If humalog was put on the shelf by a tech putting away the order, instead of the fridge, and it was there for 5 days at room temperaturem, would you feel that it should be put back in fridge and dispensed at a later time? I know there is a 28 day shelf life after opening but what if not stored correctly? I tend to lean on the side of sending it for damage returns but not sure what is correct. Thanks
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Insulin storage poll
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I remember reading the source material for some insulins and it's a <1% degradation rate while refrigerated, rises to about 10% at room-temp over the course of a month.
As a pharmacy you absolutely should not dispense it knowing it was out of the fridge for that long. As a patient it wouldn't be an issue but we're not the patient.
The only instance I can think of when you would reuse it is if harm > risk, like if you were in a hospital and you ran out of every single insulin available and were unable to procure more until Monday. Unlikely here but you figure if D50 can go short, anything goes.
That sucks. I would assign it an expiration date, and then maybe see if you can loan it to a hospital or somewhere that you're friendly with so that it'll get used.
Isn't that stupid?! It's freaking sugar water. 😕
I agree with the idea of assigning it an exp date based on only being allowed out of the fridge for 28 days.
While there may be no problems, this is a risk I would find completely unacceptable if I were a patient. Insulin is a very important drug that must work as expected. Definitely do not dispense...and train the tech about the importance of refrigeration.
Think about it this way: if there were issues and you were sued (highly unlikely, but hey...you never know!), would this be defensible in court? Probably not...
And while you could assign it an earlier expiration date, you'd be charging the patient for less than one month's worth of insulin...
Think about it this way: if there were issues and you were sued (highly unlikely, but hey...you never know!), would this be defensible in court? Probably not...
And while you could assign it an earlier expiration date, you'd be charging the patient for less than one month's worth of insulin...
Send it back. No question.
My rule: when in doubt, throw it out. Never take risks that involve a patient's life.
Plus it's adulterated. FDA say no no.
If it's been out of the fridge for 5 days, it better all be used within the next 23. Since you probably can't ensure that, it is best to send it back.
However, if you have a patient that you're close with, who is on a pump, or uses a ton of insulin, it might be okay to talk to them and have them use that vial first. We have a few patients who use like 5-6 vials per month, so they could easily use it up before the 23 days were through. I don't think I would want to risk it though.
However, if you have a patient that you're close with, who is on a pump, or uses a ton of insulin, it might be okay to talk to them and have them use that vial first. We have a few patients who use like 5-6 vials per month, so they could easily use it up before the 23 days were through. I don't think I would want to risk it though.
If humalog was put on the shelf by a tech putting away the order, instead of the fridge......
Based on that experience, what should we do to prevent future mistake?
I heard of BRAND NEW PHARMACIST making mistakes of putting cold medication on shelf, not inside the fridge. To prevent, please share with your team members to do this:
If the medication came from a fridge, please put in RED basket or somehow identify medication as RUSH ORDER so pharmacist will finish the order as soon as possible and prevent the medication from warming up to room temp for too long. Also, by identifying the order as SPECIAL, the team will help BRAND NEW PHARMACIST or BUSY PHARMACIST to remember to put the cold medication into the fridge.
The way I delivered the message was: Imagine your mom or dad buying cold medication from our pharmacy, you want your mom to get cold medication as cold medication, right? I am sure you do not want to give your mom warm insulin, right? With that heart, we treat all patients the same way we treat our mom and dad, so, please put cold medication in red basket for me. Thank you very much.
Any other trick? Please share your thoughts...thank you very much in advance.
