Advice, Please

[Sara]

Am not connected with the trade but hope that someone can help.

Have to store injections in a domestic fridge at between 2 - 8 degrees This is critical, otherwise drug loses its effectiveness. They cost the NHS £374 each - I store 3/4 at a time. I care about NHS costs! Having had problem now have a data logger to check the fridge temperatures.

All my shelves in the fridge are glass. Find that the middle shelf is the most appropriate place - fridge set at 4. This gives margin for loss of temperature on opening door. Logger stored on the top of the carboard carton. I presume that this measures the internal temperature of the fridge.

However, the other day I found the logger had fallen onto the glass and the data then showed 0.5 degrees! Question: Will the glass hold a lower temperature than the internal air temperature of the fridge?

Seems a silly question, but if thisi is the case, the box will be taking up the temperature of the shelf and the injections will have lost their use - so I'm not getting the treatment for the illness I have. Everybody else I've asked is 'hiding'/not responding. I hope that you guys, with your knowledge might be able to adviise me.

Thanks if you can - I appreciate your help

[Grizzly]

Hi Sara.
You as you suggest are taking a risk
using a standard domestic fridge.
However using a data logger is a very sensible approach.
Basically the logical answer is to set the thermostat at a given setting.
Log the recorded temps and average them out which it seems is what you have done.
The glass shelf will cool over time to the lowest temp average achieved.
Whereas the internal air temp will fluctuate up and down.
Based on the ambient temp being introduced each time the fridge door is opened.
Therefore the door opening frequency is critical.
If you have a access regime then adopt this whilst monitoring the temps.
Provided the internal air temp is within range.
Store the drugs on a say cardboard box as a form of stand-off.
If you can control the shelf temp to within your tolerances.
Then off of the shelf would be preferred.
Basically, yes the shelf has adopted the coldest temp within the fridge.
And is less prone to temperature fluctuations than the air within.

Grizzly

[Sara]

Hello Grizzly,
Thanks for your reply and wise words. Yes, it is a headache keeping this stuff ‘at temperature’ – think it’s a bit unfair to ask ordinary folk to cope. There must be hundreds of folk who don’t think about it and if I can get the powers that be to listen, maybe some NHS funds wouldn’t be wasted. Was going to get a little pharmacy fridge, but they’re expensive and I’d be stuck with it if they stop the treatment.
I’ll try what you say with the cardboard and ‘play games’ until I can stabilise the temperature.
Glad you replied – thanks again for taking the trouble. Take care.
Sara

[Brian_UK]

What might also help stabilise the temperature is to put your items inside a "Tupperware" type box, or any box come to think about it.

The, when the fridge door is opened the product will not have the warmer air directly on it. The extra box will act as a buffer.

As Grizzle has already said a stand off from the shelf is good, do you have some excess polystyrene packing from somewhere that you could use?

[Sara]

Hi Brian,
Thanks for your reply.
That's a good tip - I'll try it. It's a nightmare.

Loved the Percussive Maintenance - I used to do that with a mainframe computer .. though my ma wouldn't like to hear the definition - I'm supposed to be a lady! Made me laugh ..great stuff.
Take care.
Sara

[Tayters]

I've worked on a few LEC fridges in pharmacies and some of them have a probe with plug contacts at the top to ready for a monitor. I think they start off around £300.

Would it be worth putting the injection in one of those insulated lunch bags? Assuming the air temperature is correct then the insulation should stop the effects of the cold shelf, warm ambient air and colder chilled air. Maybe leave the opened bag inside for a couple of hours to get to the right temperature first.

It would be good if some NHS departments were as dedicated to looking after their funds.
I worked on a coldroom for storing drugs that went belly up due to the condensor being clogged up with pollen and tripping the HP switch over a weekend. They lost £60,000 (all the stock). The warehouse bloke said they didn't have a temperature alarm system as the cost outweighed the need.

"Oh well, might pay to have more maintenance visits to at least check the coil is clean."

"Maintenance? The bosses here don't have any PPM as they say it's cheaper to fix it as and when it breaks down"

Edit: Sorry Brian. After reading properly that's pretty much what you wrote. At the time I was wondering what to put in my sarnies hence the inspiration.

[Grizzly]

At the time I was wondering what to put in my sarnies hence the inspiration.

