Indiana University Health Bloomington is a 335-bed hospital serving south central Indiana and back in 2007, the pharmacy department went through a major overhaul. In addition to remodeling the pharmacy with new fixtures and an improved layout, we implemented automated dispensing cabinets (ADCs), medication carousels, automated medication ordering, and prescriber order imaging. It was during this process that we also purchased new medication refrigerators for the pharmacy.



Negative Effects of Non-Medical Grade Refrigeration
Currently, our refrigerated medication storage system starts in the main pharmacy, where medication carousels and narcotics storage are complimented by three double door refrigerators, one single door refrigerator, and one full size freezer—all medical grade. On the nursing units, we operate 42 ADCs in 42 different locations and these cabinets account for 93% of the total doses dispensed. 

On the units, refrigerated medications are kept in small, non medical-grade refrigerators located in towers adjacent to, and controlled by the ADCs. As we now have both medical and non-medical grade refrigerators in our facility, the differences are clearly apparent. After speaking with our maintenance department, we realized that non-medical grade refrigerators are simply not built to conform to the rigorous requirements of modern medication storage in a hospital setting. One of the most glaring issues is that non-medical grade refrigerators cool the internal air by means of a static refrigerant coil usually located on the back of the machine. To study the effect of this in our own institution, we placed sensors in different areas of a single refrigerator to test temperature dispersion and were dismayed to find a 2-3 degree variance. This clearly indicated that medications stored in a non-medical refrigerator do not maintain a uniform temperature. It is important to remember that refrigerated medications should usually be stored between 2°C and 8°C, already a very narrow range, and a three degree variance could easily exceed this. Such a lack of uniformity puts medications at risk. 

In the case of our non-medical grade refrigerators, it has been common for the engineering and maintenance departments to receive a high number of calls regarding refrigerators approaching or exceeding proper temperature ranges. Such events sap time and effort from both maintenance and pharmacy staff, and in the event of a range breach, our pharmacy staff have to remove all medications from the exposed refrigerator, usually to one of the medical grade units in the central pharmacy. Such an event requires a change to the dispensing process as the displaced medications now must be supplied directly from the pharmacy until the refrigerator is fixed or replaced, at which point the medications must be returned to the unit and the distribution rearranged yet again. This taxing of valuable time for a menial set of tasks is difficult to justify.

Another issue worth mentioning—as hospital pharmacy practitioners are well aware of restraints on space—is the fact that non-medical grade refrigerators are very sensitive to exterior temperatures and require substantial ventilation to work properly. When considering the average space limitations of a pharmacy or medication room, such allowances are not practical. 

Benefits of Medical Grade Refrigerators
The ideal temperature control device operates in the background, flawlessly and without interruption. However, in the real world, taking this concept for granted can have disastrous consequences. Certainly it is important to compare the real, up-front cost of medical grade refrigerators versus non-medical grade refrigerators, especially for the smaller ones, as a competitive market for commercial, “dorm style” refrigerators has driven down cost. Nevertheless, there are compelling factors that need to be included when seeking to justify the cost of medical grade technology:

• Reliability. Medical grade refrigerators are far more reliable than commercial ones. Beyond simple irritation, fixing or replacing broken equipment introduces perpetual labor costs that disrupt and put strain on the overall medication distribution process. At IU Health Bloomington, we have seen both sides of this issue. In the last five years, we have had just a single issue with our medical grade freezers. In contrast, we consistently address maintenance issues with our non-medical grade refrigerators located on the units. 
• Financial Risk. Based on a review of our three-year inventory data, the average value of our refrigerated stock comprises 34.7% of the total drug inventory in the pharmacy. Given this, the financial risk of not having medical-grade refrigeration in the pharmacy is significant, and the same argument is valid for our unit refrigerators. Refrigerated medications stocked in our oncology department alone reach a value of over $50,000. Under no circumstances should we risk losing these drugs due to a failure in maintaining proper storage temperatures.
• Compliance. Medical-grade refrigerators are manufactured using substantial, high quality materials and undergo thorough testing for their intended use. One major difference is that medical grade units employ fans inside the casing to properly circulate the internal air to ensure that all areas within maintain an accurate, uniform temperature. Stainless steel housings, synthetic gaskets, and efficient compressors enable a quick return to the programmed temperature after the refrigerators or freezers are opened. Maintaining strict conformity to medication storage requirements can significantly bolster compliance to state board and TJC regulations. 

