Have we lost our way with vaccine fridge monitoring?

What I am hearing about vaccine fridge monitoring

I have customers who are now required to download the results of a temperature logger once or twice a day. That’s not once or twice a month or even a week, but every single day.

I used to sell temperature loggers telling people “it will save you time and money” and they now laugh at me and complain about how much time they are now losing every day having to retrieve the results.

So I think we have lost our way with vaccine fridge monitoring.

The bad old days

To explain why I think we have lost our way we need to look at where we came from.

15 years ago when I started my company most vaccines were stored in domestic fridges. To make it worse these were often the combined bar fridge/freezer units, and you were just as likely to find some lunch and softdrink in there as a vaccine.

Improvement #1 – min/max thermometers

The use of a min/max thermometer was a good step forward. Staff were able to check to make sure that their fridges were operating correctly.

To be very, very clear on what the purpose of the min/max thermometer was, it was so that the staff could manually check to make sure that the fridge was operating correctly, and to act quickly if it wasn’t. It was also an audit trail to prove that everything was good.

It was, however, only a small step forward. It still relied on staff checking the min/max thermometer every day, being honest about the results, and acting upon bad results. Keep in mind that this was within a poorly controlled environment and problems were common.

My point is that once a day there was a manual check to make sure

Improvement #2 – vaccine fridges

Vaccine fridges were a huge step forward, and for the price they probably wanted to be. Having a fan forced environment inside helped to significantly reduce hot and cold spots. Having a computer controller and not just a timer ensured the temperature range was much tighter controlled.

But at the same time possibly the least known big step forward was the noisy, obnoxious alarm that is built in vaccine fridges when they get too hot or cold. The vaccine fridge it self would notify EVERYONE in the area if it became too hot or cold. So now the fridge was able to notify you when doors were left open or the compressor failed etc.

The big step forward was that daily check that happened at the end of the day was now happening every moment of the day.

So the biggest causes of problems were now covered.

The next big issue was a power failure. There’s not much that a vaccine fridge can do during a power failure, but once again when the power was returned, it could detect that the fridge temperature was too high, and it would go into an audible alarm.

So at this point one could start to argue there is no need for people to monitor the fridge. Except there is still one key issue:

Who polices the police?

There is an electronic controller that is monitoring (policing) the fridge temperature and is using that information to then control the temperature of the fridge. This same information is used for triggering the audible alarm.

What if this information is wrong?

Improvement #3 – temperature loggers

When temperature loggers were introduced they were a great step forward for domestic fridges being used for vaccines. More often than not it showed the issue and within a couple of years lead to the demise of the domestic fridge in pharmacies and GPs.

With vaccine fridges their roles are still similar:
1. a clear audit trail for when things are good
2. a clear audit trail for when a problem (e.g. blackout) occurs

but they also have a critical third function:
3. they are an independent validation

That’s why I think that any logger that is built into the controller is a bad idea. It must be an independent unit. It can be built into the fridge, but it can’t use any of the electronics or sensors of the controller.

So if a temperature logger has 3 clear roles in a vaccine fridge, then the question is:

How often does a temperature logger need to be read?

For role 2 it is really obvious – after something has gone wrong. And how do you know when something has gone wrong? Because the fridge has told you by being loud and obnoxious.

For role 1, it is debatable. In theory the answer is “before the memory is full” so you don’t lose results. For some units this could be many months. I used to say “once a month” but there is the risk that the logger is lost or damaged and losing an entire month’s data is not a great idea.

So I can understand once a week or once a fortnight. That’s a reasonable compromise.

The big question, however, is “how often does it need to be read as an independent validation?” My question is “how likely is this to be a problem?” and the answer is “very rarely”.

Is there a better solution?

Firstly, loggers such as the Logtag have a flashing red/green LED to indicate if there was a problem. You can tell just by looking at it if it has bad readings. You don’t need to download it. But better still, it has a push button that is recorded whenever it is pushed. So you can get staff to push the button when they check the LED. Now you have proof that your staff were looking at it and checking it – without spending time downloading it.

What about wireless loggers?

The big question for the industry, and Strive for Five, is what they will do with wireless temperature loggers. Now there is both the fridge alerting the staff and a remotely monitored logger. There is no need to download the results once a day because they are already downloaded.

Will we introduce the need to run a report every day to demonstrate that the fridges were fine all day?

My prediction is yes – someone will continue to lose sight of what we were trying to achieve and will be fixated on the need for reporting for the sake of reporting.

Just wait.