GP cold chain audit results revealed

fridge cold chain medicines

An audit of GP practices in NSW has found that 33 out of the 44 potentially high-risk clinics examined did not meet vaccine storage standards

“NSW Health undertook an audit of 44 practices identified as potentially being at high risk of poor cold chain management,” a NSW Health spokesperson said.

This investigation took place after it was found that a practice run by two GPs in the Sydney suburb of Burwood had been improperly storing vaccines in its refrigerator, and the results of the audit have now been revealed.

The discovery, in June 2019, saw the Sydney Local Health District put a call out for thousands of patients who had been vaccinated at the practice of Drs Darrel and Brinda Weinman since 1 January 2010 to consider being revaccinated.

The vaccines they had been given might not have been effective, the organisation warned.

National Immunisation Program vaccines including the MMR, pertussis, hepatitis B and flu vaccines had been affected, with some being stored in a way which meant they had been kept too hot, or too cold.

Other vaccines were found to have been expired and the practice’s record-keeping to have been inconsistent.

As a result of NSW Health’s investigation of the 44 potentially high-risk practices, only one GP practice was required to recall patients, in July last year.

This practice, which was not accredited, was found to have administered potentially compromised vaccines to 816 patients.

NSW Health took measures to identify any other patients that may have been affected. Patients were followed up by the GP with assistance from the local Public Health Unit.

However, a total of 33 of the 44 practices investigated in the audit were found not to be meeting vaccine storage standards.

Of these, 20 are now compliant and the revaccination of patients was not required.

Eight of these practices have closed, including the non-accredited practice which administered the potentially compromised vaccines.

Another five are no longer providing immunisation services, and revaccination of patients was not required.

“The NSW Government is investing $130 million in the 2019-20 Immunisation Program budget, including Commonwealth and state vaccines,” the spokesperson said.

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  1. Geoffrey Timbs

    Wow! 75% failure rate in GP practices identified as high risk of poor cold chain management in NSW. With about 2700 practices in NSW only 1.6% have been examined by NSW Health and 1.2% failed.
    Raises lots of questions- how identified as at risk? How many that don’t meet ‘at risk’ criteria would also fail? What is the position in other States- already identified or another 100 practices that also fail and putting patient’s and community health in danger?
    When commenting on the Burwood case Dr Nespolon of RACGP found “this isolated incident regretful”. Clearly “isolated” is no longer appropriate and perhaps negligent and criminal should replace regretful….. time for the RACGP to identify how big the issue really is and implement processes to ensure patient safety as expected.

    • Jarrod McMaugh

      You last point is valid – RACGP does need to identify whether the issue is widespread… but the 75% failure rate isn’t applicable to the entire profession. The NSW department of Health identified practices that are likely to be high risk, so the high failure rate resulted in a selection bias.

      No need to tar them all with the same brush…. pharmacists receive that treatment all too often, we shouldn’t do the same.

      • Geoffrey Timbs

        Doesn’t change the fact that only 1.6% of NSW GP practices have been checked- many not considered by the Dept to be high risk (and thus not checked) may still have inadequate procedures.

        If 75% at high risk failed, how many practices were at moderate risk of poor cold chain practices and how many of those would fail? Logically if a high percentage of those at risk fail then you move on to check those at lesser risk because a percentage of those will also fail.A task for both RACGP and NSW Dept of Health to do more thorough assessments.

        I didn’t ‘tar all with the same brush’, just pointing out that a huge individual and public health issue has been identified first in Burwood then in another 33 other practices ie not isolated- the issue deserves thorough investigation, not just check a couple of percent of practices. People may erroneously believe they are vaccinated against MMR, pertussis, hepatitis B and flu vaccines- life threatening illnesses! also what other items requiring refrigeration were stored too hot or cold?

        It still also leaves the question of standards in other States and territories- 33 in NSW, how many Australia wide?

        • Jarrod McMaugh

          Well theres a few things to consider.

          First, it seems that they are escellating their investigations. They detected a small number of issues by chance, then developed a plan to assess others based on a criteria they developed… the use of fax machines flagged those surgeries as probably having less that up to date procedures.

          Since this has shown a relatively high number of poor compliance, it’s probable that the department is going further to look at other surgeries… but you would expect that as they broaden their criteria, there will be fewer breaches, especially among those who are accredited.

          I would also expect them to look at pharmacies too. Given that accreditation is far more complete for pharmacies than clinics, this would return far fewer breaches, but it may not be zero…

          It’s still worth pointing out that the population they examined has a selection bias in it…. the number of breaches in this population will be higher (as a percentage) than the total population… Probably by a large margin

          • Geoffrey Timbs

            NSW Health and federal Health have increased their cold chain requirements after the problem was identified in July 2019. The ‘Strive for 5’ requirements were introduced nationally and NSW Health says while it is not responsible for GPs it will be doing random audits of practices re cold chain procedures. Strive for 5 requires an annual self-audit. Rather than rely on the tenuous link that practices with fax machines may not have good cold chain procedures, the self audit could be downloaded to NSW Health and any red flags followed up.
            Re the point about selection bias, of course you would expect the failure rate to be much lower in all GP practices rather than 75% in the identified practices- zero should be the target but that is impossible to know without regular, systematic testing of all practices rather than relying on self-audits

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