Conclusion
The number, types, sizes, and available options of medical-grade refrigerators available in the market has drastically expanded over the last few years as a clear response to increased demand. Although the initial cost of converting all your temperature controlled storage devices to medical grade may seem significant, having the peace of mind that your products are secure—enabling compliance, improving patient safety, and protecting valuable financial assets—are strong factors to be considered. Whether you are a 20-bed hospital or a 500-bed medical center, it is never a bad time to evaluate current refrigerated medication storage system and determine the value that medical-grade temperature controls can provide.

Bledar Doraci is the pharmacy purchasing specialist in the pharmacy department at Indiana University Health Bloomington. He has worked in health care purchasing for 15 years and now focuses primarily on pharmacy and surgery departments.

Special PP&P Buyer’s Guide: Medical Grade Refrigeration

For your convenience, Pharmacy Purchasing & Products has compiled the following buyer’s guide for medical grade refrigerators and related products. This is just a sampling of the products available to improve your pharmaceutical refrigeration needs. 

Veracity Group Inc
www.VeracityGroupInc.com

Undercounter Refrigerator
The new VersaFridge medical grade refrigerator aids pharmacies in becoming fully compliant with TJC MM.03.01.01 Elements of Performance 3 and 6 regarding medication security. The units feature a completely removable refrigeration module for easy service, integrated wireless temperature monitoring including door status, a secondary lock box, a universal electronic keypad lock, and integrated locking handles. Using less than 1 kWh/day, VersaFridge offers a variety of shelf arrangements, fully welded drip proof drawers, 5.68 cubic foot capacity, a housing made of 100% stainless steel with a 1” fully welded spill pan, and comes with a five-year refrigeration package warranty.

Wireless Temperature Monitoring
The VersaFridge is specifically designed to support wireless temperature systems featuring a recessed compartment to place the wireless transmitter for protection and ease of use. Units also include an access probe port to allow for easy temperature probe installation within the refrigerator and each refrigerator has a glycol product simulator holder. Additionally, all refrigerators have built in door contact switches for monitoring access and line power to be used with VersaTrak wireless transmitters, which extend transmitter battery life to 15 years.

Countertop Miniature Refrigerator
Veracity Group announces the newest additions to the VersaFridge line—the Micro countertop 1.4 cubic foot model and the Mini 2.8 cubic foot model. These units incorporate all the same features of the undercounter VersaFridge. Additionally, these units are available in both refrigerator and freezer models by simply swapping out the refrigeration module. 

Talyst, Inc
www.talyst.com

Talyst announces the refrigerated AutoCarousel HD, a pharmacy-grade refrigeration system that ensures medications are kept at a safe temperature. The carousel technology allows for the consolidation of refrigerated medications as part of a comprehensive, integrated pharmacy inventory system. The refrigerated AutoCarousel HD streamlines stocking and picking using pick-to-light indicators, decreases required storage space by 30% to 50%, and automatically tracks and documents activities through Talyst’s software platform—AutoPharm Enterprise. The carousel also supports bar code confirmation of all stocking, picking, and dispensing for increased patient safety.

Helmer, Inc
www.helmerinc.com

iPR245 Pharmacy Refrigerator 
The iPR245 pharmacy refrigerator offers superior temperature uniformity and quick recovery with a heavy-duty, forced-air refrigeration system, and reduced humidity levels create a dry storage environment ideal for storing boxes and other containers. All i.Series refrigerators are monitored with the i.C³ user interface, which provides constant temperature monitoring and control, and multiple information logs with historical data that can be downloaded and saved. 

