Medication Refrigerator Temperature Log printable pdf download

MEDICATION REFRIGERATOR TEMPERATURE LOG

Milwaukee, Wisconsin

Department __________________________________ Month________ Year_______

MEDICATION REFRIGERATOR - Acceptable Range (36°F to 46°F)

Location within department _______________________________________________

°F

Min. Temp.

°F

Current Temp.

Acceptable range (36°F to -46F)

°F

Max. Temp.

Within Acceptable Range

Yes / No (Y /N)

Reset Thermometer

Yes / No (Y /N)

INITIALS

Signature

Initial

Signature

Initial

Signature

Initial

Signature

Grid

A new log is obtained from the Aurora Net at the beginning of each month to ensure the most current form is utilized.

This log is used to record temperatures of medication refrigerators that are used to store patient medication. This is done on a daily basis.

Please see below for instructions on using the log and what to do if the temperature is out of range. There should be entry for each day of the month.

USING THE LOG:

Enter your department, location within the department, month and year at top of page.

Read the thermometer inside the unit immediately after opening the door. Record the Maximum, Current, and Minimum temperature of the unit on a daily

basis in the box indicated for that day of month. Indicate whether temperatures were within the acceptable range by listing yes or no daily. Also, indicate that you reset the

thermometer by listing yes or no daily.

Place your initials in the "Initials" square for that day. Place your initials with your signature in the signature grid if you have not done so this month.

If temperatures are outside the acceptable range notify Plant Operation, your department Supervisor/Manager/Designee, and contact a pharmacist before documenting the

actions taken. A Pharmacist will determine the safety of the contents of the refrigerator. Do not use contents until safety of the contents is approved by appropriate personnel.

Managers / Supervisors must review medication refrigerator log monthly and document this review before archiving the monthly log. At a minimum, this review will: assess for

proper completion of form, review min/max documentation to assure daily resetting, assess for proper actions for out of range temps, and assure proper utilization of form.

Completed log should be retained by the respective department for 18 months.

Use this Section to document problems and actions taken. List the name, date, problem and action taken for daily entry.

______________________________________________________________________________________________________________________________________________________________________________

Manager/Supervisor Signatures of review: _________________________________________________________ Date: ____________________________________

AHC X23472 .j (12/04)