Improvements in prehospital medication storage practices in response to research.
TL;DR: Most of the MICUs in the state have changed their practices in controlling and monitoring prehospital medication storage temperature, demonstrating a positive impact from previous research.
About: This article is published in Prehospital Emergency Care.The article was published on 2002-07-01. It has received 7 citations till now. The article focuses on the topics: Intensive care & Emergency medical services.
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TL;DR: This report reviews and summarizes the past 15 years of published research relating to out-of-hospital medication temperature exposures, and indicates that the evidence is clear that EMS medication storage is not consistent with the USP definition of controlled room temperature.
29 citations
TL;DR: Evaluated medications used by NPS Parkmedics at extremes of temperatures likely to be faced in the field recommended that EMS providers replace atropine, naloxone, diphenhydramine, fentanyl, and midazolam frequently if they are practicing in low call volume or high-temperature environments.
14 citations
TL;DR: A structured process based on common pharmacy practices was developed to review medications carried by EMS agencies to identify situations that may lead to medication error and to determine some best practices that may reduce potential errors and the risk of patient harm.
14 citations
TL;DR: The effectiveness of a simple stock rotation strategy in mitigating EMS medication exposure to excessive heat and cold and consistency with the official United States Pharmacopeia definition of controlled room temperature is described.
Abstract: The United States Pharmacopeia recently published a general chapter specifically addressing on-ambulance storage of medications, including a suggestion for stock rotation. This study describes the effectiveness of a simple stock rotation strategy in mitigating EMS medication exposure to excessive heat and cold. Previously collected on-ambulance temperature data from 5 US cities were randomly resampled to generate model exposures of 2 days to 6 months duration. The temperature measurements for every other 24-hour period were then set at 20°C to model the rotation of medications into a controlled environment. For each model, we then determined consistency with the official United States Pharmacopeia definition of controlled room temperature. Without stock rotation, excessive heat occurred in 39.9% of the model exposures. With stock rotation, exposures to excessive heat occurred in less than 1% of northern city models and in 2.9% of the central US models. Stock rotation did not reduce heat exposures in the models for southern cities.
7 citations
Cites background from "Improvements in prehospital medicat..."
...Such systems are commercially available and some EMS systems do use them [12-14]; however, we have not been able to identify any reports in the peer-reviewed literature documenting the effectiveness of such systems....
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TL;DR: This report reviews and summarizes the past 15 years of published research relating to out-of-hospital medication temperature exposures, and indicates that the evidence is clear that EMS medication storage is not consistent with the USP definition of controlled room temperature.
5 citations
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TL;DR: The results indicate that the thermal stability of E PI and the formation of EPI-SA depends on the method of heat exposure and the amount of bisulfite present in the solution.
Abstract: The degradation of epinephrine in USP injectable cartridges was investigated under different heating conditions. Epinephrine (EPI) and EPI sulfonic acid (EPI-SA) levels in 1:10,000 (0.1 mg/mL) EPI injectable solutions subjected to either cyclical (65 degrees C for 8 hr/d for 4 to 12 weeks) or constant (65 degrees C for 7 days) heating were determined using high-pressure liquid chromatography with diode array and electrochemical detection. Constant (169 total hours of heat exposure) heating resulted in complete degradation of both compounds and dark brown discoloration of the solution. Cyclical heating (672 total hours of heat exposure) resulted in a 31% reduction in EPI concentration and a 225% increase in EPI-SA concentration with no discoloration of the solution. In laboratory-prepared solutions, the degradation of EPI and the formation of EPI-SA was found to be dependent on sodium metabisulfite concentration and the duration of cyclical heating. These results indicate that the thermal stability of EPI and the formation of EPI-SA depends on the method of heat exposure and the amount of bisulfite present in the solution.
29 citations
TL;DR: It is demonstrated that out-of-hospital medications are subject to temperatures both above and below recommended storage temperatures, and time-temperature indicator labels can reliably monitor exposure to elevated temperatures.
Abstract: Objectives To determine whether temperatures inside drug boxes used in the out-of-hospital setting are within the U.S. Pharmacopeia recommendations for "controlled room temperature," which is defined as a temperature maintained between 15 degrees C and 30 degrees C with a mean kinetic temperature less than 25 degrees C, and to determine whether time-temperature indicator labels can reliably monitor mean kinetic temperatures. Methods Two methods were used to monitor temperatures: miniature electronic temperature recorders and color-changing time-temperature indicator labels. These were placed in drug storage boxes of advanced life support units over three summer months and two winter months. Results In summer, the electronic recorders logged temperatures exceeding 30 degrees C in all drug storage boxes, ranging from 3% to 29% of the total time. The mean kinetic temperatures by location for the whole period ranged from 21 degrees C to 30 degrees C. In the winter, the electronic recorders logged temperatures exceeding 30 degrees C at one location 2% of the total time. There were significant temperature excursions below 15 degrees C at all locations, ranging from 16% to 90% of the total time. At one location, there were temperature readings below 0 degrees C for 9% of the total time. The mean kinetic temperatures obtained from the electronic recorders and the indicator labels differed by less than 1 degrees C. Conclusions This study demonstrates that out-of-hospital medications are subject to temperatures both above and below recommended storage temperatures. Time-temperature indicator labels can reliably monitor exposure to elevated temperatures.
28 citations