The Heatwave Ended. Did Your Medicines Survive It?
The temperature outside has fallen. The medicine cupboard looks exactly as it did before the heatwave.
That does not necessarily mean there is nothing to check.
Correct storage helps medicines retain their quality, effectiveness and safety. During periods of extreme heat, medicine cupboards, treatment rooms, parked vehicles and bags can all become considerably warmer than expected.
Medicines safety therefore starts before the drug round—not only when a tablet is removed from its packaging.
What temperature should medicines be stored at?
Always follow the storage instructions supplied with the individual product.
UK Health Security Agency guidance states that most medicines should be kept below 25°C. They should usually be stored somewhere cool and dry, away from direct sunlight and windowsills.
Some medicines require refrigeration, but this does not apply to every product. A refrigerator is not an automatic solution after a hot day. Medicines should only be refrigerated when their specific instructions require it, because inappropriate refrigeration can also affect product stability.
Which products can be affected by heat?
The Medicines and Healthcare products Regulatory Agency warns that excessive heat can affect a range of medicines and medical devices, including:
- tablets and capsules;
- inhalers;
- hormone patches;
- insulin;
- adrenaline auto-injectors;
- some liquid medicines; and
- blood glucose meters and test strips.
Heat may break down active ingredients or affect the performance of a device. A medicine may then be less reliable when it is needed.
Changes in colour, smell, texture or general appearance are reasons to seek pharmacy advice. However, care services should follow their temperature-excursion process rather than relying only upon a visual check.
What should care staff do after a temperature excursion?
A temperature excursion occurs when a medicine has been stored outside its permitted range. The significance depends upon the particular product, the temperature reached and the length of exposure.
If a storage limit may have been exceeded:
- Pause before administering the affected medicine.
- Follow the organisation's medicines policy and temperature-excursion procedure.
- Check the manufacturer's instructions on the packaging and patient information leaflet.
- Separate or quarantine the product when required by local policy, clearly preventing accidental use.
- Record the concern and the known storage conditions.
- Seek advice from a pharmacist, medicines lead or other appropriate healthcare professional before deciding whether the medicine can still be used.
Do not discard medicines, alter doses or stop prescribed treatment without appropriate advice.
Storage is only part of the heat-related risk
Hot weather can also change how the body responds to some medicines. Dehydration may increase the risk of dizziness, low blood pressure, falls, electrolyte disturbance or medicine accumulation.
The NHS Specialist Pharmacy Service advises against routinely stopping medicines during hot weather. People should generally continue prescribed treatment, remain hydrated unless a fluid restriction has been advised, keep cool and follow the storage requirements for their medicines and devices.
Anyone becoming unwell should receive an appropriate assessment rather than having symptoms automatically attributed to the weather.
What should care providers review?
Providers may wish to check that:
- room thermometers are working and temperatures are recorded when required;
- staff know the action to take when permitted storage limits are exceeded;
- medicines are positioned away from direct sunlight and windowsills;
- medicines carried during domiciliary visits are not left in hot vehicles or bags;
- refrigerator items are monitored separately and correctly; and
- staff know whom to contact for timely pharmacy advice.
These are small operational checks, but they protect against medicines being administered when their quality or effectiveness is uncertain.
Medicines safety starts before the drug round
Safe administration is not limited to selecting the right medicine, dose, person, route and time. It also depends upon the medicine having been stored correctly before it reaches the person receiving it.
After an unusually hot period, taking a moment to review storage records and raise concerns is part of safe, accountable care.
Safe Skills Training
Safe Skills Training provides practical medicines-management education for staff working in residential, domiciliary and other care settings.
To discuss training for your organisation, visit:
https://www.safeskillstraining.com
SOURCES
UKHSA: Heat-Health Alert action card for health and social care providers
https://www.gov.uk/guidance/heat-health-alert-action-card-for-health-and-social-care-providers
MHRA: Don't let this heatwave affect your medicines
https://www.gov.uk/government/news/dont-let-this-heatwave-affect-your-medicines-three-important-tips-from-the-mhra
NHS Specialist Pharmacy Service: Heatwaves and medicines
https://sps.nhs.uk/articles/heatwaves-and-medicines-assessing-and-managing-patient-risk/