Many pharmacies, practices and clinics are still using domestic refrigerators to store drugs and vaccines, contrary to guidance given in the Green Book. Whilst the cost of buying a specialist fridge is high in comparison to that of a domestic equivalent, the pharmacist needs to be aware of the potential consequences of not providing the correct cold storage.
Professional pharmacy fridges have been specifically designed from scratch to meet the stringent needs of storing heat sensitive medicines. Drug manufacturers recommend storage between 2°C and 8°C, with potential loss of potency and reduced shelf life if product is stored outside this range. The temperature inside a domestic fridge can fluctuate between 0 and 10°C and the only control of that temperature is generally a dial marked one to five, with five being the coldest setting. Without introducing an external thermometer to capture the temperature at any particular time, it is impossible to tell how cold it actually is and whether the correct temperature is being constantly maintained.
Pharmacy fridges incorporate a controlled cooling system with the temperature visibly displayed externally, usually in an easy to read digital format. In addition, some models include a safety thermostat with an acoustic and visual alarm system and a back-up power supply in case of power outage. They also offer the ability to access an alarm history which stores all the relevant values during a temperature alarm – minimum, maximum and average temperature – as well as the duration of the alarm, which is very useful in the event of any type of unit failure.
Pharmacy fridges should be large enough to carry the stock with sufficient room around the packages for air to circulate, as this enables the temperature to remain constant. A forced air circulation system increases cooling efficiency, maintaining the temperature despite frequent or extended door openings and ensuring that there are no hot and cold spots. Domestic refrigerators do not have such an efficient cooling system and there may be variations in temperatures within the cabinet, particularly in the door pockets and drawers.
Accurate and easy record keeping
It is recommended that the cabinet temperature of a fridge storing pharmaceuticals should be taken twice daily with appropriate records of these readings kept for the life of the stored product. A professional fridge has an integrated minimum and maximum temperature recorder which, at the touch of a button and without having to open the door, displays all the necessary information for reporting purposes. If using a domestic fridge, a thermometer needs to be placed inside the unit, potentially leading to inaccurate readings as the door has to be open to do so.
Security, safety and cost
Security is essential in a medical environment and lots of safety features are offered on specialist pharmacy fridges which are not available on the domestic equivalents. Key operation to switch the refrigerator on and off and a visible power switch helps safeguard against it being switched off accidentally. An integral door lock negates the need to keep the fridge in a locked room, and a door alarm alerts if the door is left open at any time. Pharmacy fridges come in a variety of sizes and are also available as an option with clear glass doors so that stock levels can easily be monitored without the need to open the fridge. In addition, it can act as a display cabinet in a retail environment.
It is estimated that up to half of all pharmacies are still using domestic refrigerators, and there are clearly many issues surrounding this. The extra cost of buying a professional pharmacy fridge is easily outweighed by the safety, security, control and convenience that it will provide. Given the high levels of regulation pharmacists operate under today, added to the increasingly litigious nature of society, the industry is being urged to heed current guidelines and recommendations and replace any domestic refrigerator still being used.