The push to vaccinate Americans for Covid-19 is highlighting a potential weak link in the supply chain: refrigerators and freezers.
The Moderna and Pfizer vaccines approved for emergency use in the U.S. both require cold storage, and at least two hospitals have reported vaccine freezer failures, including the Boston VA where an unplugged freezer spoiled 1,900 vaccine doses.
Who is Responsible for Freezers?
Hospitals storing vaccine should take several steps to mitigate and minimize human error that can cause spoilage. From an operations perspective, management should be asking two important questions: Which department is responsible for freezer/refrigerator maintenance? And what systems are in place to notify the responsible parties in the event of an outage or failure.
Some hospitals will task Biomedical Engineering with freezer maintenance, while others use Plant Operations. Once that responsibility is clearly defined and assigned, the next step is to ensure that refrigerators and freezers are alarmed and monitored 24/7, so that someone is notified immediately should they fail.
Some facilities rely on a manual, once-a-day temperature check, with the result being logged in a logbook. That's fine when the unit is working properly, but if the temperature goes out of range, it could be up to 24 hours later before anyone notices a problem. And even then, you will have no idea how long the temperatures have been out of range.
Save with Alarms
A proper alarm system and documented failure protocols and procedures can help prevent a breakdown from turning into a catastrophe. Refrigerator alarms should be part of your Building Management System or a RTLS, Real-Time Location System.
I have heard many clients say they cannot afford alarms, but the real question is can you afford not to have them? I once worked with an allergy clinic that lost every vial of allergy medicine (valued at $150,000) due to a refrigerator failure. In addition to a significant financial loss, the failure put patients’ health at risk as many relied on the shots stored in the refrigerator.
I'm reminded just how many freezers and refrigerators there are in healthcare facilities and their varied uses.
At a hospital, medicines and vaccines requiring refrigeration are typically stored in the main Pharmacy, but smaller med refrigerators proliferate throughout in departments and clinics and on patient floors.
In clinical labs, there are biological samples and reagents that require precise temperature control. Hospitals with IVF labs require special freezers for eggs, sperm, and embryos. The failure of any of these units would be devastating and further make the case for proper alarms and notifications.
Triggering Work Orders
Alarms can be local, remote, or networked. If you have Nuvolo for Facilities and Clinical Engineering, it is possible in most cases where you have a computerized alarm system to integrate into Nuvolo. Nuvolo can create an emergency work order and send out notices through either email, pages, or messaging to the assigned engineer or technician should an alarm be generated. In addition, notifications and updates can be forwarded to department managers and directors keeping them informed automatically through Nuvolo’s work order process.
Of course, an alarm won’t help if it’s not paired with a proactive response/escalation plan. To develop a plan, you need to ask several ‘what ifs’ and identify what alternatives are available before a failure occurs.
Planning for Worst Case
Among other things, the plan should clarify who owns maintenance of the freezer/refrigerator, and where contents can be moved in the event of an emergency. In some cases, the answer may be another physical location because the freezer may be the only one on site that can maintain the required temperature for vaccine or medication storage.
Earlier this month, a California clinic was forced to put its emergency plan into action when a freezer malfunction nearly destroyed 830 vials of Moderna Covid-19 vaccine. Facing a ‘use it or lose it’ crisis, hospital staff worked the phones and sent out text blasts to quickly line up hundreds of new patients for the vaccine.
Thankfully, the plan worked. By days end, every dose had been administered and every patient was logged for follow-up injections and tracking.
Joseph Fishel is a Nuvolo Process Consultant with 20+ years of healthcare facilities management and clinical engineering experience. Healthcare IT Leaders is an Elite Nuvolo implementation partner.