Duragesic patches

[leonurse]

Are there any tricks for securing duragesic patches on pts who perspire excessively, or so that they will not get lost after showering, etc? Being that they are narcotics, they freak me out when they go missing. I have secured them with tape, but I have heard that this isn't supposed to be done....? This does seem to help, but this has become a pain in my rear. I hate when they go missing.

[jjensen]

You can put a tegaderm on the patches too...

[txspadequeenRN, BSN, RN]

i have always used op-sites .....

[Pepper The Cat, BSN, RN]

We use tegaderm.

[NurseStephRN]

would applying no-sting barrier wipe prior to applying the duragesic affect the absorption of the med? idk... i haven't had the problem... what i do find is several duragesic patches on the patient, because the previous one hasn't been removed!

[GLORIAmunchkin72]

They are a pain! For one thing some of them are so small they blend with the skin and become almost invisible; whatever writing was on them are gone because of either sponge baths or showers or whatever...and we are told we cannot use Tegaderm or similar products to secure them because it would be an 'inappropriate' use of such products but thank God we're allowed to use plain paper tape as a last resort. We've had people being accused and let go because of missing fentanyl patches and I'm always wondering if it's rightfully so. They do come off and sometimes residents peel them off because 'it itches'.

[canoehead, BSN, RN]

we cannot use Tegaderm or similar products to secure them because it would be an 'inappropriate' use of such products

Pray tell, what is an appropriate use? We've ruled out providing appropriate drug coverage, and protecting your employees' reputations and licenses. What exactly could be more important and beneficial? Maybe you could Tegaderm a$$holes shut so the stick up there doesn't damage the good furniture.

[GLORIAmunchkin72]

Beats me! I call it 'nitpicking'.

[ghillbert, MSN, NP]

Tegaderm for sure

[CT Pixie, BSN, RN]

Op-site was what we used with one resident who's patch would always be found in the bed linens. This resident would sweat profusly and the patch would slide down to an area it wasn't placed or it would just come off the residents body totally. We have used tegaderms also.

We would place the patch, then skin-prep the area around it and place an op-site over it. Worked wonders, never again did the patch travel to other areas or come off completely.

To NurseStephRN, I don't think I'd want to skin prep the area that the duragesic patch will be placed, whether or not it would alter the medication delivery I honestly don't know, but I'd rather not take that chance. I found skin-preping the area around works fine.

[Not_A_Hat_Person, RN]

We prep the area with a Skin-prep wipe (the sticky kind), attach the patch, then put a tegaderm over the patch. We still lost some patches in the shower, but we lost fewer.

We also changed one resident's shower schedule to coincide with her patch removal schedule.

[melsch]

We have been told not to use tegaderm because the skin warms up under the tegaderm and increases the rate the medication is absorbed. I am told this is a manufactor recomendation. We use paper tape around the edges. We do use tegaderm under the patch if we want a half dose of the patch.