Reapply a Fentanyl Patch? - page 2

by wifeandmomoftwo 20,900 Views | 50 Comments

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... Read More


  1. 1
    we usually put tape over the duragesic patches, so that we would have a way to write on them the initial and date when applied. That, and it gave it more adhesive to make it stick.
    loriangel14 likes this.
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    Quote from CathyLew
    we usually put tape over the duragesic patches, so that we would have a way to write on them the initial and date when applied. That, and it gave it more adhesive to make it stick.
    Especially the 12 mcg/hr patches. They are so tiny.
  3. 0
    I used to sell Duragesic (Fentanyl) for J&J before it went generic.

    Not sure on the generic patch versus when it was branded, but that patch may no longer be effective.

    Patches do come off sometimes but should have been inspected for signs of being pulled off too.
  4. 12
    Quote from BabyLady
    ....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.
    The part I put in bold is the part I have a problem with!

    Seriously...the patient has an order to have a Duragesic patch on around the clock...if the current patch becomes unusable, put a new one on. I have never worked at a facility that required an order for that...I sort of understand the logic of requiring an order, but not really. I would make sure it was documented in the narcotic record why it was changed early, but I certainly wouldn't just leave it off and supplement with another form of pain control. If I had to get an order, I would get an order. Doctors are on call for a reason.
    Akeos, Kidnurse1963, TDCHIM, and 9 others like this.
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    I always put a Tegaderm (opsite)over patches so this doesn't happen.
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    Quote from cotjockey
    The part I put in bold is the part I have a problem with!

    Seriously...the patient has an order to have a Duragesic patch on around the clock...if the current patch becomes unusable, put a new one on. I have never worked at a facility that required an order for that...I sort of understand the logic of requiring an order, but not really. I would make sure it was documented in the narcotic record why it was changed early, but I certainly wouldn't just leave it off and supplement with another form of pain control. If I had to get an order, I would get an order. Doctors are on call for a reason.
    Not sure about this posters facility but with us in the order for the fentanyl patch.. part of it says to change the patch every 72 hours. To put another one on.. we have to call the MD and get a one time order to put a new patch on.
    Chin up likes this.
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    If a pt dropped a pill on the floor you would get a new one and give it -right?
    The patch fell off. Either re-apply or put a new one on. To let a pt go without pain medication does not seem right.
    If you had to call a doctor to do that, then that is what you should have done. How long would it have taken? I agree with the posters that state MDs are on call for a reason. If they have problems with being called about a patch falling off, then maybe you need to get a policy in place that you can replace the patch.
    Kidnurse1963, loriangel14, BabyLady, and 6 others like this.
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    This does happen sometimes. We just dispose of the patch that fell off, put a new one on, change the date when the patch is next due to be replaced, and document the reason for the early change.

    Not understanding why you would need an order to do this? Yes the order states change every 3 days but you're not giving a dose of pain relief every 3 days, you're giving the pain relief continuously and to do this you have to replace the patch after 3 days (because that's how long it lasts) or earlier if it falls off before then.
    Akeos, Kidnurse1963, loriangel14, and 5 others like this.
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    Quote from CompleteUnknown
    This does happen sometimes. We just dispose of the patch that fell off, put a new one on, change the date when the patch is next due to be replaced, and document the reason for the early change.

    Not understanding why you would need an order to do this? Yes the order states change every 3 days but you're not giving a dose of pain relief every 3 days, you're giving the pain relief continuously and to do this you have to replace the patch after 3 days (because that's how long it lasts) or earlier if it falls off before then.
    Decided by the powers that be. The powers that be where I work also decided that we have to waste the old patch..thats been on someones skin for 3 days..with an RN supervisor. Not another nurse that would be too convenient.
  10. 2
    Quote from wifeandmomoftwo
    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
    At our facility we have policy and procedures for everything. We would have taped it right back on. Since it's a continuous release med you don't want your resident to be without that patch at all. It can be difficult to get pain under control and keep it that way.
    The next lesson here is it does not matter what time it is or how close it is to the end of the shift when someone reports something to you it is your responsibilty to assess the situation.If you find the same cna's are doing this to you often then you need to discuss it with them.After all, they will be waving "goodbye" to you as you remain at the desk completing your tasks (after you notify your supervisor,of course)
    chelynn and wooh like this.


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