Priceless!!
Or should I say "Food for Thought!"
Grizzly

[Sara]

Hi Tayters,
That incident about the pollen is amazing. What a waste of £K60 …. what WE could do with that, eh! Supports my view that there are too many clipboard carriers who conduct orchestras when they can’t play a fiddle .. so to speak. Time people who know what they’re talking about did the important jobs and took the decisions. Must make the job frustrating for you. I’m a great supporter of the NHS – the alternative concerns me. My husband’s got cancer and I hear of folk who can’t get treatment because of the cost. So I’m really determine that someone will listen about these temperature-critical drugs.

I’ve done the cardboard and tupperware bit and the fluctuation in temperatue is still there but not as severe. I’ve put this down to the self-cleaning system. If I had a fridge that frosted up I’d still be in a cleft stick because I’d have to ‘park’ the jabs in order to clean it. If I win the lottery I’ll set up a company making tiny mini-fridges for this specific purpose. You’ll never see them on the market ‘cos I couldn’t win a wet newspaper. Put my little 'cool bag' in the freezer bit to cool it ... now you could smash a window with it! stupid girl. Anyway will give it a whirl.

Thanks for your help. Stay well. Enjoy your working life …. retirement ain’t much fun nowadays.
Sara

[Peter_1]

Sara, what I suggest is that you place the injections in a box but you place in that box also a brick or better, metal or aluminum pieces which will act as a buffer.
You can find small parts of aluminum in factory that does CNC punching.
This metal has a high thermal inertia and will help maintaining a stable temperature. Or a lot of small rocks (don't know the correct English expression for this) - in your Upperdare box...(sorry, couldn't resist) ...Tupperware box and you lay on these rocks your injections/
We are all technicians and we rarely meet here a lady, so only joking.

[frank]

If the drugs are in a sealed glass phial, you could put an open or closed Tupperware type container in the fridge, filled with water and store the phials in the water. The water, once down to the required temperature, would not be so susceptible to temperature fluctuations due to door openings etc.

Same principle as my beer bottles - once down to temp, etc......... except that they don't normally last long enough to suffer from temp variations due to door openings

[Peter_1]

Does this work also with beer instead of water Frank?

[frank]

Peter....

Never store anything in beer - and....don't mix water with beer.

[monkey spanners]

Same principle as my beer bottles - once down to temp, etc.........

Just remembered the beer i put in the freezer so it'd cool quicker, hope it hasn't burst

[Sara]

Hello Grizzly, Brian, Tayters, Peter, Frank and Monkey Spanners,
Apologies for the silence and lack of thanks – I’ve been a bit ill.
First of all, can I thank all of you for taking the trouble to help me – I can’t tell you how grateful I’ve been for your support.

It’s been a nightmare trying to keep these injections (2,000 NHS pounds worth!) ‘at temperature’, and the situation finally came to a head when a pack of unthawed bacon dragged the temperature down to 1.5. Have tried all the suggestions and thought I’d cracked it. Now think the answer is a pharmacy fridge – over-kill, I know, but I can’t go on like this.

Can I ask you whether:
1 fluctuation of room temperature (heating on and off) will mess up the temp. of the pharmacy fridge?
2 will it recover the set temp. quickly if it goes ‘out of temp.’?
3 will it function properly if there is only a three small boxes in it. Would stuffing it with paper to fill the empty space help?
I’d be grateful of any advice before I stick my neck out and part with 400 quid. Any assistance to drag this expensive contraption I have to the quicksands in Morcambe Bay and let it sink will also be met with delight!
Regards
Sara

[chemi-cool]

Hey Sara,
With all the respect to my colleagues, I think you should get a professional person to have a look at the fridge and see if there is any serious problem with it.

Meanwhile, enjoy this one
http://www.dailymotion.com/video/x54...lan-sara_music

[r.bartlett]

If the NHS were happy to give you the drugs in the first place without specifing a suitable fridge then in all honesty I think providing it's kept cold then that will be fine.

You really don't need to worry that it's dropped to 1.5 deg's (assuming you have a calibrated thermometer g.tee'd to measure to that accuracy) did you discard those which did?

I suspect they aren't kept for very long at home unless they are giving you a years worth.Keep them in the fridge and use them as applicable. The biggest problem would be to freeze them or let them warm up to room temperature.

The official advice will always be store at the correct temp and discard those which don't comply but common sense should prevail

[Peter_1]

Ow, ow, ow, look to post 10 (Frank) about the water

[chemi-cool]

If the drugs are in a sealed glass phial, you could put an open or closed Tupperware type container in the fridge, filled with water and store the phials in the water. The water, once down to the required temperature, would not be so susceptible to temperature fluctuations due to door openings etc.

Same principle as my beer bottles - once down to temp, etc......... except that they don't normally last long enough to suffer from temp variations due to door openings

Thats a very good idea Frank! I like it.

