the medication safety benefits and lower number of service calls make the project well worth the effort. At our facility, the new medical grade refrigerators have brought about increased peace of mind, as pharmacy no longer needs to respond to numerous out-of-range alerts or worry about the safety of medications stored at improper temperatures.
Sylvia Wong, PharmD, is the medication security pharmacist at the University of California Davis Medical Center in Sacramento. She received her degree from the University of the Pacific School of Pharmacy in Stockton, California. Sylvia’s professional interests include finding creative ways of resolving regulatory issues in the hospital pharmacy environment.
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