Fentanyl patch & witnessing - page 3

Hello My facility does not require a 2nd RN to sign off when a fentanyl patch is removed and wasted. An RN today was surprised that this was the case and said everywhere she has worked, the... Read More

  1. Visit  elkpark profile page
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    I worked as a hospital surveyor/regulator for my state and the Feds for several years, and investigated a death due to acute fentanyl overdose on an inpatient psych unit a few years ago. In the course of doing the investigation and research necessary to resolve the case, I learned that the Federal DEA and my state DEA (and probably your state DEA, too) expect used fentanyl patches to be handled like any other partially used dose of a narcotic -- wasted/destroyed with the disposal witnessed/documented by two nurses. There is still a significant amount of fentanyl gel in the patch when you peel it off someone after three days, and a high potential for diversion and abuse. The patches (even used ones) are enormously popular with recreational and addicted narcotics users.

    My state DEA office told me that the DEA rules (for hospitals and other healthcare facilities, that is, not private homes) require that the patches 1) be destroyed by cutting them in half and flushing them down a toilet (cutting so that the remaining gel will be diluted/washed out of the patch), the preferred method, or, if the local water authority objects to the hospital doing that, 2) storing them in a locked container to await removal and incineration by an authorized/regulated firm -- and specifically stated that the DEA does not consider a sharps box to be a "locked container" that is sufficiently secure for this purpose.

    The hospital in which I was investigating the death got into serious trouble with CMS and the DEA because a psych patient died of an acute fentanyl overdose on the psych unit in the hospital and the hospital couldn't prove that the patient didn't have easy access to used patches, because they couldn't demonstrate that they were adequately controlling the used patches (patches were being used on several patients on the psych unit at the time of the death, so there were used patches "floating around" the unit) according to the rules/regs and accepted standards of practice.
  2. Visit  indigo girl profile page
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    Quote from elkpark
    I worked as a hospital surveyor/regulator for my state and the Feds for several years, and investigated a death due to acute fentanyl overdose on an inpatient psych unit a few years ago. In the course of doing the investigation and research necessary to resolve the case, I learned that the Federal DEA and my state DEA (and probably your state DEA, too) expect used fentanyl patches to be handled like any other partially used dose of a narcotic -- wasted/destroyed with the disposal witnessed/documented by two nurses. There is still a significant amount of fentanyl gel in the patch when you peel it off someone after three days, and a high potential for diversion and abuse. The patches (even used ones) are enormously popular with recreational and addicted narcotics users.

    My state DEA office told me that the DEA rules (for hospitals and other healthcare facilities, that is, not private homes) require that the patches 1) be destroyed by cutting them in half and flushing them down a toilet (cutting so that the remaining gel will be diluted/washed out of the patch), the preferred method, or, if the local water authority objects to the hospital doing that, 2) storing them in a locked container to await removal and incineration by an authorized/regulated firm -- and specifically stated that the DEA does not consider a sharps box to be a "locked container" that is sufficiently secure for this purpose.

    The hospital in which I was investigating the death got into serious trouble with CMS and the DEA because a psych patient died of an acute fentanyl overdose on the psych unit in the hospital and the hospital couldn't prove that the patient didn't have easy access to used patches, because they couldn't demonstrate that they were adequately controlling the used patches (patches were being used on several patients on the psych unit at the time of the death, so there were used patches "floating around" the unit) according to the rules/regs and accepted standards of practice.
    That's interesting. The facility I work in most, and have seen patches wasted, where do we waste them? In the sharps box, no cutting, just throw them in.
  3. Visit  barbyann profile page
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    Quote from elkpark

    My state DEA office told me that the DEA rules (for hospitals and other healthcare facilities, that is, not private homes) require that the patches 1) be destroyed by cutting them in half and flushing them down a toilet (cutting so that the remaining gel will be diluted/washed out of the patch), the preferred method, or, if the local water authority objects to the hospital doing that, 2) storing them in a locked container to await removal and incineration by an authorized/regulated firm -- and specifically stated that the DEA does not consider a sharps box to be a "locked container" that is sufficiently secure for this purpose.
    Is it just me or does this not sound right? Why would the DEA demand that a new narcotic patch be kept under double lock, but then announce a used one, with significant potency, only be kept under single lock container? Do the nurses have to count off the used patches at shift end? And are there firms out there that actually charge to incinerate these patches? Is this a scam or what?

    Call me old fashioned, but I prefer the old flush twice method. I am sure the wastewater treatment facility in my town is not concerned about a few pieces of plastic causing a problem?