This icon driven monitoring system features a door mounted, 7” full-color touchscreen, 12 roll out baskets and two shelves, although each unit can be customized with a combination of shelves, roll out baskets, and drawers. Storage trays with dividers are also available to simplify and organize storage needs. Available in sizes ranging from 11 to 56 cu ft, in single and double door models, Helmer pharmacy refrigerators include alarm monitoring, bacteria-resistant powder coating, and self-closing doors.

iPR225 Pass-Thru Refrigerator 
The iPR225 pass-thru pharmacy refrigerator features superior temperature uniformity with quick recovery, self-closing doors with magnetic gaskets, and a drawer catch that ensures proper closure to maintain airflow. A covered top on the cleanroom side prevents accumulation of dust particles within the cleanroom. Offering the same i.C³ user interface as the iPR245—constant temperature monitoring and control, multiple information logs with historical data, and a door mounted 7” full-color touchscreen—custom storage options include drawers, rollout baskets, and shelves. An optional skirt and finish trim kit are available to conceal the space between the walls and floor. The iPR225 is available in 25 and 56 cu ft capacity sizes.

iLR105 Undercounter Pharmacy and Lab Refrigerator
The iLR105 undercounter pharmacy and lab refrigerator features the same i.C³ user interface and benefits as the 245 and 225 models. Other features include an interactive temperature graph, home screen customization, and password protection. The iLR105 is designed for convenience and performance and can be stacked, placed undercounter, or used free standing. The iLR105 includes two shelves, although each unit can be customized with a combination of shelves, roll out baskets, and drawers.

Follett Corporation
www.follettice.com

Countertop Refrigerators
Designed for smaller storage needs, Follett’s new REF1 and REF2 countertop refrigerators provide quick pull down to temperature and consistent cooling, even with frequent door openings, yet are quiet enough to be used in noise-sensitive areas. The space saving, 19” by 20” footprint fits on countertops and automated dispensing cabinets (ADCs) for convenient, ergonomic access to stored products. The 1.0 and 1.8 cu ft refrigerators also feature an external temperature display in °F or °C, and include user-programmable high and low temperature alarm alerts and dry contacts for remote alarming. 

Undercounter Refrigerators and Freezers
Follett’s line of undercounter refrigerators and -25°C freezers provide secure, consistent temperature control for medications and vaccines. The completely front-breathing design allows installation below counters with no top, side, or back ventilation required. ADA-compatible models allow use below lower counter heights. An external display shows temperature in °F or °C for easy logging and operation confirmation. Field-reversible doors are equipped with heavy-duty, edge-mount hinges to withstand the hard use seen in undercounter applications. Integral, user-programmable high and low temperature alarm alerts provide additional product security. 

Upright Refrigerators
Follett upright refrigerators combine high performance refrigeration with advanced features for superior cabinet-wide cooling, user-programmable monitoring and alarming, and important energy savings. The back-ducted airflow design delivers cold air to six levels, assuring top-to-bottom temperature consistency. The feature-rich interface includes a large LCD temperature and alarming display with intuitive navigation to user-selectable settings. Audible and visual alarms include high/low temperature, power failure, door-ajar, low battery, and probe errors. Dry contacts and an RS-485 port provide remote alarming and data streaming capability. LED light bars, a full 2.75” of CFC-free insulation, and low-emittance glass coatings provide significant energy savings.

Thermo Scientific
www.thermoscientific.com/cold

Revco UxF -86°C Freezer
Providing outstanding product protection while maintaining high standards in energy efficiency and capacity per footprint, Revco UxF Series -86°C freezers from Thermo Scientific are equipped with a touchscreen interface featuring an event log, integrity monitoring system, and controlled access options. Five new capacities range in size from 14.9 - 33.5 cu ft and provide a number of options to suit any storage and space requirements. The freezers’ new cabinet design and vacuum panel insulation provide expanded storage. To conserve energy, the Revco UxF Series provides the choice of a high-performance or energy-savings mode through the touch-screen display.

Dual-Temperature Refrigerator and Freezer Combination
The Jewett dual-temperature refrigerator and freezer combination is equipped for general purpose pharmacy storage. This versatile refrigerator and freezer combination unit offers the advantage of two medical-grade performance cabinets in a single, space-saving unit. Both sub-units are heavily insulated and controlled by a microprocessor temperature management system set to operate at 2° to 4°C (refrigerator) and -20°C (freezer). Construction features include forced-air circulation for temperature uniformity, an epoxy-coated steel exterior and stainless steel interior, and CFC-free, foamed-in-place, polyurethane insulation. Both cabinets have automatic defrost and feature CFC-free R-404a / R-134a refrigerants. The optional HemaPro 2000 Surveillance Center features an electronic event log that records time, date, and the duration of alarm conditions.

