Reapply a Fentanyl Patch?

Nurses Medications

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First of all sorry for the miss spelling. Just noticed and can't figure out how to edit that part :(

About 30 minutes before the end of my shift I had a CNA come to me and say "Ms. Smith's patch came off. I tried to stick it back on." I knew that it was her pain patch and went to check on it. It was just barely on there and had just been applied the day before. This particular patient has had this happen before but it was just before she was due a new patch anyway so we just gave her PRN pain pills for about 12 hours until time to reapply the patch. She didn't have nearly the quality of pain control she normal does though. Anyway, the resident was not currently experiencing discomfort and I could not get the patch to adhere. I put it in a zip lock bag for the oncoming nurse and charted about this incident. The oncoming nurse didn't look thrilled and said she was just going to tape it back on. This was suggested to me by another nurse but I didn't think it would work.

I'm just a new grad LPN. I've been working LTC on 11-7 for six months. Thought I could learn something from this experience. I would have called the MD myself and gotten an order to change the patch earlier but didn't have time with other meds due, narcotics to count, and report to give. Thanks :)

Specializes in LTC/Skilled Care/Rehab.

Maybe different facilities have different rules but at my facility insurance will only pay for so many patches a month. If we replace a fentanyl patch early there would be a few days that pharmacy wouldn't send another one because it is "reorder too soon". I would have just taped it back on.

Specializes in Intermediate care.
I too would have put on a new patch and changed the MAR to reflect the new schedule. I would think that falling off potentially change the effectiveness of the patch.

If your patient had an order for the duoderm to the butt to be changed q3days would you try to tape it back on if it fell off or would you get a new one?

Well if its on the butt...that's a different story. But i don't know of anyone that puts a fent. patch on the butt. :D

Maybe different facilities have different rules but at my facility insurance will only pay for so many patches a month. If we replace a fentanyl patch early there would be a few days that pharmacy wouldn't send another one because it is "reorder too soon". I would have just taped it back on.

What if one falls off and you can't find it? What if it falls off and you find it stuck on the bed sheets or rolled up in a ball or folded over stuck to itself? All these things have happened at my facility. I personally would not feel comfortable reapplying a patch that could be damaged or one that had been found stuck on something else. Do we really know if it still contains the correct amt. of medication and will still work properly to deliver the amt. of medication it's supposed to?

Specializes in Hospice Palliative Care.

I wouldn't put it back on either - I would have wasted it and put a new one on and changed the schedule to reflect this. I would be worried about how well it was being absorbed once it had been removed or fallen off. We would just replace it - but if you need a new Dr's order then that is what should have happened.

It is also our policy -from the manufacturer I believe - that we do not put tegaderm over the patches as they warm up from the body heat and it increases the absorbtion rate. We can use tape around the edges to secure it but we are not to completely cover it - even with clear tape. We do use tegaderm underneath it if we are making a 12.5 patch out of a 25mcg patch for example.

Specializes in LTC, Psych, Hospice.

I always place an opsite patch over fentanyl patches. They are too darned expensive and easily come off during baths.

Specializes in Hospice / Psych / RNAC.

Well sounds like the facility is supercalafragilistic uptight when it comes to the narcs. Like others, secure with clear drsg or change it. The changes are reflected in the narc count therefore pharmacy sends what's needed; well at least where I've worked.

A few years ago I was with another nurse and we were attending this hospice patient who was wearing a 100mcg patch. Well, the nurse had a replacement patch (she was changing the patch and had called me to the room) I saw her unwrap it, then she starts talking about how she doesn't' know how to put on the patches. During this time she took off the patch that was on the patient. So I'm like "OK; let me show you how you..." the patch is gone; no where to be seen. We looked everywhere and finally went and got another; documented as wasted and carried on.

Long story short the next day I was getting ready for work and yep you guessed it; the patch was on the bottom of my shoe. I have absolutely no idea how the patch got on my shoe but it was hilarious.

I am sorry that you and others (from what I've read) must call a doc for another order before actually putting on another patch. Nurses shouldn't have to do that at night or any other time. The med is a continuous release med and it stands that if a mistake is made or a patch falls off for whatever it needs to be replaced quickly.

It saddens me that facilities are not trusting and empowering licensed staff as they should and seem to be growing more suspicious and making more rules to monitor nurses. Not to make our jobs easier; but suspicion, as if there's no trust anymore. How about respect and honor; some good old fashion beliefs that we as nurses know what we're dong and can be trusted.

Specializes in ED/trauma.
....I have to state, I have an issue with this.

A patient's pain was not managed properly because nobody had time to attend to it and nobody wanted to wake the physician to get a new order?

Seriously, THAT is why physicians get paid the salaries that they do...if I need to wake them up for a legitimate reason, I wake them up...if they get mad, that falls under the category of too bad.

But why wake a physician for some basic critical thinking? I'm ALL FOR waking physicians when they need to get involved, but you don't need a new order for some tape. As a previous poster said, these patches are pretty fickle. Sometimes it's best to save the trouble and add tegaderm on top of every brand new patch.

My understanding is that they can not be reapplied, once off they need to be replaced with new.

and if a new order is needed, then get on. Where i have worked NO ONE has ever suggested that that was required.

Fentanyl patches should only be taped along the edges or covered with a Tegaderm or Bioclusive:

http://www.duragesic.com/sites/default/files/pdf/duragesic_patient_instructions_0.pdf

Manufacturer also recommends replacing a patch that has fallen off before the 72 hours are up with a fresh patch.

A couple 2AM phone calls, and the doctors will start writing admission orders that state, "Apply a new patch PRN patch falling off patient." :) Pity your facility won't let you use your nursing judgment for that.

Specializes in CCT.
Manufacturer also recommends replacing a patch that has fallen off before the 72 hours are up with a fresh patch.

Gee, the manufacturer recommends using more of their product? Ya don't say....:D

Specializes in Intermediate care.

I think it depends upon the situation as well. If its been on the floor, and you don't know how long its been there then clearly it should not go back on. You don't know how long its been off, if its even the correct one, if ts been stepped on, spilled water on etc.

But if you found it hanging on the skin, and you knew it was on 15 minutes ago when you did your assessment, then yea i would just tape around the edges.

I guess it would be up to the nurse to use their best judgement. I'm not saying the nurse in this situation was wrong, maybe she was correct. I dont think there is a clear cut answer since its so dependent upon the situation with this. Do i think she did something wrong??? Nope!! not at all.

Specializes in NICU, Post-partum.
But why wake a physician for some basic critical thinking? I'm ALL FOR waking physicians when they need to get involved, but you don't need a new order for some tape. As a previous poster said, these patches are pretty fickle. Sometimes it's best to save the trouble and add tegaderm on top of every brand new patch.

...you can use basic critical thinking unless your facility policy states you cannot for certain medications.

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