Covering up Medication Patches

[Turtle in scrubs]

Hello friends,

Just wanted to get your take on how you handle medication patches that won't stay on, or get missed when they should be taken off.

I find with nitroglycerin, fentanyl patches, etc. they often get lost. Either lost on the patient, or lost off the patient. Meaning they should be taken off, but are left on because they are not seen, or you go to take on off, but can't find it... not knowing how long it may have been off.

I've been told to never totally cover medication patches because it can cause them to heat up and increase the rate of absorption. Others say tagederm is ok because the patch can breathe through this. I've also seen covers come with some patches. Personally I have taken to getting about a 2 inch piece of silk tape and writing the med and date on it, then taping it to about 1/3 of the patch itself. My pharmacy seems to think this is ok, but recently I had a doc question it. I like it b/c you can't miss it, and it does help hold the patch on, but doesn't cover it completely.

Just seeing if there are any better, safer, ideas out there.

Thanks!

[BrandonLPN, LPN]

What gets me is that we are told once we initial patch placement verification in the MAR, we are responsible for it for that shift. So day shift and I check Mary Sue's patch together when i come in at 3pm. At 11pm the night nurse and I check again and the patch is missing. Now, according to management, this is narcotic diversion on my part same as if a norco were missing from the narc box. Seriously? Nothing else could have happened in the last eight hours? It could have fallen off. She could have peeled it off. Grandson could have taken it off for all I know. Am I supposed to keep Mary Sue next to me all shift to watch? I refuse to take responsibility for patches residents wear. I'm only "responsible" for it for the 5 seconds I looked at it at shift change.

[pfongk]

We cover it with basically the adhesive part of primapore (I've had a blank on what it's called) we cut a hole in the middle so you can see the name on the patch then we date the adhesive stuff.

[turnforthenurse, MSN, NP]

Tegaderm or tape.

Patch location should be documented, but that doesn't always mean the nurse pays attention to that. I've come on to see patients with two NTG patches because the nurse before me forgot to take the old one off before applying the new one...thankfully the patient was okay but if it was something like a Fentanyl patch??? I personally like to pass off in report where a medication patch is located if a patient has one. Patients don't always know where they are.

[prinsessa]

We use tegaderm. It drives me crazy when someone applies a patch and doesn't document where they applied it or when. We even have a spot on our eMAR for notes. And the note will stay at the top of the MAR until someone else edits the note (we use EPIC). There have been quite a few times that I don't know a patient has a fentanyl patch until the patient tells me or I actually see it on the patient. So dangerous!