The current shortage of suxamethonium has triggered discussion around best practice in the safe storage and usage of refrigerated medicine stocks.
Prior to beginning a day’s list, operating theatre staff gather medicines that may be needed throughout the day, including those that normally require refrigeration between 2–8oC, such as rocuronium and suxamethonium. All medicines, including refrigerated items, then remain at room temperature until used, or the theatre is closed.
It may be tempting to assume that a ‘few’ hours unrefrigerated wouldn’t significantly affect a product that has one to two years remaining before expiry. However, returning stock to the refrigerator without a documented history, especially if repeated, may compromise the reliability of the entire supply. Those hospitals who guarantee the quality of medicines for every new list by disposing of unused ampoules each evening are now considering alternative systems that ensure each ampoule can be fully used.
Healthcare workers are familiar with the guideline that insulin vials may be stored at room temperature (up to 25oC) for one month. However, it is less well known that similar information is available for other products, or that manufacturers may be able to provide reports on the stability of medicines when stored in conditions not compliant with their product information. For example, the product information for Esmeron® (rocuronium) advises that unused vials may be stored at room temperature for 12 weeks, whereas suxamethonium has been shown to be stable at temperatures up to 25oC for three months.
HPS Pharmacies recommend clients who remove medicines from refrigeration with the intent of non-immediate use should affix a label with the date of removal, and discard any product not used within the known duration of stability as advised by a reputable resource.
Information regarding expected dates for supply may vary subject to delays which are out of our control. HPS Pharmacies does not accept responsibility for such changes but will endeavour to keep our clients updated as information is made available from drug manufacturers or wholesalers.