When it comes to a medical lab's medication refrigerator: how to keep an accurate medication refrigerator temperature log is a critical skill. In fact, there are things that medical labs should do, and things they must do. Here are seven such "musts."

  1. Why use medication refrigerators?

The recommended temperature of certain chilled medicines and tissue samples must be maintained in order to keep them from spoiling. A spoiled medicine is one that cannot provide the therapeutic remedy the doctor seeks or, even worse, can become toxic and make a patient sick. Tissue specimens must result in highly reliable data that medical clinicians need to help maintain the health of their patients. Tissue samples may be held in medication refrigerators along with medications. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) issues standards for the safety of medicines and tissue samples that must be refrigerated. Failure to follow JCAHO recommended standards threatens the medical facility's credentials.

2. What are the appropriate medication refrigerator temperatures?

JCAHO says a small optimum temperature range exists for chilled medicines and tissue. According to the Centers for Disease Control (CDC), the ideal medication refrigerator range for vaccines is between 36 to 46 degrees Fahrenheit. (A medication freezer must be below 10 degrees Fahrenheit.) Any temperature above or below the ideal range requires immediate action.

Because the medication refrigerator's temperatures are designed specifically for storing pharmaceuticals and tissue samples, staff cannot store food or beverages in the medication refrigerator. And only fresh drugs and tissue samples are allowed. Expired drugs and spoiled tissue samples are thrown away.

3. How does a medical facility monitor the medication refrigerator temperature?

While JCAHO does not require that accredited facilities keep a temperature log, the Commission's standards certainly require monitoring of medical equipment daily. Keeping a medication refrigerator temperature log is the easiest way to document compliance with that monitoring standard.

4. What does the medication refrigerator temperature log monitor?

The CDC recommends the following procedure for monitoring medication refrigerator temperatures:

• Check and record the minimum and maximum temperature at the start of each day. This means checking the coldest and warmest temperatures in the refrigerator since the last check.Do not forget to reset the automatic thermometer device after logging the day's record.
• Check the current temperature often. If the medication refrigerator does not automatically record the minimum and maximum temperatures, then Johns Hopkins recommends checking and recording the current temperature at least two times, at the beginning and end of the day. In addition, whenever the staff opens the refrigerator to access medicine or tissue samples, check and record the current temperature.

JCAHO recommends installing a refrigerator with an alarm system that triggers when the temperature goes out of the appropriate range.

5. What does a medication refrigerator temperature log look like?

Johns Hopkins' temperature log is instructive. The caption to the log shows the facility name, the year and month, the unit or room where the refrigerator sits, and the serial or identification number of the specified refrigerator.

The log has 8 vertical columns and 31 horizontal lines (one for each day of the month). The first column holds the date (1-31). The second column is where staff records the minimum temperature (36 degrees F or more) at the start of the day. The third column is where the staff records the maximum temperature (46 degrees F or less) at the start of the day. The fourth column records the current temperature. The fifth column is for the staff to record their initials. The sixth column contains the comments column. The final two columns are for initials by unit review and lab review.

6. What if the medication refrigerator temperature goes out of range?

If a medication refrigerator operates out of the optimum temperature range, take immediate action.

If the staff can solve the temperature problem, then the staff should fix it and document the steps taken in the comments section of the medication refrigerator's temperature log. Such fixable problems may appear in the comments section as:

• Refrigerator's plug was unplugged, plugged back in and continue to monitor
• Refrigerator's door was not closed properly, closed the door and continue to monitor
• Inventoried, stocked or removed supplies
• Refrigerator overstocked, removed excess stock and rearranged stock so airflow improves
• Reset thermostat to appropriate levels

If the medication refrigerator problem cannot be easily solved, remove medications and/or tissue samples to another refrigerator that is temperature monitored. Place a sign on the broken refrigerator stating the problem and warning staff not to put anything in the broken refrigerator. Leave a note as to where medications/tissue samples were moved.

Important! Document the comments section of the refrigerator's temperature monitoring log sheet with the type of problem, how the problem was fixed or that maintenance was notified to fix the refrigerator.

In addition, a facility may adopt a monitoring policy about the medication refrigerator which includes requiring a temperature monitoring log. The policy also may require staff to notify the pharmacist or the medical lab when a medication refrigerator is out of the optimum range. In that case, the pharmacist (or the medical lab) will make the final decision regarding the disposal of the medicine/tissue. The staff should note the disposal decision on the temperature log.

7. Is it ever okay not to check/record in the temperature log?

That depends on the type of facility using the medication refrigerator. If a facility closes on weekends, holidays, or snow days, then the temperature log should note those closings. Most hospitals, rehabilitation centers, and assisted living facilities will never close so the temperature log notations should show check/record notations every day. On the other hand, doctor's offices, some medical labs and acute care facilities may maintain vaccines, tissue samples and other drugs that require refrigeration. Such facilities may close on weekends or on certain holidays. Therefore, staff in those types of facilities will note the closures on the temperature log. If the facility has a medication refrigerator that records temperatures automatically while the office is not in operation, it will disclose the minimum and maximum temperatures during the closed period. The staff will note those minimum and maximum temperatures on the temperature log on the first day that the office reopens.

To learn more about how important monitoring refrigeration temperatures is in research, you may enjoy the March 2019 article from news-medical.net "How Should Freezer and Fridge Temperatures Be Monitored for Research."