    Over the past two weeks I found one patient biting and licking his fentanyl arm patch (then told me it was defective and needed a new one), another patient kept asking for a hot pack for lower back pain (guess where those hot packs ended up) I documented and educated on each instance. These patches work well but do create problems on the floors.
  4. Visit  TazziRN profile page
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    Quote from barbyann
    Huh? That container must be worth a fortune! Who empties the container and do they drive a Mercedes?
    It's taken care of by EVS like the sharps boxes and is destroyed as contaminated waste. Impossible to get into, like the sharps containers. It's for any amount of pourable/usable medications. The sharps containers are for sharps only, and meds can't be wasted in any sink or toilet because of contamination of the sewage system (like it's not already contaminated???). If we pull narcs out of a vial then the wasted amount can be left in the vial and tossed in this container. If it's from a glass ampule then the entire amount is to be drawn up, the excess squirted into this container instead of down the sink (not easy!), and the ampule tossed in the sharps box.

    This is per OSHA.
  5. Visit  elkpark profile page
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    Quote from barbyann
    And are there firms out there that actually charge to incinerate these patches? Is this a scam or what?

    Call me old fashioned, but I prefer the old flush twice method. I am sure the wastewater treatment facility in my town is not concerned about a few pieces of plastic causing a problem?
    I was referring not to firms that specialize in incinerating fentanyl patches, but the firms that are licensed/regulated to incinerate "regular" hospital biohazard waste -- every hospital has a contract with a firm that regularly hauls away all their biohazard waste and burns it in accordance (we hope!) with EPA standards, and gets paid by the hospital to do so. (That's why hospitals always make a fuss about wanting everyone to be sure that only "real" biohazard trash (not regular, ordinary trash) goes in the biohazard containers -- becaue they pay by the pound to have that stuff specially handled and disposed of).

    Like you, the DEA prefers the "cut 'n flush" method of disposal, as I noted, but the DEA official I spoke to did say that the water authorities in some communities object to this -- because of the fentanyl going into the water supply, not because of the "pieces of plastic" -- and, if that is the case for a particular hospital, then it is also acceptable to store the used patches in an "inaccessible" locked container to await incineration.
  6. Visit  vamedic4 profile page
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    Quote from doodlemom
    I've worked in several different places and have not ever seen any policy of wasting the patches. There is little to no medication left in the patch when it is taken off so I've never seen a need.

    This is absolutely not the case...depending on how often you are changing patches. And as I posted before, if you are NOT on LT narcotic therapy, getting ANY of this med on your hand could spell disaster for you. Typically these are, of course, given to chronic pain patients at high dosages...please be careful when handling this medicine.

    vamedic4
    1:1 again :wink2:
  7. Visit  Saralyn profile page
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    I work in a substance abuse facility & when someone comes in with a patch on I have my tech watch me remove & waste it- it's not required but you know the saying -CYA!

    -Sara
  8. Visit  barbyann profile page
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    Quote from elkpark

    Like you, the DEA prefers the "cut 'n flush" method of disposal, as I noted, but the DEA official I spoke to did say that the water authorities in some communities object to this -- because of the fentanyl going into the water supply, not because of the "pieces of plastic" -- and, if that is the case for a particular hospital, then it is also acceptable to store the used patches in an "inaccessible" locked container to await incineration.
    I realize you have all the experience in this area but it just sounds crazy. When flushing fentanyl does it not become so diluted that it is inert? Why on earth would any water authority not want fentanyl to mix with raw sewage?
  9. Visit  TazziRN profile page
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    Are you sure about the DEA's preference for disposing of patches? That's why we have the med waste boxes, because of the DEA and OSHA.
  10. Visit  lsyorke profile page
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    Our last JCAHO survey(2005) the "correct" answer to the disposal of a fentanyl patch was to flush it. We don't have to witness a disposal.
  11. Visit  SitcomNurse profile page
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    It has come to the attention of NYS that people are hoarding the used patches and in conjunction, taking the "leftovers". Ew. Our facility has strict rules on placing and removal, we must check for placement every shift, and witness the disposal. We put it right in the sharps, as this is a locked unit that is destroyed. We dont put it in a seperate container, as anyone could walk away with that container, and consider it yummy.
    Any normal way of disposing of a narcotic drug is acceptable, we just opted for the sharps. And the patches must be written on when you place them, so you dont put an old one on, say its new and take a walk.
    And this is all written into the policy. I think thats why there are differences, it depends on your policy. Flushing, tossing, cutting... all policy issues. I dont believe there is a mandate on how it is destroyed/disposed of, so long as it is.
    Hope this helps.
  12. Visit  TheCommuter profile page
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    Quote from gtmoore
    My facility does not require a 2nd RN to sign off when a fentanyl patch is removed and wasted. An RN today was surprised that this was the case and said everywhere she has worked, the removal of the patch needed to be witnessed. What are other facilities policies on this?
    I'm an LVN at a large long term care facility. I am permitted to remove and waste used Fentanyl pain patches without another nurse having to witness the act. Usually I just throw the used patches in the regular wastebasket with the rest of the garbage.

    When applying a new Fentanyl patch to someone's chest wall, I always sign and date the patch.


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