Compact Refrigerators and Freezers
Jewett counter-high and undercounter pharmacy refrigerators and freezers are built with the same high-quality components and controls as the larger Jewett cabinets. This allows pharmacists and technicians to keep critical products close to their workspace without the temperature variations found in lower quality dorm-style units. Thermo Scientific Jewett compact models come with easy-to-clean, stainless steel interiors and exteriors and choice of pharmacy storage, blood bank, and plasma configurations. Blood bank and plasma units come standard with the CP101 temperature surveillance center which includes the HemaPro 101 monitor and 7ER temperature chart recorder.

Nor-Lake, Inc
www.norlake.com

Nor-Lake Scientific pass-thru refrigerators are available in one of three configurations—with a glass front door and solid back door, with two glass doors, or with two solid doors. All models feature microprocessor control with high/low audible and visual alarm, remote alarm contacts, and an LED digital display. The exterior front, solid doors, and sides are white. The interior liner and interior door panel are white and there are three epoxy-coated shelves per door, which can be adjusted in one inch increments and are available with several optional features including two way sliding basket drawers and/or stainless steel drawers.

SANYO North America
us.sanyo.com/biomedical 

New from SANYO is the 26 cu ft VIP PLUS Series MDF-U76VC freezer. Consuming a mere 15.1 kWh/day—helping to reduce both operating and cooling costs—these freezers offer a large storage capacity of 576 boxes in a footprint of only 9.5 sq ft. SANYO compressors are specific to ultra-low applications and they reduce compressor temperatures internally and externally, which increases compressor longevity and reliability, and reduces heat output to the room. In addition, the VIP vacuum panel composite insulation uses patented high-efficiency panels for an increased interior volume while maintaining conventional dimensions, thereby offering more storage capacity per square foot of occupied floor space.

Health Care Logistics
www.GoHCL.com

Three-Drawer Stainless Steel Refrigerator
The stainless steel, drawer-style refrigerator with magnetic gaskets increases storage capacity and allows for supply segregation to eliminate costly mix-ups. Spacious, ventilated drawers accommodate bulky items as well as lock boxes and storage bins for organized storage. A digital thermostat mounted on the outside of the refrigerator allows for temperature readings without having to open the unit and features a digital keypad for quick temperature setting or changes. The unit’s operating range is 35° to 46°F, it features automatic defrost and a fan-cooled compressor, and can be used freestanding or placed under a counter. 

Glass Door Refrigerator with Chrome Lock
A clear, tempered glass door allows easy viewing of contents while providing restricted access. The front-mounted chrome lock keeps important products secure and an interior-mounted, MicroSentry Scientific refrigeration monitor with electronic temperature control and digital display provides superior temperature accuracy. Each unit features user-adjustable temperature set points between 1° and 7°C and issues an audible alarm if the temperature goes above or below the set point, or if a door is left ajar for more than five minutes. The alarm stops when the door is closed or when the temperature condition is corrected. The temperature monitor automatically reads and stores interior temperatures every five minutes while a powerful compressor ensures fast temperature recovery after door opening or product loading. Physical features include a wrapped-door frame for gasket protection, a full-length door handle, and two adjustable wire shelves, as well as auto-cycle defrost. 

Internal Refrigerator Locking Boxes
Deluxe refrigerator locking boxes keep supplies secure and enable users to restrict access to temperature-sensitive drugs while keeping them stored at a regulated temperature. Made of clear, durable plastic, these front-opening boxes allow for easy visual inspection of contents and a roll-stop lip prevents vials from rolling over the edge of the box. The box can mount to the underside of a wire shelf and the thin, flat attachment mount takes virtually no space away from the shelf above. Heavy-duty, double-sided tape secures boxes to glass shelves. Available in two styles—easy mount and compact easy mount—with a digital lock, a key lock or a double key lock. Accessories include removable trays, dividers and a series of covers.