1. John Lloyd
  2. systèmes d'information sur la vaccination
  3. jeudi 19 mai 2016

It's a mystery to me, considering that manual temperature monitoring of vaccine stores using monthly charts and glass thermometers was the first MIS achievement of the EPI in the last 4 years of the 1970s - yet the first Remote Temperature Monitoring (RTM) studies were 10 years ago and only a handful of countries have implemented RTM today. The benefits of the manual monitoring in 1976 were simple, clear and motivating. Those of the RTM should be even more enticing. Temperature recording is automatic and does not suffer from low compliance and inaccuracy. Supervision dashboards can post the problems in realtime, enabling oversight to be timely and constructive. Repair technicians could be equipped with diagnostic tools to respond to SOS calls based on data on failure modes, ask Nexleaf and PATH. Supervisors will be able to track areas and stores that are strong or weak in vaccines and equipment care. And managers will be equipped to base the selection of new equipment models for procurement, on those that actually perform the best.


So, if the technology has arrived, where is the implementation? The CCE Optimization Platform expresses RTM as a 'required upgrade’ to the WHO, minimal monitoring norm; I see it as the way to achieve a step-change towards safer, more efficient vaccine supply chain (SC). In a word, improved oversight of the supply chain will enable vaccines to be used to the limits of thier stability.:



  • to interest the countries, they should be presented the ‘big-picture’ benefits of supervision oversight

  • to do this, program managers meetings could allow presentations and consultants could be trained

  • financing to scale up the effort should be sought for the whole region - otherwise, it will be too slow!

  • RTM planning templates could help quantify the costs and training burden fast, with just enough data

  • present/brief/train consultants now working in the region


Now, what do you say? Isn't RTM the first step towards 'end-to-end' supply chain monitoring? Importance = HIGH?

Margot Terrell-Jenkins Réponse acceptée

Remote temperature monitoring (RTM) is available and has become an integral part of the cold chain management process for many of our Australian customers. Where RTM is enabled, remote temperature monitoring is possible for multiple small, medium and large facilities, geographically distributed across regions/states. RTM enables a supervisory level to have a total picture of cold chain management for a group of facilities as well as providing the ability to drill down to specific facilities for detailed temperature data.

We have been implementing RTM via Temp°Track™ for years in large research labs, warehouses, medical facilities and hospitals. The benefits far exceed the benefits of manual monitoring:

  1. Automated monitoring and alerting 24/7 with viewing of temperature data and alerts at both local level and supervisory level on or off site, ensuring accuracy and compliance.
  2. Diagnostic and problem solving can be initiated (or followed up) by the supervisory level.
  3. At a minimum there is a good “overview” of temperatures and alarm conditions for every facility or store.
  4. Online floor plans can be used to remotely view the various sites and temperature status by local and/or supervisory level
  5. Reporting can be initiated at the local and/or supervisory level
  6. All temperature data is stored in a comprehensive database so data can be retrieved at any time by multiple sites when RTM is enabled. This historical data is beneficial for quality audits and compliance.

Whilst ownership and accountability at the local level are very important and an integral part of ensuring good cold chain management, supervisory oversight can provide additional benefits:

  1. Early corrective action to prevent and minimise wastage, not withstanding ownership at the local level also initiating corrective action
  2. Improvement in the quality of vaccine programs
  3. Assisting in accurately forecasting vaccine levels/needs across all facilities
  4. Enhances communication between the facility and the supervisory level
  5. Potentially provides a means to remotely further educate on immunisation processes for remote communities. This increases staff skill and confidence in managing the vaccine cold chain process.
  6. Where direct patient care is imperative, the RTM technology can take care of monitoring vaccines, 24/7, while staff can focus on direct patient care.

We see this dual responsibility for cold chain management working effectively where RTM is installed. Implementation of RTM is straightforward and available at low cost. The server software is hosted on a central pc server with the remote client software installed on multiple pcs connected to the server. RTM makes the cold chain management process robust particularly with the option of tailoring the use of RTM to internal processes defining local and supervisory level responsibilities.

 

Margot Terrell-Jenkins

Director
Temp°Track™ Systems Australia
margotterrell-jenkins@e2eit.com.au,temptrack.com.au

Prashant Réponse acceptée

RTM is a good tool however I too completely endorse that ownership & accountability are critical for its success unlike any other existing or new technology. Motivation along with proper training & people with right attitute once involved can also make this technology too successful, however if not than despite temperature escalation on RTM if the concern ground staff does not reacts as expected than it is as good as manual recorder.

Also I belief that Operational cost of any intervention once exceeds the product cost (Vaccines) than scaling such technolgy at multi State level or even National level needs to be carefully evaluated by a third party auditor to access cost benefit or social return on investment as such initiatives seeks surplus & consistent Financial resources.

