Cold Chain Audit in compliance to NSQHS Std 4.10.3

Yang Liu

Stephen Lim

Pam Allsop

Pharmacy Department

Objective

To assess compliance to the Department of Health Vaccine Cold Chain Guideline (OD0355/11)

To promote medication safety at AHS by ensuring correct storage of temperature- sensitive products

Method

Audited all refrigerators at AHS and the corresponding community centres

Compliance to the Department of Health Vaccine Cold Chain Guideline (OD0355/11) was assessed

Survey period: 17th – 28th of June 2013

Std 4.10.3

Temperature- sensitive medicines are stored appropriately and in accordance with manufacturer’s recommendation

Use refrigerators specifically for cold chain products only and ensure they are fitted with temperature recording devices

What is Cold Chain?

A system of transporting and storing vaccines within the recommended safe temperature range of +2ºC to +8ºC

ManufacturedTransported to

distribution centres Administered

Shared responsibility

Strive for 5!

Cold Chain Breach (CCB)

Occurs when the temperature falls outside of the recommended temperature range of +2°C to +8°C at any point during the cold chain process

Due to:• Refrigeration failure• Power outage• Overheating during transportation• Freezing

Leading to a loss of efficacy to the vaccine

Vaccine storage management

Delicate biological substances Ensure individuals receive an effective health

product Expensive and may be in short supply Destroyed or become less effective when

exposed to:• Freezing (≤ 0°C)• Heat• Direct sunlight or fluorescent light

Most vaccines can be regarded as damaged at 0ºC

Results

Finding Percentage compliance Type of fridge Purpose built: 75% Bar: 25%

Vaccine storage only 0%

Temperature monitored daily 57.9%

Temperature chart used for daily monitoring 68.4%

Person responsible for daily temperature monitoring

Nurses: 80% Other: 20%

Approved temperature recording device installed 84.2%

Fridge is plugged into essential power 84.2%

Signage affixed to the fridge door indicating its contents

10.5%

Fridge maintained according to manufacturer's instructions

63.2%

Fridge is centrally monitored 68.4%

Fridge cleaned routinely 31.6%

Aware of cold chain policy in this hospital 68.4%

Results

Discussion

Vaccines and temperature- sensitive medicines are stored in the same refrigerator throughout the hospital

Installing a purpose built refrigerator is not yet at 100% compliance on all wards

Fridges must be consistently monitored daily and temperatures recorded at the same time each day

No designated person is responsible for educating or implementing policies

Discussion

Refrigerators which contained vaccines did have an essential power supply and monitored centrally at AHS

Updated imprest list of refrigerator contents were placed on the door

Do not store food and other goods in the fridge Equipment maintenance should be conducted

annually and include:• Changing thermometer batteries

• Checking the accuracy of the thermometer

• Defrosting and cleaning the fridge

Discussion

Wastage due to power failure Cost of new refrigerator ranges from

$1595 to $3195

Ward AMU contents

worth $323.69

Ward: ED contents

worth $5066.93

Conclusions

The Department of Health Vaccine Cold Chain Guideline (OD0355/11) was not adhered to at AHS

An individual needs to be appointed in each area to oversee cold chain management

Ongoing education to all staff is vital Re- audits will be performed regularly to

ensure implementation of recommendations

Any questions?

Thank you