Operating a multi-site healthcare network with varying, and sometimes numerous, pieces of equipment in each clinic may not seem like a pressing issue with all the other matters that demand your attention. But what about the costly compliance risk created by using dissimilar storage equipment for temperature sensitive inventory in the back of your clinic? That’s the kind of scenario that makes your stomach tighten.
The hidden costs of a non-standard procurement
Multi-site networks are rarely born disorganized – they grow that way. One site buys a fridge from a local supplier, another’s manager finds a cheaper option online, and the third inherits their equipment from whomever was there before them. Soon enough, you have a network of ten clinics, all with different refrigerator brands, two data logger systems, and no two with the same maintenance schedule.
This is an unwieldy set of circumstances for your staff to operate under. For every different model of equipment, there is a different set of spare parts that must be kept on hand, a set of fault codes that must be memorized by technicians, and a user interface that roaming staff must familiarize themselves with. And because each was purchased individually, you’re paying retail for every single unit.
The less obvious cost of this approach is compliance risk. When it comes time to perform a cold chain audit, procurement officers are expected to be able to demonstrate that each unit, at every site, is compliant with organizational and regulatory standards. With a non-standard fleet of domestic, commercial, and purpose built units, that’s not going to be easy to do.
Aligning procurement to cold chain compliance requirements
The first step to developing a standardized procurement policy for medical refrigeration is simple, but not necessarily easy – the exclusion of domestic fridges, modified commercial units, and any exceptions for low-volume sites. Vaccines have very specific storage requirements – 2-8 degrees Celsius – and any deviation from this range is considered a breach of the cold chain. This means that a domestic refrigerator – even an upgraded model – is ill-suited for this application. It simply doesn’t have the technology to remain within this range consistently throughout the day. It’s built to keep the inside cool, not precisely controlled temperatures, and it lacks an alarm that has been tested and certified for cold chain monitoring applications.
Vaccine refrigerators, by contrast, are engineered to perform precisely within this range. They utilize different technology to ensure the most consistent distribution of temperature within the unit’s interior, which works in tandem with the seals on the door, which are rated for a certain number of openings and closings per day. Finally, there is the alarm, which is factory-set to alert staff when the temperature falls below or rises above the acceptable range.
If you have twenty clinics, each with three refrigerators, each purchased from a different distributor in a lowest-price procurement process, you now have sixty points of failure with different technologies and requirements.
When multiple clinics consolidate their refrigeration procurement, a national and specialized distributor like Rollex Medical can ensure that each of your locations receives the same units, and the same service and maintenance from a single provider, who can also supply the parts needed to repair any of the units in your fleet.
Establishing a single view across all of your refrigeration assets
Having standardized equipment across your network is a good start, but it won’t necessarily do much to address the differences in how each site is able to monitor and manage its refrigeration assets. The problem is usually found at the point of data collection – your thermometer works fine, but one site can’t get it to communicate over your IT network, and another has to schedule a downtime to export the data. Sites find that the Ethernet port on their unit is disabled, and in doing so, learn that their refrigerator isn’t actually network-capable.
To develop a uniform and organization-wide multi-site monitoring strategy, you’ll need your refrigeration vendors to help you. They will need to modify their units to ensure that every one of their devices is network-capable, using a standard communication protocol that your organization can support.
Every network-connected device that your IT department doesn’t control is a potential entry point for cyber attackers, which is why you will also need to request documentation from your refrigeration vendors that their equipment meets your organization’s cybersecurity requirements prior to purchase.
Mandate that any refrigeration unit that enters your fleet must be compatible with your organization’s monitoring platform, as a means of standardization. This single requirement will eliminate a number of potential issues during implementation.
Writing SOPs that span across an entire network
Standardizing equipment across all of your locations is one part of the equation, while standardizing documentation, training, and job aids for your staff is the other. This documentation should serve as the backbone of your cold chain management, crossing all Ts and dotting all Is in terms of compliance and regulatory requirements. A well-written SOP for equipment use, including alarms and power management, will serve you well in this regard. They also need to be scalable and easily applicable across your network, without variation from site to site or requiring new procedures to be written for each new location that utilizes a different type of refrigerator.
