Reapply a Fentanyl Patch?

Forever Sunshine, ASN, RN · May 9, 2011

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

Such as a fentanyl patch which is a controlled substance and is in the narcotic count.

Our order goes like this, it must be followed to a T.

Fentanyl Duragesic Patch 12.5 mcg/hr

Apply to skin. Change every 72 hours or as per MD order.

If another patch is needed before the 72 hour change.. an MD order is required. Again, this is my facility. Another facility might let a nurse just waste the old one and slap a new one one. But we would have to first get a doctors order to put a new one on.

CompleteUnknown · May 9, 2011

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.

Such as a fentanyl patch which is a controlled substance and is in the narcotic count.
Our order goes like this, it must be followed to a T.
Fentanyl Duragesic Patch 12.5 mcg/hr
Apply to skin. Change every 72 hours or as per MD order.
If another patch is needed before the 72 hour change.. an MD order is required. Again, this is my facility. Another facility might let a nurse just waste the old one and slap a new one one. But we would have to first get a doctors order to put a new one on.

It seems a bit like fiddling while Rome burns to be still talking about this, it's not really a big deal in the whole scheme of things but it's just one more example of how our jobs are being made harder all the time. Who needs to be phoning doctors for things like this when you've got a million other more important things to do?

It's never been suggested that an order is needed for this where I work, and even if the order was written as it is in dajulieness's facility I still wouldn't interpret that to mean I'd need an order to replace a patch that has fallen off. It sounds like the general instructions from pharmacy or the manufacturer more than anything.

For the people who need an order, do you know why that is? If it's something to do with trying to prevent possible abuse or controlling costs it doesn't seem like an effective way of going about it.

morte, LPN, LVN · May 9, 2011

It seems a bit like fiddling while Rome burns to be still talking about this, it's not really a big deal in the whole scheme of things but it's just one more example of how our jobs are being made harder all the time. Who needs to be phoning doctors for things like this when you've got a million other more important things to do?
It's never been suggested that an order is needed for this where I work, and even if the order was written as it is in dajulieness's facility I still wouldn't interpret that to mean I'd need an order to replace a patch that has fallen off. It sounds like the general instructions from pharmacy or the manufacturer more than anything.
For the people who need an order, do you know why that is? If it's something to do with trying to prevent possible abuse or controlling costs it doesn't seem like an effective way of going about it.

. yup.

Forever Sunshine, ASN, RN · May 10, 2011

It seems a bit like fiddling while Rome burns to be still talking about this, it's not really a big deal in the whole scheme of things but it's just one more example of how our jobs are being made harder all the time. Who needs to be phoning doctors for things like this when you've got a million other more important things to do?
It's never been suggested that an order is needed for this where I work, and even if the order was written as it is in dajulieness's facility I still wouldn't interpret that to mean I'd need an order to replace a patch that has fallen off. It sounds like the general instructions from pharmacy or the manufacturer more than anything.
For the people who need an order, do you know why that is? If it's something to do with trying to prevent possible abuse or controlling costs it doesn't seem like an effective way of going about it.

To prevent possible abuse.

People are that desperate for drugs that they will use a patch thats been on someone elses skin for 3 days.

AtomicWoman · May 10, 2011

To prevent possible abuse.
People are that desperate for drugs that they will use a patch thats been on someone elses skin for 3 days.

Not only will they use it, they will eat the gel inside to get the residual drug all at once. :eek: Google it and you can see all kinds of "how to" discussions. Barf. At my former facility, we had to put used Fentanyl patches in the sharps container.

CompleteUnknown · May 10, 2011

Not only will they use it, they will eat the gel inside to get the residual drug all at once. Google it and you can see all kinds of "how to" discussions. Barf. At my former facility, we had to put used Fentanyl patches in the sharps container.

Yes I realise that, although I think it's a bit harder to get at the drug in that way since they changed the formulation away from the gel type patch. We put our used patches in the sharps too.

Just saying I don't think making the staff call the doctor before replacing a patch that's fallen off is an effective way of preventing or addressing possible abuse. The controlled drug register or pharmacy records will show if patches are 'falling off' frequently.

morte, LPN, LVN · May 10, 2011

Yes I realise that, although I think it's a bit harder to get at the drug in that way since they changed the formulation away from the gel type patch. We put our used patches in the sharps too.
Just saying I don't think making the staff call the doctor before replacing a patch that's fallen off is an effective way of preventing or addressing possible abuse. The controlled drug register or pharmacy records will show if patches are 'falling off' frequently.

Bingo!

thehipcrip · May 10, 2011

Regardless of whether a patch that has fallen off is reapplied with an occlusive dressing or a new patch is used, it should be placed in the same location as the one that came off.

If the patch is placed in a new location, the patient will have to wait for a new skin depot of the drug to form before the medication is released into their system, causing a break in pain relief.

Source: Medscape News

flashpoint · May 11, 2011

Once they have fallen off and been put back on, do they adhere well enough to receive appropriate amounts of the medication? That would be my biggest concern with putting the old one back on.

I never knew about reapplying the patch in the same place...thanks for posting that!

blessedbe5 · Feb 4, 2012

I have only skimmed replies, but as a long-time pain patient, I can tell you any effort to tape down or reglue, etc., a patch that has come off is completely useless, both for generic and brand name, gel or plastic patch. Once that initial bond is broken, taping it next to skin will not help, the meds will not absorb. And let me tell you...it is agony when it happens and the patch is pretty new, and no one will help get an extra so you can go ahead and apply the new one early. You may be ok from meds in system from that or previous patches, but the gap in time will make a difference, and at some point the old meds will be out of the pt system while the new patch is waiting to be applied or even work.

DookieMeisterRN · Feb 5, 2012

When I worked in LTC an MD order would be needed to reapply a new patch if the old one fell off prior to the change date so insurance would pay for the extra dose. Pharmacy only sends exactly what a resident will need. If you use an extra patch than the facility will have to pay unless you have an order.

Either way, if you can't replace the patch you need to call for an order (in a LTC) don't leave it for the next shift to get around to since the resident could be without the correct pain meds and technically that would be an error. It's not right to substitute more than an hour or so with different meds for pain when there are specific orders.

Please OP, next time just call the doc right away, they get paid to take weekend call and would YOU like to be in that bed unable to have adequate pain control?

Frankie Slade · Feb 11, 2012

Don't let this nurse drag you down. You did what you thought was best for the patient. This nurse should have more patients with you because you are a new grad. Never forget this experience, because, someday you'll be a seasoned nurse and can help and encourage a new grad. Nurses eat their own because most nurses are unhappy and really don't like themselves. Lets turn this around by helping each more, and being more understanding instead on being judgmental. We are all part of the human race. Let's always make it about the patient. If nurses are good to each other, then that will always be good for the patient.