My good people! It’s been a minute, or has it? Technically, it has been a year, a busy one at that. I trust you have been well and in the best of health. If you are a medical practitioner, I sincerely hope that you are handling cold chain products correctly. In my last post, I spoke about the 3 sins of cold chain handling: Assumption, Apathy, and Ignorance. I went into some detail about the assumptions we make when handling cold-chain pharma and why they are so potentially harmful. In this post, we dig deeper into talking about apathy. What exactly is apathy? The good old Oxford dictionary defines it as a lack of interest, enthusiasm, or concern, or in other words, indifference to the situation. What is so terrible about apathy is that, more often than not, one has the knowledge and resources to do the work right, but chooses either to do the bare minimum, which is pointless, or nothing at all. I will go over a few scenarios already previously highlighted in the last post that characterize apathy towards best practices in cold chain handling.
Leave nothing behind! Fill it to the brim – Packing cold chain products for transportation or storage requires sufficient space for air circulation to maintain uniform temperature. It’s often tempting, when dispatching cold-chain products, to fill the cold box to the brim rather than go through the arduous steps of preparing a second cold box. While logistical considerations may force us to fill cold storage and transportation units to the brim, the practice is highly unfavorable. You risk losing the products and thereby incurring a similar, if not higher, loss of value should the affected products require replacement or, worse, find their way to patients, in which case the reputational damage is both monumental and irreparable. I know you pride yourself on being able to carry all the grocery bags in one trip, but let’s not extrapolate that glory to packing cold-chain products. Take a few minutes to pack the additional cold box to ensure the medicines or vaccines reach the intended destination in the best possible condition.
Nothing has gone wrong, so nothing will – Murphy’s Law dictates that if something can go wrong, it will eventually go wrong. While we are familiar with this Law, very few of us are proactive enough to plan for the unwelcome eventualities. The same goes for the cold chain handling of medical products, where the apathy toward planning for simple risks, for instance, power blackouts or equipment failures, is often palpable even in management meetings. The resulting loss is usually financially devastating and catastrophically disadvantageous to patients reliant on those products. The bigger risk is when there is either a deliberate intent to distribute cold chain products affected by a temperature excursion emanating from such a breakdown, or even worse, when there is no system to either detect such a breach or support objective decisions regarding the final disposition of these products. Adverse events such as drug reactions, unreliable test results from reagents, and poor response in patients can very easily occur from the consumption of affected products.
Another dimension of apathy is knowing the right thing to do and still circumventing it in favor of what is momentarily convenient. Two common trends I have come across in my years of practice are: first, not monitoring cold chain storage temperatures; and second, playing fast and loose with expiry dates. The expiry date isn’t a suggestion; just because you kept the medicine in the refrigerator doesn’t mean it’s still good after the expiry date. Cold chain products have a limited shelf life determined by the manufacturer, just like any other pharmaceutical product. We know this, yet instead of promptly discarding the expired product in the fridge, we give in to the temptation to use it, as if cold-storage confers some sort of chemical immortality.
Having a gut feeling over actual temperature monitoring is playing Russian Roulette with patients’ lives. Monitoring temperatures enables you to track your cold chain storage unit’s performance and make informed decisions in the event of an excursion. This is in no way a new concept to medical practitioners, yet how many of us, especially Pharmacists, have medicines and/or vaccines in refrigerators that we don’t monitor the temperature in? What exactly happens when the power goes out at night or over the weekend when there is nobody at work? How long does your fridge stay between 2 °C and 8°C? Are you even sure that on its best working day, it’s within this temperature range? Could this potentially put our patients at risk? Guilty? Do something today about it.
Unlike Assumption, which didn’t quite find a circa with Dante, apathy does! What’s this got to do with cold-chain medical products? Everything I have mentioned above, and many more small actions or lack thereof, that put patients at risk of consuming products whose quality has avoidably deteriorated. In Dante’s Inferno (it should be evident by now that I am a big fan), the apathetic, those who lived without commitment or passion, are eternally punished in an eternal marathon chased by wasps and hornets, symbolic of the constant irritation they avoided in life. Hilarious but poetic justice in the sense that in cold chain handling, going the extra mile to do that additional little task can be irritating and often requires discipline and supervision, if not both.