This is all the more achievable when the SOPs that you need to write for your standard cold chain equipment are fewer in number and scope. There’s only so much that can be done with temperature sensors, and the number and location of these sensors, as well as the cooling element itself, are design choices that have been made by your equipment vendor.
Calculating the total cost of ownership rather than purchase price
It’s human nature to gravitate towards the lowest price, but when it comes to medical refrigeration, that approach can be counterproductive. A unit that costs less to purchase but requires more frequent calibration, has a shorter warranty, is less energy efficient, or has limited service options, can end up costing more over its lifetime than a higher-priced unit.
Over the lifetime of a refrigeration unit, the total cost of ownership typically consists of the purchase price, installation costs, annual calibration costs (since these will not be entirely covered by the warranty), the cost and frequency of consumables (door gaskets, filters, etc.), and out-of-pocket service calls that are not covered by the warranty.
Using the TCO spreadsheet as a reference, you can compare the total cost of ownership for two different refrigerators across fifteen sites. After five years, the cheaper refrigerator has required calibration service calls, three parts replacements, two service calls for the same issue, and has caused an increase in your site’s electricity bill. The other refrigerator only required regular calibration service throughout the five years. In this case, the more expensive refrigerator was the less expensive option.
Procurement departments need to work in tandem with equipment specialists during the design process to adopt a standardized spreadsheet, and then require that vendors complete it as part of the formal tender and quotation process.
Establishing vendor frameworks and service level agreements
By consolidating procurement under a single manufacturer or distributor, you can reap the rewards of their volume purchasing agreements. A network that plans on outfitting thirty-five locations over the next twenty-four months with the same equipment is a large client for any vendor, and they should be willing to provide you with favorable pricing, priority installation scheduling, and service level agreements.
Service level agreements for medical refrigeration might not seem like the most exciting aspect of procurement, but they are the backbone of your risk management strategy. A generic SLA will outline the maximum on-site attendance time for service calls, confirm that the required parts will be available for the models that you have purchased in volume, and establish escalation procedures in the case that the initial service call is unsuccessful. For high-volume facilities that carry a large inventory of vaccines at risk, we recommend an onsite attendance window of no more than four hours following a breakdown, within normal business hours.
Auditing your current fleet and planning a rollout
Very few networks have the resources to retrofit every single non-compliant refrigerator at once, which is why the standardization process always begins with an audit of your current fleet. This audit should be used to categorize your equipment by age, type, compliance, calibration status, and the volume and risk profile of the site that it serves. A ten-year-old domestic refrigerator at a high-volume vaccination center is a much higher priority for replacement than a two-year-old purpose-built unit at a low-volume clinic with limited inventory.
The results of the audit will then be used to develop a phased replacement schedule, which will see high-priority sites moved to the new equipment first, with lower priority sites following in subsequent phases. This approach also allows you to test the new equipment specification and SOP framework at a smaller number of sites before rolling out to the larger network, mitigating the risk that issues will be discovered at the fifty site mark rather than the fifth.
Designing redundancy into the standard specification
An equipment standardization plan that only addresses the refrigerator or freezer is not considering the full scope of cold chain risk management. The cold chain runs through the power cord at the back of the unit, which means that if the primary storage is considered critical enough to warrant backup power, the standardization project should also consider a single solution for backup power as well.
Every multi-site network site with refrigeration that requires basic redundancy should have either an uninterruptible power supply with access to a reliable power source or a circuit on the facility generator. For part two facilities at high-risk locations, the solution might be both. But settling for a solution that only covers the redundancy needs of the sites that the previous equipment buyer happened to serve is not standardization.
Transport coolers are another aspect of cold chain management that are often overlooked but are just as important as primary storage. Much like backup storage, transport coolers will be found in a variety of sizes and brands as buyers compare prices and specifications over a period of time, with varying degrees of success. In the end, there is likely to be one model that suits everyone’s needs best, which is why the storage plan should also address a single standard cooler model in the SOP.