Do You Use Fentanyl Transdermal Patches Safely?

[NRSKarenRN, BSN, RN]

another great tip from dr brad truax @ patientsafetysolutions

“do you use fentanyl transdermal patches safely?”

in our june 28, 2011 patient safety tip of the week “long-acting and extended-release opioid dangers” we discussed potential dangers of a number of long-acting opiates. one of those was the fentanyl transdermal patch. while this opioid preparation has a very important role to play in patients with chronic pain who are opiate-tolerant, it is extremely dangerous when used in patients who are not opiate-tolerant and even has dangers in those who are.

the california department of public health recently released its summary of deficiencies and plans of correction for serious events occurring at california hospitals in 2010. one of those related to deficiencies in use of fentanyl transdermal patches in 7 patients at one hospital (cdph 2011). though that hospital apparently was fined as a result of the findings, we discuss the issue not in a punitive light but rather to point out that similar deficiencies likely exist in multiple healthcare organizations. we hope that the lessons learned will help all organizations take steps to ensure that these patches are utilized in a safe manner for appropriate patients.

the document identifies a common theme in most of the cases: the indications for use of the fentanyl transdermal patches were not documented, there was no pharmacist review of the orders for appropriateness or for establishing that the patient was opiate-tolerant, failure to document pain levels or response to medications, and the doses were often escalated without appropriate review. they review on a case-by-case basis what prior doses of opiates the patient would have had to been receiving to qualify as “opiate-tolerant”. they cite the fda alert about dangers of fentanyl transdermal patches and the manufacturer’s warnings in the package insert regarding use of the fentanyl transdermal patch in the elderly. they note that reduced fat stores, muscle wasting, and reduced elimination of the drug from the body increase the sensitivity of the elderly to the effects of fentanyl and that respiratory depression is the main hazard of this drug in the elderly....

[elkpark]

You have to be able to log in to the site to see the article ...

[catlvr]

Try this instead: the article is on the front page of the site at http://patientsafetysolutions.com

[NRSKarenRN, BSN, RN]

Fixed link.

I'll never forget finding patient who was opiate-naieve barely arousable when I visited him @ home. Checking meds found family MD had prescribed "that new fangled Duragesic 25ug patch for his back pain".

Doctor took my urgent phone call and late in-office visit where I educated him with written info our Hospice team had just received from drug rep and taught doc drug conversion scale.