Question about Fentanyl/Durogesic patches

I've found these patches can cause problems when first used, for those who have a low tolerance for them. I ahd one lady last week who suffered dizziness, nausea and vomiting. The symptomps disappeared when the patch was remove, and though the doc wanted to try half a patch, she said, "NO thank you!!"

Don't blame her! To get half a patch, you either put a Duoderm under half of it, or leave half the backing on, and tape it to secure it. HOWEVER....!!! We have been informed by the company that makes Duragesic that this is NOT a method of delivery that has been researched and tested and found to be safe.

So, until we can get some concrete data on the safety and effectiveness of this method, we have been told not to apply the patch this way. It's either a whole patch, or nothing.

It's a wonderful thing...with fewer side effects for the elderly folks.We check placement of the patch q shift and document this on the MAR.Have had a few patches that just would not stay put-anyone know if hypofix or op-site is contra-indicated? Out of our 3 staff docs only one is amenable to suggestions for good pain control.One doc is hesitant to prescribe any meds that will "depress respirations" and another just does not believe that people even have pain...As a consequence we have seen many residents suffer..The DON and the head of social services are both very anti-hospice. I was so hoping that this would be a focus during our last survey but it seems the surveyors were satisfied with what they saw...

Knew a nurse who ended up dead b/c she was self-medicating with used patches. Exactly how TNcanNurse said, she would take a syringe, remove the gel, & shoot up. What a way for a 15 year to find her mom, dead on the bathroom floor!

what would happen if someone would eat the contence offf 10 50mg durogesic patches? would that be leathal couse we had a patient who "tricked" us into beliving he was using them but he was only saving them for a suicide we found out later. But question is would he have made it if he would have swallowed it? Luckely a leaninglady found them in time.

Enox,
the nature of your question is sort of alarming.

Are you a nurse, nursing student, ect?

I'm going to just say that taking any medication other than the way it is intended can cause severe harm. Duragesic's delivery system (IMHO) leaves alot to be desired, and I would discourage altering the patch in any way shape form or fashion.

Dave

Even one 50mg Duragesic patch can be fatal in someone who has never used narcotic pain medicines before.

This drug is interended for transdermal (skin) slow sustained release. Anyone who tampers with the drug patch is at high risk of harming themselves and their loved ones.
It must be used by clients with adequate instruction and prescribed only by knowledgeable practitioners who monitor/evalute the clients pain response and side effects.

website:
http://www.duragesic.com

Fentanyl patches are a godsend to people with chronic pain, but, all of us out there that are administering them, PLEASE be aware that there is a high risk of diversion/abuse. The literature is full of articles nowadays. I am a surveyor/inspector for my state and for CMS (the Feds) and investigated a death on a psych unit in our state related to a patient who was abusing patches (cause of death was acute fentanyl toxicity) that were legitimately prescribed by the attending on the psych unit and administered by the nursing staff. The hospital ended up in serious trouble with the Feds because the person was dead and the nursing staff could not account for the used patches.

The preferred method of disposing of them is to cut them in half and flush the two halves, according to the DEA. That way, the gel is washed out and diluted. The other acceptable method is to secure the patch(es) in a tamper-proof container until they can be incinerated. Amazingly enough, a sharps container is NOT considered a tamper-proof container by my state DEA -- they need to be LOCKED UP somewhere ...

And, as another poster mentioned, a used patch should be handled the same as any other partially used dose of narcotics -- two people should witness and sign that it was wasted.

Isn't it SOP to check placement of the patch at least once a shift-or more frequently? It is even on our MAR-we do it and we sign it off...We have staff and residents that will pull of duragesic patches mistaking them for nitro patches...so we have to be vigilant..

In LTC they also have a tendency to fall off during normal care activites. I've gotten calls that houskeeping found them, they came off on a showerbed, even lost one on a strecher in the ambulance.

Patches not only need to be checked Qshift, they need to be marked so that some sort of identification can be made as to whom they belong.

-Dave