Unlike other parts across the Globe where RTM is getting utilised, in India too RTM is being piloted in few States since 2014 with an in-house RTM product developed & supported by a Call centre concept.

prabirkc Réponse acceptée

Have a picture of a walk in cooler at 8.3 degrees. The temperature monitor has a USB download system apparently. This is a demonstration from a field trip of what Kshem is saying- data needs to be looked at, technology sometimes adds lots of data, but we need to make sure that action is taken on time. (The problem here has been rectified- but this may be happening elsewhere too)

Pièces jointes

I would like to comment that training of managers is key! We are currently having problems with health workers monitoring temperatures during weekends and public holidays. The current fridge tags have also their problems and some health workers still miss the original dial and stem thermometers which were very unreliable. I personally think the RTM devices will be ideal as many supervisors will be alerted in case of any temperature excursions. In Zimbabwe, all HFs have access to a network service and are used to rapid data reporting as part of IDSR. We are currently seeking for support for RTM for our nationwide on-going installation of SDD refrigerators, supported by ELMA, UNICEF and ECONET.

Kshem Prasad Réponse acceptée

I wish to add on to the concerns shared by Karan Singh Sagar. one comes across situations of RTMDs installed through franchisee services, where no EPI staff was trained, nor any documents left with them. As a result, the device has been operating in a passive mode for the last 2 years. Suchissues of documentation and training should be taken care through the procurement contractual terms. Putting a HW/ store manager at ease with his instruments and process is the essential to ensure his continuing to use them regularly as required.

Further if the RMTD is to be used regularly by the national staff, the data needs to be easy to retrieve, read and analyse rapidly. I recently came across the RMTD which stores 32 days of data that can be retrieved on an USB pen drive. However, each of these 32 days is a separate file with 48 measurements in the 24 hours. This is very impractical and I cannot imagine a supervisor or manager having the patience to go through each of the file.

The Manufacturers need to be told to provide simple excel table and graph that make analysis easy and rapid. Many times the data is provided in pdf format, making it difficult to handle for further use.

prevenir98 Réponse acceptée

Good afternoon everyone: Monitoring the temperature of vaccines alone can have complications, the ideal procedure is combining the suitable refrigeration equipment enabling alone have spaces of time sufficient for the preservation of the safe temperature vaccines (hold over) and parallel monitoring process that allows for prudent actions in case of accidents cold chain. I commented, I have a system that allows access via internet at any time and from anywhere in the world and that every 15 minutes send data packets reporting the following characteristics: opening doors, voltage, temperature and variations and if power outage, alarms, etc. This work with a patented system that won the prize of Science and Technology and Innovation in the state of Jalisco in Mexico, is currently running as a pilot project in six states (Mexico), with important results and allowing vaccination may be a greater success by extreme component quality control.

Dr. Francisco Jose Anaya Eguiarte. Guadalajara Mexico

Dr. Karan Singh Sagar Réponse acceptée

RTM is an important technology and it's use will certainly drive better vaccine management but as with any technology, this also does not lend itself to automatic action. The managers, workers need to be trained, supervised and motivated to use it. In the field, I have seen many occasions when the temperature loggers, freeze tags have been put in the equipment and still the workers don't care about using them because no one trained them, their supervisors don't ask them about it. The lack of ownership and accountability has to be addressed before scale up of these technologies or else we will be investing a lot of money but will not be getting the value for money.

Claire Frijs-Madsen Réponse acceptée

Hi John,

I fully agree with you that RTM has a huge potential in easing the whole process of temperature surveillance and that it cannot be installed fast enough at all central and regional stores. As you state “Temperature recording is automatic and does not suffer from low compliance and inaccuracy”. However, the installation of RTM systems is not enough in itself to protect the vaccines. It still requires a system of surveillance processes and accountabilities. RTM also can suffer from non-compliance. Even though the technology is there to automatically monitor the temperature in cold storage and send SMS alerts, SOMEBODY needs to react and take appropriate measures in case of temperature excursions and the RTM system needs to be maintained.

There have been instances of sites who have experienced vaccine looses due to temperature excursions even though an RTM system had been installed. Either the parameters for alarms were too strict which led to the system showing too many alarms (so people just stopped paying attention) or the person responsible for the monitoring of the system changed and the replacement did not have the same abilities and motivation.

I have been working for UNICEF on a website on temperature monitoring (to be hosted on Technet-21 and released very shortly) and RTM represents a considerable chunk of the content of the website. It contains a lot of material as well as a step-by-step guidance on RTM implementation. It stresses the need for a good framework of well-defined roles and responsibilities, training and accountabilities. More about it shortly...



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