Reapply a Fentanyl Patch? - page 4

by wifeandmomoftwo 20,702 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. 0
    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.
    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.
  2. 0
    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.
  3. 4
    Fentanyl patches should only be taped along the edges or covered with a Tegaderm or Bioclusive:

    http://www.duragesic.com/sites/defau...ructions_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.
    dishes, imanedrn, rnmi2004, and 1 other like this.
  4. 2
    Quote from AtomicWoman
    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....
    loriangel14 and ktwlpn like this.
  5. 0
    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.
  6. 0
    Quote from imanedrn
    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.
  7. 0
    Quote from BabyLady
    ...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.
  8. 0
    Quote from tyvin
    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.
    Quote from dajulieness
    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.
  9. 0
    Quote from CompleteUnknown
    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.
  10. 0
    Quote from CompleteUnknown
    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.


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