Reapply a Fentanyl Patch?

  1. 0
    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
    Last edit by madwife2002 on May 8, '11

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  2. 50 Comments...

  3. 0
    Can you use adhesive spray to stick it back on? These patches come off so easily during washing and dressing.
  4. 4
    Of course, 30 mins before 11pm is when all the crap happens and they all must tell me at the same time. One CNA came up to me.. I kid you not.. 10:40pm. "ok so I hear a wheeze in her.. theres a sore on this one's sacrum and ." I'm like "its 10:40.. they are all breathing and alive.. please don't tell me these things 20 minutes before the end of the shift.. heres a treatment for Mary's bottom.. call it a freaking night"

    Each facility has a different policy on this. We would have to get another order to replace the patch. But since it was 12 hours until it was changed next.. I would have used tegaderm to keep it on. Just be glad the patch wasn't missing :x .
    prettymica, NurseLoveJoy88, tyvin, and 1 other like this.
  5. 8
    I would have taped it back on and called it a day.
  6. 2
    Is there some reason you just didn't apply a new patch?
    Fentanyl patches are time released - its not like you'd be overdosing her.
    NurseLoveJoy88 and tewdles like this.
  7. 1
    Quote from Pepper The Cat
    Is there some reason you just didn't apply a new patch?
    Fentanyl patches are time released - its not like you'd be overdosing her.
    Her orders state to change the patch only every three days. It hadn't even been 24 hours so a new order was needed to do that and I didn't have time to get one before I left. Oncoming nurse was reluctant to call that early in the morning on the weekend.
    lgail likes this.
  8. 15
    If it were me, I would've reapplied it by securing it w/ either a tegaderm or an opsite.
    lgail, turnforthenurseRN, tokmom, and 12 others like this.
  9. 0
    You could prep the skin with an alcohol wipe (let the alcohol completely dry), then tape on or secure with Tegaderm.
  10. 1
    Quote from jnrsmommy
    If it were me, I would've reapplied it by securing it w/ either a tegaderm or an opsite.
    Exactly what I was thinking. When I have had pts with issues getting patches to stay on I typically put a tegaderm or some sort of adhesive tape on it. If this has been a problem before for this pt you would think that the nurses would be experimenting with ways to keep it from continually falling off.
    canoehead likes this.
  11. 20
    Quote from wifeandmomoftwo
    Her orders state to change the patch only every three days. It hadn't even been 24 hours so a new order was needed to do that and I didn't have time to get one before I left. Oncoming nurse was reluctant to call that early in the morning on the weekend.
    ....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.
    NurseKatie08, Kidnurse1963, HHRN22, and 17 others like this.


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