Good practice guidance for refrigerated medicines in care homes
For all staff responsible for storing medicines in care homes.
You can download a full pdf version of this document by following the link on the right.
Aim
Outline the controls that should be in place to ensure safe storage of medicines that need refrigeration.
Care homes should include how and where refrigerated items will be stored in their own medication policy.
The 4 R’s of monitoring refrigerator temperatures
Read temperatures at least daily
Record temperatures on a standard form, including signing.
Reset after each temperature reading.
React by taking action if temperature is outside +2C to +8C. Document this action.
Fridge requirements
Medication that needs refrigeration should be stored in a separate, secure, fridge only used for medicines. Do not keep any food or pathology samples in the 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 you get medicines requiring refrigeration, they should be immediately identified and put in the medicine’s fridge.
Check that the fridge wall socket (where it’s plugged in) is clearly labelled to leave on so that it doesn’t get switched off at the wall. Some pharmaceutical fridges are directly wired so that this can’t happen
All fridges where medicines are stored should be serviced at least yearly.
An annual service and calibration programme should be done by a specialist, and periodic portable appliance testing should happen in line with organisational policy.
Consider activating the fridge warranty as this may also be helpful.
Store medicines in an organised way 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. Don’t keep large amounts of medicines in the fridge. 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, refer to The Green Book.
Ensure fridge medications are regularly date checked and the stock rotated.
Clean all fridges as part of the general cleaning rota and keep dated records. Domestic fridges (that are not self-defrosting) should be defrosted regularly and dated records kept. The home policy should state where the fridge contents should be refrigerated whilst cleaning takes place.
Store all medicines to the requirement in section 6.4 of the product’s summary of product characteristics (SPC).
If medicines have been exposed to out-of-range temperatures, use the refrigerated medicines stability tool.
Thermometer requirements
You must monitor the medicines fridge using a thermometer which measures both the minimum and maximum temperature. The thermometer, or its temperature monitoring probes should be in a central location within the fridge, preferably between the products. Do not put the probes in the door.
Daily temperature recording
You must check the fridge temperature and record it daily. Record all the minimum and maximum temperatures and the current temperature. (See appendix 1 for sample recording chart).
The fridge temperature must be kept between the range of +2C and +8C. If the fridge temperature is outside of this range, take action immediately. See below for what you must do.
Ensure staff taking the thermometer readings understand how to read and reset the thermometer. Explain why this is necessary.
What to do when the fridge temperature is out of range of +2C and +8C
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.’ Keep within a designated fridge while you get advice.
Attach a notice to the fridge clearly stating don’t 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.
Dispose of any stock promptly that you’ve been told is no longer usable in line with local protocols
Contact the GP to explain what has happened and request replacement medicines, if needed.
If necessary, call out an engineer to repair the fridge.
Remember to record the action taken on the fridge temperature record sheet.
Ensure that it’s clear where medicines should be stored (in an emergency) if the fridge malfunctions.
Appendix 1
For a sample fridge temperature recording sheet for care homes, download the pdf by following the link on the top right of this page.