Monitoring Shipping
I am exploring methods for monitoring temperatures for shipments—especially in extreme weather conditions of summer and winter. Does anyone have procedures on how they do this that would be willing to share? What methods do you use? And what resources do you use?
Submitted By: Jean Macias, Pharmacy Manager, Home Medical Services Infusion Pharmacy
Response Summary
There were 2 Listserv responses to Jean’s question:
Bryan Nichols, RPh, Director, Business Development, Infusion Innovations replied: We use cardboard boxes that have foam inserts that are 1/2 inch thick. We mostly utilize UPS for our shipping. Any zip code in our state is delivered the next day, or within a 24 hour time period.
We tested the several size boxes we utilize with the foam liner adding different quantities of 1 pound re-freezable bricks (i.e. 1 brick/box. 2 bricks/box, 3 bricks/box), newspaper filler and a simple inexpensive thermometer from Wal-Mart.
We recorded the stable registered temperature inside the box and the time. We sealed it up and sent it to ourselves. When the boxes came back to us we recorded time and temperature. This gave us an idea of how many bricks were needed to keep contents of foam lined box at a temperature acceptable for the contents.
We tested all our seasons, but we used the data we collected for July and August (when we got to summer season). These are the hottest months in Utah riding in the back of an un-insulated brown delivery van, and ship our boxes accordingly all year long.
It was a cheap easy way to know temperature change for shipments out of our facility. It of course does not show fluctuations, but the boxes are insulated so one has to be
confident that temperature excursions would not be widely high or low.
Calls to patients indicated that the bricks are still frozen or partially frozen when delivered within the 24 hour window we see with UPS.
I think others will agree, a patient will call if they think their delivery has been subject to too much heat, i.e. cold bricks are completely flaccid. They know! Hope this helps.
Ken Fagerman, Granger, IN stated: Bryan: What is your rule of thumb for the number of cooling blocks per container? Also, as a tip, I keep refrigerated NS and D5W on hand to use for compounding of these shipments to pre chill them. My measurements of the pumped delivered volume to my elastomers showed no significant differences.
Bryan Nichols, RPh, Director, Business Development, Infusion Innovations responded to Ken’s question with: Ken, 4 x 1lb frozen bricks go in our 14"x14"x14" and 12"x12"x12" boxes. 2 x 1lb bricks go in the smaller boxes that are 8"x8"x10" and 8"x8"x6". With the size of our frozen bricks, we get a complete layer of ice packs for the
inside dimension of the bottom of the box.
Additionally, the drug product has usually sat for at least an hour in our pass-thru fridge for cool down so I also get the added advantage of the product itself acting as a cooling agent just as you utilize refrigerated diluents.
Ken Fagerman had these final thoughts: In the last few years I've had a couple of extreme challenges and with student TPN patients traveling overseas during University breaks. For these cases, I purchased the largest, high end picnic type coolers with Thinsulate insulation which maximized the space and had the very best cold retention. These also had luggage type handles and wheels. Using these cooler packed with frozen
cooling bricks, pre-chilled TPN and patient taking pump and tubing’s as carryon luggage, I've supported two extended trips. One to Istanbul, Turkey and another to San Paulo, Brazil. In one case the student continued to use the cooler as a refrigerator and rotated refrozen cooling bricks to it. In another case, I mixed and supplied TPN with lipids to maximum of shelf life and then had patient switch to non lipid bags for last few days until return. Both cases went well and communication by Internet email went well also.
Rock-Pond Analysis
Jean’s question has been answered very thoroughly by both Bryan and Ken. The Home Infusion industry is constantly faced by many challenges in providing care and service to our patients in the home. Shipping of compounded medications is just one of them but critical to the success in providing the care our patients expect.