Reapply a Fentanyl Patch? - page 3

by wifeandmomoftwo

20,368 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
    Quote from dajulieness
    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.
    Sigh. Every day there's another ridiculous rule isn't there? Sometimes I wonder why any of us are still able to face going to work........
    tyvin likes this.
  2. 1
    I would have taped it back on as well, with clear tape so it is still visible as to what it is. You never want to cover it, so its not visible. This puts the patient at risk for that patch not being removed. I once saw someone do something like this but with a nicotine patch. they put a dressing over it. (Good intentions...) but i couldnt find the patch to remove it. I looked back on the MAR to see where the nurse who put it on charted the location. (we can look back and see the site it was placed on).
    It would be much much worse if this were a pain patch as there is potential for overdose.
    So clear tape would have done the trick. As long as the medicated padded part is touching the patients skin they are getting it.
    chelynn likes this.
  3. 2
    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..\
    Yes, this. I would have just put on a new patch and changed the MAR to reflect the change. My facility does not require an order for this. If the facility policy really did want an order for this I'd just call the on-call and get the order, end of story.
    chelynn and wooh like this.
  4. 1
    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?
    morte likes this.
  5. 1
    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.
    chelynn likes this.
  6. 0
    Quote from casi
    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.
  7. 1
    Quote from prinsessa
    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?
    CompleteUnknown likes this.
  8. 1
    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.
    TDCHIM likes this.
  9. 0
    I always place an opsite patch over fentanyl patches. They are too darned expensive and easily come off during baths.
  10. 4
    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.


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