Monitoring and protecting vital medications, as well as vaccines, tissue and blood products, has a direct impact on cost, patient safety and clinical quality.
Failure to detect out-of-range events can lead to the loss of expensive, temperature-sensitive inventory, or worse, administration of compromised inventory to patients. Hospitals are obligated under federal medication management standards, specifically The Joint Commission (TJC), to monitor refrigerators, freezers and other temperature-controlled storage areas, though the organization does not dictate a monitoring approach.
Furthermore, hospitals must comply with state and federal guidelines on humidity monitoring of sterile storage, operating rooms, treatment rooms, pharmacies, and laboratories. However, according to Darryl S. Rich, PharmD, MBA, FASHP Surveyor, Division of Accreditation and CertificationOperations at TJC "About one-third of organizations struggled with MM.03.01.01, the medication storage standard" — a significant finding in light of the potential patient safety and financial impacts.
Given these challenges and the amount of staff time required to meet compliance standards, an increasing number of hospitals are implementing automated solutions such as Real-time Location System (RTLS) technology. These wireless temperature and humidity monitoring systems can protect a hospital's significant investment in costly vaccines, medications and other temperature controlled assets, while also reducing the labor burden associated with meeting governmental compliance and protecting the organization's Joint Commission accreditation.
Temperature compliance is labor intensive
TJC's temperature monitoring standards have remained relatively unchanged since 2004. TJC's medication management standard, MM.03.01.01, elements of performance (EP 2) "addresses medication refrigerators and proper temperature control, and indicates that simply providing written temperature logs and thermometers to monitor temperature is insufficient. Temperatures need to be monitored consistently at least 90% of the time, and staff needs to take timely action if a temperature is out of range, and then document what has been done to rectify the situation." The standard applies to all areas—including procedural settings, operating rooms, hospital-owned physician practices, and ambulatory care facilities— and all corrective actions should also be consistent with the hospital's internal policy.
Other compliance issues dictate that areas of the hospital that are not open 24 hours must have the necessary tools to efficiently resolve refrigerator temperature issues that occur when those areas are closed. Many hospitals have resolved this compliance challenge by installing small wireless temperature sensors inside equipment that automatically transmit readings over a network to software that graphically displays the units' performance. This provides the ability to centralize temperature documentation and provide enterprise-wide data access for staff members. Some automated tools can preserve temperature logs even in the event of a network disruption and greatly improve compliance with issue resolution documentation.
Intelligent systems are able to notify personnel immediately when any storage unit is out of the correct temperature range, decreasing reaction time. Most importantly, the timely alert eliminates spoilage costs that can run into the thousands of dollars per year for temperature-sensitive products.
Humidity monitoring and documentation also a compliance challenge
In addition to temperatures in storage units, TJC surveyors are closely evaluating humidity levels in ORs, delivery rooms, central sterile, labs and other treatment areas. Humidity monitoring is important in hospital environments because of the patient safety risk, for example:
- Low humidity increases the risk of anesthetizing gases igniting and causing a fire.
- Low humidity increases the survival of cold and flu viruses, which increases the risk of hospital acquired infections.
- Low humidity dries nasal passages, making patients more vulnerable to the spread of infection while hospitalized.
- High humidity promotes the growth of bacteria and molds.
The challenge for hospitals is that manually logging humidity data and generating timely corrective action documentation is costly and labor intensive. However, with an automated, wireless system those staffing hours can be repurposed for higher value activities such as patient care.
An RTLS monitoring system can automatically log ambient room humidity as well. At the moment an out-of-range condition is detected, the system is able to send real-time alerts to the appropriate staff members by smart phone, email or pager. In addition, staff members can view temperature and humidity status and trends from any computer or handheld device.
Automation offers patient safety and financial benefits
The benefits of an automated system are significant when compared to a manual process. An intelligent solution that provides efficient, continuous monitoring of temperature and humidity in all appropriate areas of the hospital supports compliance efforts. In a manual environment, temperatures are typically logged twice daily, and there is no record for any given device or storage unit outside of these 5 to 10 second windows. Automation also provides a significant opportunity for labor savings. Based on the US Bureau of Labor Statistics in 2013, the median national RN annual salary was $66,220. Using this salary and adding 30% for employee benefits, a basic projection shows that monitoring 170 tags for six minutes each day would result in a labor cost of approximately $290,000 per year.
Another benefit is that continuous monitoring ensures that the appropriate staff is immediately notified of a temperature deviation and can attempt to rectify the issue or move the contents to another storage unit. This prevents the loss of medication, vaccines, tissue, blood and food due to equipment failure or malfunction. For example, in one instance staff responded to alerts caused by a brief power outage that had turned off all the refrigeration units in an entire medical office building. Even though the building regained power, the equipment needed to be reset due to the power problem. Without an active monitoring system, the out-of-range temperature could have easily gone unnoticed until morning, resulting in the loss of the entire vaccine inventory.
RTLS technology's alert management and escalation features provides tools and processes to quickly and efficiently respond to and document such temperature and humidity events—thereby increasing workflow efficiency and protecting patient safety. These features create alerts that require an acknowledgement by an investigator, who can then comment on an action taken or escalate the alert to another staff member who can properly resolve the issue.
Optimizing assets through the use of data trends
Automation also helps determine when low-performing units need replacement and provides the data to cost-justify decisions. In certain cases, units that are consistently outside the specified temperature range may only require a settings adjustment. In other instances, units that have erratic swings in temperature that are not related to stocking events, such as when the door is open, are candidates to be replaced. Equipment may need to be replaced due to age, expanded to eliminate over-stocking issues, or upgraded when they are malfunctioning. However, in every case, the data helps administrators understand the challenges and simplifies the decision if replacement or an upgrade is recommended.
Monitoring temperature and humidity levels is vital for healthcare organizations that need to comply with governmental regulations and Joint Commission standards. Automated RTLS-supported monitoring not only helps organizations achieve these requirements, it can also enhance the quality of care and offer significant ROI in improved asset management, reduced spoilage, lower labor cost and enhanced efficiency.
Tim Roche is CEO for Awarepoint.
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