[r.bartlett]

Ow, ow, ow, look to post 10 (Frank) about the water

Yep my bad didn't see Franks post -I'll edit mine out

[Sara]

Hi Chemi-cool
Thanks for the message and the link. Not heard that before enjoyed that. There’s an engineer coming Monday, beginning to agree with your views.

Peter and co
Jabs are ‘pens’ and not in glass phials, so the water storage is not an option … storing in beer might put an interesting slant on it, but I think the medics would do a frown! (joke).
These jabs are supplied by a private company and funded by the NHS (£400 a time). 2 – 8 degree storage is critical and they have already said that two might be useless. Awaiting advice from hospital. They can cause lymph cancer, lupus and dozens of other awful side effects. I seem to be ‘fussing’ but the prospect of injecting a substance (from mice), which has lost it’s treatment benefit but can cause such awful illnesses , is daunting.

Thank you all for your input. Enjoy the rest of the weekend.
Sara

[chemi-cool]

Sara,
I don't know what kind of fridge you use but here is a link to a professional fridges,
Have a look, it might interests you.

http://www.medical-fridge.co.uk/

[centrecipew]

Hi, I wonder if wrapping the drugs in a few layers of Bubble wrap would be effective? Cheap and simple!!

[colinra]

Hi,

My opinion is as follows:

Buy a new fridge with a digital controller (instead of a rotary dial thermostat), an internal air circulating fan, an enclosed evaporator plate and wire shelves.

I work for a company which supply these fridges to the NHS and other drug manufacturing companies. (i am reluctant to mention the name which may upset the moderators).

The Foster HR150 is a good fridge with all of these features, and is built in the UK. A local specialist near you will probably be able to supply one.

I totally understand your problem, I think it is rediculous you are expected to store 2-8 in a domestic fridge, which probably has none of the above features.

Obviously, there are other manufacturers that make fridges like this, I mention foster because I like them personaly. I also have experiance of temperature mapping these types of fridges to ensure compliance. This involves having multiple air temp sensors recording every minute over a set period of time.

The link kindly posted shows 'labcold' which is a big name in this section of the industry. My advice would be to be very specific in what you order from them.

The other (much cheaper solutions) from the other members may help, and are definately worth trying.

Best Regards

Colin

[Quality]

Alternatively pm me your details as I have A number of brand new medical refrigerators with lock and key available at 50% retail

[Sara]

Hi,
I’ve been amazed that busy young men have taken the trouble to read my posts and offer advice. I’d like to say ‘thank you’.

It’s been a good experience to venture into someone else’s expertise and realise that ignorance has lead me to mis-manage my fridges for years - buy it, plug it in and stow the food. Incidentally, the guy who delivered it did just that. I’ve left freezers to get to temperature but, as you say, have never read the fridge manual properly before.

I’ve now bought a pharmacy fridge and stopped the panic. But if only I'd read Quality's post first! Thank you for that. I'll remember vv friends who may need one.

Wonder if I can pick your brains a little more. This fridge is in a furnished domestic environment. Now it’s central heating time the room temperature will increase – do I need to drop the setting or will the unit just cope with it? I can see power cuts being the order of the day this winter (industrial action): will the unit just recover itself when the power returns or is there anything I need to do?
Sara

[Tayters]

Manual? That's normally the last resort, or you read it first but don't let on.

No need to touch the setting. It wont cool any quicker/slower - just run less/more until the setpoint is reached. A point explained to countless office staff around the world about their A/C and it still gets wacked down as low as possible. Hey Ho. It will be designed to run up to a maximum ambient temperature (probably around the 30*C mark). Above that it will struggle but there is more chance of it going belly up due to ambient conditions in the summer. As long as the recommended gaps are around it then fine.

In short, there is nothing you need to do except check the fridge works afterwards following a power cut.

Some systems have trouble restarting if they are turned off momentarily as the compressor finds it hard to pump against a high pressure at its outlet it has already built up. It needs the system to equalize each side of the compressor beforehand - a minute or so. It could have a delay built in before a restart (not normal on smaller models like yours) or an overheat sensor on the compressor which will cut out the now hot compressor (hot due to trying to pump but not able to), cooling down and then restarting by which time the system would have equalized.
In practice the power cut would be long enough for the system to equalize (hopefully not too long though!) and the compressor may not have been on anyway at the time of the power cut.

Hopefully that hasn't contradicted the manual

Cheers,

Andy.

[Sara]

Hi Andy,
Thanks for coming back with some advice. Think I can stop fussing now and relax. Have been glad of the help ... ta!

Sara