Executive Forum Reviews Current State of Cold Chain Management in Health Systems

ASHP’s Executive Forum on Cold Chain Management convened virtually on April 19 to review the current state of pharmaceutical cold chain management in health systems. The event was the first in a series of executive forums on cold chain management and part of the ASHP Innovation Center’s efforts to influence innovation and digital transformation to advance the safe and effective use of medicines.

The importance of the pharmaceutical cold chain attracted the public’s attention as the need for wide distribution of COVID-19 vaccines became urgent in 2021.

“That need will continue as the number of products requiring cold chain storage and handling are predicted to grow almost twice as fast than non-cold chain products by 2024,” pointed out Richard Montgomery, contracts and operations manager-pharmacy for Advent Health and facilitator of the forum. “Additionally, the cost of lost pharmaceutical products due to cold chain deviations is estimated to be in excess of $15 billion per year. This is why this is such an important topic.”

Attendees included representatives from health systems, academic institutions, group purchasing organizations, wholesalers, and pharmaceutical manufacturers. Participants were tasked with identifying the current state of cold chain management, particularly as it has evolved during the pandemic, and how cold chain management affects health systems now and in the future. Participants noted that although their organizations made significant investments in cold chain infrastructure, the pandemic continues to stretch resources and showcases the importance of emergency preparedness.

Montgomery said cold chain management has implications for pharmacy design as well. “It’s not as simple as it used to be. Now we need to consider adequate storage capacity, integrated monitoring systems, and electrical circuits with non-interrupted service,” he said.

A major challenge identified at the forum was how to transport small quantities of products that require ultra-low temperature storage to remote locations. Attendees also discussed the need to standardize how temperature excursions are managed and to improve transparency across the cold chain to help identify sources of excursions.

Jason Chou, system assistant vice president of pharmacy operations at Ochsner Health System in New Orleans, Louisiana, said it’s imperative to identify and communicate about the source of the excursion.

“It’s critical to determine who is responsible when excursions occur. It’s an important conversation to keep having,” he said.

Forum participants also discussed emergencies or natural disasters that could disrupt product delivery or increase the likelihood of temperature deviations. Chou reviewed how Ochsner navigated cold chain management last year during Hurricane Ida, which ultimately caused $95 billion in damages to New Orleans and the surrounding regions.

“There are normal operations that are challenging, but weather events can be even more complicated,” explained Chou. “We went to a hub-and-spoke model, but intermittent power outages and transportation limitations became a challenge. We bought more freezers and put them in central locations and consolidated our cold chain storage. And even then we had generators fail, but luckily had backup systems. And don’t forget the challenges that follow, including getting into the cities after with downed power lines and closed streets. It’s not just the weather event itself.”

Meeting attendees consolidated a list of priorities and recommendations for cold chain management based on their experiences. Among the recommendations were:

• Ensure everyone in the chain is educated on procedures.
• Increase transparency and alignment across all stakeholders.
• Develop systems to accommodate additional efforts to maintain cold chain integrity.
• Continue investments in capabilities to serve under-resourced areas.

Attendees were also polled about their organization’s motivation for increasing their capacity for cold chain management. The top responses included risk mitigation and regulatory compliance and product integrity for the end user. But, as one participant stated, “the vaccines were such an important public health need” and “nobody wants to be that hospital who mismanaged their vaccines.”

A resource guide with recommendations for health systems and industry will be developed and available on the ASHP.org website. This series of executive forums is made possible with the generous support of Cold Chain Technologies.