ObjectiveIncorrect storage and handling of refrigerated medicines may result in destruction of medicines and financial loss for hospitals. At the Medicine Information Centre we receive and answer queries on drug-related issues. In this study we aimed to investigate and quantify savings made following advice supplied by the Medicine Information Centre in reply to queries regarding the incorrect storage of refrigerated medicines.MethodsA retrospective study was conducted by systematically reviewing each drug when the cold chain had been impaired, in order to determine whether the drug could continue to be used, possibly with a shortened expiry date. Thus, by examining all cases of incorrect storage, the value of drugs that pharmacists advised could be used despite a broken cold chain, could be estimated.ResultsThe Medicine Information Centre dealt with 171 cases concerning incorrect storage in 2013. Data show that advice from Medicine Information Centre pharmacists resulted medicine cost savings of DKK 13 million (approx. €1.7 million) in hospitals in the Capital Region for that year.ConclusionsSubstantial savings can be made by seeking the advice of a team of information pharmacists regarding the incorrect storage of medicines.

BackgroundThe Medicines Information Centre is contacted when medicine has been exposed to temperatures deviating from their specific standard storage conditions. In order to determine whether or not the medicine should be discarded, many factors have to be taken into consideration.When lacking approved stability data, we must deduce and extrapolate from facts to make a ‘professional judgement’ (eg, can it be used conditioned by reduced shelf life?). This may result in variations in our case handling and hence conclusions.There are a number of incentives which support investing time in finding a rational solution other than discarding the medicine (eg, a large number of medicine stored in the refrigerator are very expensive and we experience more frequent backorder situations). Handling a case of a medicine stored incorrectly can be resource consuming and therefore it is also relevant to find a balance between the time invested in case handling and the price of the medicine.PurposeTo develop a procedure which embraces tools and guidelines to ensure uniform quality and consistency in our decision making regarding a medicine stored under non-standard conditions.Material and methodsIn addition to professional judgement, we have developed the following tools and guidelines to support the caseworker.List of databases and sources of information retrieval: SmPC;local database of previous cases;UK database;Micromedex and other databases on storage and stability;manufacturer.A guide to use shelf life estimation methods (ie, when to use an equation to estimate the reduced expiration date).De minims limit: Obtaining a balance between resources spent on case handling and the cost of the medicine.ResultsOver a 5 month period, 330 medicines were processed as having incorrect storage. In 186 cases (56%) only guidelines and tools were applied; in 85 cases (26%) guidelines, tools and professional judgement were applied; and in 59 cases (18%) only professional judgement was applied. All of the above mentioned guidelines and tools were applied in the cases.ConclusionAll of the guidelines and tools are important and useful in the case handling of incorrect storage of drugs, but they cannot stand alone in all cases. Professional judgement remains an essential element to complete the cases.No conflict of interest.

РЕЗЮМЕ Цел: Неправилното съхранение и манипулация на замразени лекарства може да доведе до унищожаването им и до финансова загуба за болниците. В Информационния център за лекарства получаваме и отговаряме на запитвания относно проблеми, свързани с лекарства. В настоящото изследване, извършено след консултации, предоставени от Информационния център за лекарства в отговор на запитвания относно неправилното съхранение на замразени лекарства, целта ни е да проучим и определим количествено икономиите. Методи: Бе проведено ретроспективно изследване посредством систематичен преглед на всяко лекарство, когато студената верига бъде нарушена, за да се определи дали лекарството може да продължи да се използва, вероятно с по-кратък срок на годност. По този начин, проверявайки всички случаи на неправилно съхранение, може да бъде приблизително изчислена стойността на лекарствата, за които фармацевтите препоръчват, че може да бъдат използвани, въпреки нарушената студена верига. Резултати: Информационният център за лекарства е разгледал 171 случая относно неправилно съхранение през 2013 г. Данните показват, че консултациите, предоставени от фармацевтите от Информационния център за лекарства, са довели до икономии на разходи за лекарства в размер на 13 милиона датски крони (приблизително 1,7 милиона евро) в болници в Столичния регион за тази година. Изводи: Може да бъдат направени значителни икономии като се търси съвет от екип информационни фармацевти относно неправилното съхранение на лекарства.