Ron Jue, PharmD
Administrative Director of Clinical Services
Community Hospital of Long Beach

• Complete your written policies and procedures before going live with the new system. You can always tweak these as you come across new procedures that work for your institution. It is much easier to adjust wireless temperature monitoring policies than to create a P&P manual as you go.
• During implementation and prior to going live, hold a meeting with all stakeholders (e.g., nursing, pharmacy, IT, etc.) so that expectations are set and everyone understands their responsibilities. Make sure vendor support arrangements (e.g., hours of support, responsibilities for first call, etc.) are clearly defined and the system administrators for each department know how to access support.
• When deciding whether to throw out medications from a refrigerator that has gone out of range, go directly to the drug manufacturers to ascertain the length of time the medications can be stored out of range and still be viable. For the medications we routinely store in refrigerators, we obtained letters from the manufacturers upfront stating how long the medications could be stored out of range.

Rosario (Russ) Lazzaro, MS, RP
Director of Pharmacy Services
Holy Name Hospital

• Involve clinical engineering representatives from the onset. Rather than running wires throughout the facility, determine signal strength and viability for all areas that will use wireless temperature monitoring. This process, often done by trial and error, will dictate the number of transmitters needed and their physical placement. Depending on the layout and construction materials used in certain areas of the hospital, the transmitter layout may need to be customized.
• One great benefit of wireless data transmission is the multiple capabilities available from certain vendors. Some monitoring systems allow for additional measurements, including humidity and air pressure. Consider taking advantage of these features if you are seeking USP compliance.
• Accurate and easy access to data is particularly important when dealing with investigational drug and vaccine storage. For investigational drugs, the data stream often must be maintained over a period of time, and a Web-based wireless system will allow for easy and consistent data availability. Likewise, vaccines require multiple temperature reviews daily, so having the data available 24/7 is important.
• One of the key issues for The Joint Commission (TJC) is consistency. We are looking to achieve this consistency by taking a facility-wide approach to temperature monitoring. In addition to pharmacy, we will extend wireless temperature monitoring to other operations, including the lab and nutrition services. Keep in mind that a facility-wide system must include all devices used on a temperature-dependent basis; so in addition to refrigerators and freezers, warmers also must be monitored. Too often these devices are overlooked. During a TJC inspection, the surveyor may note that the OR is storing IV bags in a warmer and will want to know who is monitoring that temperature data. Therefore, best practices must be in place not just for cold products, but warm ones also.

Christine M. Teslik, CPhT
Pharmacy Technician

and

Rick Myers, RPh
Director of Pharmacy
Baylor All Saints Medical Center

• Some refrigerators have difficulty staying within the prescribed range, often because the door is opened frequently. Therefore, be sure to order about 10% of the monitoring devices with a glycerin bottle. The glycerin bottles are helpful in measuring a more constant temperature for refrigerators that frequently fall out of range as they measure the true temperature of the liquids in the refrigerator. Unfortunately, it is tough to predict which refrigerators will need the glycerin bottles until you actually start using your devices.
• Managing alerts can be tricky at times. Each facility will have to decide on the best customizations for their monitoring practices. While your wireless temperature monitoring vendor may make recommendations, you need to make sure that how you choose to manage alerts works for the facility and the staff dealing with the alerts. For example, during our busy surgery times we turn off the alerts for our warmers. The surgery warmers are so busy during procedures with nurses going in and out that they will flash alerts constantly. Additionally, when we receive an alert for a device, we check the device’s temperature activity via the monitoring system; this helps us determine if someone needs to look at the device immediately or if the device simply needs to be watched more closely.
• Before wireless temperature monitoring is installed, make sure all refrigerators are defrosted. If possible, set the temperature dial at the midway point in the acceptable range. If the temperature dial is set higher than midway, it will freeze the condensation, preventing good readings and increasing alerts. When you have multiple refrigerators to monitor, it is a good idea to create a master list of the refrigerators that require periodic defrosting. When our pharmacy staff notices a refrigerator on a nursing unit that needs to be defrosted, they note it on the list and we follow up with the maintenance for that refrigerator. Once the refrigerators are on a regular maintenance schedule, you will see the number of alerts decrease.

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