Going that ‘last mile’

“Cold chain at the local pharmacy level: the real ‘last mile’ of distribution. ...We need to ‘get it right’ now,” says James Soucey, director of clinical services, Wal-Mart Specialty Pharmacy.

Soucey thinks that this part of the pharmaceutical cold chain is the point where a break in adequate temperature is most likely to occur. Inadequate temperature control could cause adverse patient responses to a product or adulterated product that could lead to increased legal exposure and a more hostile regulatory environment.

Soucey’s comments came during the 5th Annual Cold Chain Distribution for Pharmaceuticals event held Sept. 10 - 13 at the Pennsylvania Convention Center in Philadelphia.That “last mile” to the patient is the subject of an increased focus at Thomas Jefferson University Hospital in Philadelphia, where I had the opportunity to tour in-hospital pharmacy operations during my recent visit for the “Cold Chain” event. For years, this progressive hospital has used automated machinery to fill unit-dose prescriptions for patients. Unlike retail pharmacies, where scripts are often dispensed in multiple doses—say for a montly prescription—hospital patient doses change daily, sometimes several times a day.

Thomas Jefferson’s bar-code system for verifying that the right unit-dose scripts get to the right patients at the right times was impressive. Still, the hospital plans to upgrade its “last-mile” distribution to better track meds going from a nurse’s station or cart to the patient. The in-hospital pharmacies, which are located on different floors, maintain refrigerators whose contents are typically packaged in an assortment of cartons, bottles, vials, and pouches. Interestingly, I was told that while the volume of “cold chain” pharmaceuticalsor biopharmaceuticals used at
the hospital is modest in number, their financial value
is sizeable.