The Utility of Continuous Temperature Monitoring of Refrigerators in a Long-Term Care Facility

Abstract

Background: It is the current practice in most long-term care facilities to use manual logs when documenting refrigerator temperatures. This process is commonly associated with poor or fabricated compliance, little oversight, and documentation errors, both because of overt omissions and unsubstantiated values. It is also well-established that medication storage requirements are mandated by the Centers for Medicare & Medicaid Services (CMS). This analysis demonstrates the potential risk of poor cold-chain management of medications and establishes the possible utility of digitally recorded continuous temperature monitoring over manual logs. This small case-oriented review of a large nursing facility's storage process attempts to expose the risk associated with improper medication storage.

Outcomes: The primary outcome of the study was to determine if a difference existed between temperature logs completed manually compared with those done with a continuous monitor.

Methods: American Thermal Instruments (ATI) thermometers were placed into each of the existing refrigerators in a 147-bed nursing facility. Through a mobile app, the data recorded in each refrigerator were compiled into daily reports. Data were collected from a total of 12 refrigerators, 3 of which were medication refrigerators. Logging intervals were done over a 263-minute period and compiled the lowest recorded temperature, highest recorded temperature, and the average temperature for each refrigerator. In addition, reports showing the real-time results were compiled using the ATI DataNow service.

Results: All of the refrigerators analyzed had highest temperature recorded readings exceeding the maximum allowable temperature (50°F for refrigerator). All of the refrigerators had lowest temperature recorded readings below the minimum allowable temperature (32°F for refrigerators). All of the refrigerators also reported average temperatures outside of the allowable temperature range. The results necessitated the replacement of a refrigerator and the evaluation of a dairy refrigerator in the food service area. This resulted in consistent measurements within the allowable range.

Conclusion: Following this analysis, it can be concluded that the common assumptions about the effectiveness of manual temperature logs should be verified. It can also be concluded that continuous temperature monitoring improves temperature-reporting accuracy. Proper medication storage is mandated by CMS; risk does exist that an improperly stored vaccine, biologic, or medication could lose effectiveness. While it has not been proven, improved medication storage offered from continuous monitoring could result in improved medication viability and hence improved patient outcomes associated with those medications.