1. Cold Chain Audit in compliance to NSQHS Std 4.10.3 Yang Liu Stephen Lim Pam Allsop Pharmacy Department

2. 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

3. 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: 17 th – 28 th of June 2013

4. 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

5. What is Cold Chain?  A system of transporting and storing vaccines within the recommended safe temperature range of +2ºC to +8ºC Manufactured Transported to distribution centres Administered Shared responsibility Strive for 5!

6. 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

7. 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

8. Results FindingPercentage compliance Type of fridgePurpose built: 75% Bar: 25% Vaccine storage only0% Temperature monitored daily57.9% Temperature chart used for daily monitoring68.4% Person responsible for daily temperature monitoring Nurses: 80% Other: 20% Approved temperature recording device installed84.2% Fridge is plugged into essential power84.2% Signage affixed to the fridge door indicating its contents 10.5% Fridge maintained according to manufacturer's instructions 63.2% Fridge is centrally monitored68.4% Fridge cleaned routinely31.6% Aware of cold chain policy in this hospital68.4%

9. Results

10. 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

11. 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

12. 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

13. 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

14. Any questions? Thank you