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Care Homes: Refrigerated Medicines

Good Practice Guidance for Refrigerated Medicines in Care Homes

For all staff responsible for storing medicines in care homes

Aim:

To outline the controls that should be in place to ensure safe storage of medicines that require refrigeration.

Care Homes should include in their own medication policy how and where items that require refrigeration will be stored.

 

The ‘four Rs’ of monitoring refrigerator temperatures:

 

Read:                  Read temperatures at least daily

Record:              Record temperatures on a standard form, including signing

Reset:                 Reset after each temperature reading

React:                 React by taking action if temperature is outside +2°C to +8°C and document this action

 

Fridge Requirements:                                                

  • Medication that needs to be refrigerated should be stored in a separate, secure, fridge that is only used for medicines (do not keep any food or pathology samples in medicines fridge)
  • The fridge should either be locked or kept in a locked medicines room. Staff should be aware of key storage and access
  • When medicines requiring refrigeration are received within the home they should be immediately identified and placed in the medicines fridge
  • Check that the fridge wall socket (where it is plugged in) is clearly labelled to leave on so that it does not get inadvertently switched off at the wall. (Some pharmaceutical fridges are directly wired so that this cannot occur)
  • It is very important not to place the fridge in direct sunlight or heated areas as this increases the workload of the  compressor which can cause a fridge to stop working.
  • All fridges where medicines are stored should be serviced at least yearly and a record kept
  • Store medicines in an orderly fashion on shelves, not on the floor of the unit, or in the door. Avoid overfilling and keep a space between boxes and vials for proper circulation. Do not keep large amounts of medicines in the fridge as this can lead to inadequate air flow and potential freezing. Medicines should not touch the cooling plate in the back of the fridge
  • Specialised refrigerators are available for the storage of pharmaceutical products and must be used for vaccines and diluents. Vaccines should NOT be stored in domestic refrigerators. For further information on vaccine storage please refer to The Green Book
  • Ensure fridge medications are regularly date checked and the stock rotated
  • All fridges should be cleaned as part of the general cleaning rota and dated records kept. Domestic fridges (that are not self-defrosting) should be defrosted monthly and dated records kept. The home policy should state where the fridge contents should be refrigerated whilst cleaning takes place
  • All medicines should be stored to the requirement in section 6.4 of the product’s Summary of Product Charateristics (SPC) www.medicines.org.uk

 

 

Thermometer Requirements:

 

  • The medicines fridge must be monitored using a thermometer which measures both the minimum & maximum temperature. The thermometer, or its temperature monitoring probes should be sited in a central location within the fridge, preferably between the products – they should not be placed in the door

 

 

 

 Daily temperature recording:

  • The fridge temperature should be checked and recorded daily. It is recommended that the minimum and maximum temperatures and the current temperature are all recorded. (See appendix 1 for sample recording chart)
  • The fridge temperature must be kept between the range of +2°C and +8°C. If the fridge temperature is outside of this range action should be taken immediately – see below for required actions
  • Ensure staff taking the thermometer readings understands how to read and reset the thermometer and why this is necessary

 

What to do when the fridge temperature is out of range of +2°C and +8°C

  • Inform the care home manager immediately
  • Quarantine (separate and put in a safe place) the affected fridge stock by bagging and labelling ‘Not for Use’ and keep within a designated fridge while advice is sought
  • Attach a notice to the fridge clearly stating do not use
  • Estimate how many hours the fridge has been out of range (you should have the reading from the previous day’s check)
  • Contact your local pharmacy or the individual product manufacturer for advice
  • If you are advised to use the stock within a specific short timeframe, label clearly and dispose of promptly after that timeframe expires. Contact the GP to explain what has happened and request replacement medicines, if required
  • If necessary, call out an engineer to repair the fridge
  • Advice should be sought from Medicines Resource Centre if need be for drugs within the fridge, i.e. if they can still be used. They can be contacted at –  bucks.medicinesresourcecentre@nhs.net
  • Remember to record the action taken on the fridge temperature record sheet
  • Ensure that it is clear where medicines should be stored (in an emergency) if the fridge malfunctions

 

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