Fentanyl patch & witnessing

[gtmoore]

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 removal of the patch needed to be witnessed. What are other facilities policies on this?

Thanks

[nursenatalie, ADN, RN]

We have to witness waste with another nurse. Form comes with patch, we must cut patch in two and put in sharps container.

[Cyndee, MSN, NP]

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 removal of the patch needed to be witnessed. What are other facilities policies on this?

Thanks

Maybe that RN doesn't realize that fentanyl is a Schedule II drug. I work at a pain management clinic and we prescribe it all the time. Always make sure to tell your patients to stay away from heat sources (a heating pad placed over a fentanyl patch can kill a person). I had a patient last week who went to the beach with the patch exposed. Needless to say, he got all of his medication during a few short hours. Since he had been on opiates for years, he didn't OD. Unfortunately for him, the next 2 days he wasn't getting any drug and started going through withdrawal! Also, tell them to never cut the patch. It's okay to cut the backing, but never the patch. When I have a patient who is getting sick from the patch, I have them cut the BACKING in half and that way they are only getting half the medication.

Also, fentanyl lozenges/lollipops are very dangerous. I make sure my patients with kids keep those things under lock and key. They are loaded with sugar and would make a tasty treat for a little kid, but would kill them. Also, warn your patients to be careful filling Schedule II scripts. We have had people robbed while leaving the pharmacy. Oxycontin & fentanyl have a very high street value.

[Noryn]

Actually my last job did not require that we had someone sign when changing patches. We flushed it down the toilet which probably isnt the best thing to do but I generally always told my patients to do this. That way you know a child or pet will not come into contact with it. Also as the above poster said people will do anything to get ahold of this medication. If somehow they found out this was in someone's trash they very well may break in and rob them.

Even a used patch has a significant amount of medication in it so I think it would be good policy to have someone witness the wasted patch.

[vamedic4, EMT-P]

It is not a good idea to cut those patches in half...get some on your hands and you could be in a bit of trouble. Flushing them down the toilet is a much better option, as is putting them in a sharps container.

vamedic4

Working all night

[TazziRN, RN]

We have a container to waste meds in, cannot waste things in the sharps box or down the sink or in the toilet.

[fgoff]

Where I work we must have a witness to the flushing, & they must sign the control sheet.

[barbyann]

We have a container to waste meds in, cannot waste things in the sharps box or down the sink or in the toilet.

Huh? That container must be worth a fortune! Who empties the container and do they drive a Mercedes?

[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.

[jmgrn65, RN]

we don't need a witness to change patches, we are to throw away in a sharps container or flush it.

[leslie :-D]

needs to be discarded then signed for by 2 nurses.

leslie

[indigo girl]

It depends on where you work. In RI, never was an issue although in one facility I worked in as agency, you had to check with the on-coming nurse that each patient had their patch on. In CT, two nurses have to sign off when wasting. Not so, in Maine...I think it matters if there has been a problem highlighted in your state.