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Does Your Vaccine Storage System Protect Patients and Your Business?

Drug Topics® is joined by Madeline Camejo, MS, PharmD, to vaccine storage systems, the common challenges linked to them, and the best practices that pharmacies should adopt to ensure safe storage.

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Drug Topics®: First, why don't you introduce yourself?

Madeline Camejo: I am Madeline Camejo. I am the chief pharmacy officer for Baptist Health South Florida.

Drug Topics®: When thinking about vaccine storage systems, what are the most common challenges or issues faced in the health system or retail setting?

Camejo:I think making sure you choose the right equipment for storing your vaccines as well as monitoring. Plus making sure you have the proper standard operating procedures to monitor vaccines. I've seen a lot of folks use substandard refrigerators that don't keep actual consistent temperature ranges. They fluctuate and that can cause a lot of damage to the vaccines you have in place. Make sure you if you're going to go into vaccinations that you invest in what I call medical-grade quality refrigerators, not a dorm refrigerator or a home refrigerator. I've seen that happen where they buy these refrigerators from the house and put vaccines in. You really need to make sure you have the most top-rated medical refrigerator that can actually do some monitoring capabilities.

Drug Topics®: Not sure what your current vaccine storage system looks like and what are the pros and cons of the system?

Camejo: So, with our monitoring system, we really did a lot of work. We did an assessment on what we were going to need. Actually, before we went out and picked a particular company, we made a complete checklist of everything that we actually needed to do. So, for us, what was really important for us was being able to differentiate different types of monitoring like ‘what would I need in this room versus in another room’, ‘how is the temperature in this room or humidity versus others.’ Make sure you do that preassessment. So, when we did that, we actually customized every room to what type of refrigerator or freezer we needed. All of that was pretty much preplanned and done. Ours does give and receive different types of alerts, that's really important as well.

We actually looked for the company that will give us a lot of training, whether it was in person or manual. As you get new people, you have to constantly be training. So training is really a big part of the company that we chose to go with. Being able to customize roles for alerts that was an important feature for us which we have and being able to log in at the actual worksite or online. If you're not on site, being able to have that capability was important. And then the last thing was actually sensor reading. So, if our Wi-Fi goes down, it continues to monitor until the internet comes back up. Being able to transmit that data because you constantly need that monitoring is really important. Technology has really advanced and now you don't have to do internet, you can do cellular data, which is also good for areas where Wi-Fi may not be a good connection, even though cellular data as well.

Last but not least the recording and documentation functions, the ease of that was also important to us and make sure that whoever we chose could give us what we needed.

Drug Topics®: If you could create your ideal vaccine storage system, what elements would it include?

Camejo: I think ideally, I would like to see more of a mobile app. You're often remote because you can’t be there 24/7. The other piece would be being able to store data for more than 3 years. It’s important for consistency, especially for audits and things that may need be done. A system that can record temperature out of ranges quickly and send those alerts so that you can document on the fly as you're resolving those issues and anything that can produce reports that are needed for inspection to show compliance. Those I think are the main things that are important to have in a good vaccine monitoring system.

Drug Topics®: Why is it important for health system and retail pharmacies to have a quality, reliable vaccine storage system?

Camejo: Because it's your responsibility to ensure vaccine safety up until the time of administration to the patient. Vaccines are very fragile and they’re a biological substance and not storing them at the right temperature can make vaccines less potent and even destroy active ingredients. You put your patient at risk by giving an ineffective vaccine. It's really important from a public safety perspective that they trust that what you are doing is correct for the health and benefit of the population.

Drug Topics®: What are some best practices for storing vaccines in a health system or retail pharmacy setting that the viewer should keep in mind?

Camejo: I think there are 5 things that I would have as a best practice.

The first thing is understanding what your practice needs really are. We did a preassessment of the types of locations that are going to require monitoring, how many sensors you’re going to need in each location. You should also look at doing some temperature mapping of the areas where you are going to place a refrigerator to make sure you know humidity in the room.

Creating that preassessment is really important to them being able to have a clear and thorough installation plan, which is the second thing. Based on your assessment, you know what sensors you need, where your sensor placement should be, what kind of equipment you need to have that will perform the desired functions you're looking for. Then develop your written standard operations policies for routine monitoring emergencies and then identify the contact personnel who will be responsible for responding to address those issues.

The third thing I would look at is establishing and implementing a thorough training protocol for the staff. Training should be conducted for every new employee on a recurring annual basis. If you have any vaccines, you should make sure you go over all the handling processes for each vaccine. We didn't know how to store the COVID-19 vaccines, but we’ve gotten better before you had to have a subzero refrigerator. The storage is very different for a COVID-19 vaccine versus some of the other ones that we are used to. So, making sure you protect those vaccines correctly is important.

The fourth thing I would look at is really optimizing your alerts and your alarm capabilities. Set up notifications so that they're sent to different people or groups depending on what problem is detected. For example, if the refrigerator alerts a power outage, make sure you send it to someone in facilities. Did the power go out in the whole building or just that particular outlet? It alerts people to the different types of alert messages that you can get, so that you have the right person being able to resolve the problem quickly.

The last thing I would say is do regular reviews of your data logs. I think you should print out your data monthly, review your out-of-range recordings, other alerts to see if there's any pattern with a particular refrigerator, or there's any different monitoring trends that you may have to do some improvement plans on. It's important to do on a monthly basis than wait for an inspector to show up and ask you for a year's worth of data. Then everybody's scrambling to get that data. I think it's a good way to do it. We do it that way. That way when an inspector comes in, we just pull the logbook. It shows we're transparent how we address programs, and the auditors are much more at ease when they see that you have a very good practice in place.

Drug Topics®: Are there any final thoughts or key takeaways you'd like to leave our viewers with?

Camejo: I think it's extremely important to protect your vaccines from temperature fluctuation for the sake of public safety and financially for your own organization. Vaccines aren’t cheap and just 1 disaster can cause thousands of dollars in loss to your practice. So, it's really important to practice good, safe storage and be able to give that quality back to make sure that we're doing what's right for the public.

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