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I would also argue this is unsafe practice. How come the MD can not write a letter to the powers that be and explain the situation b/c this certainly seems odd that they will only pay for the drug in only selected strengths. I would write the order for the 25mcg but than request they dispense it in 2 12.5 mcg patch (might work). I agree with you that since Tegaderm does breath and can wick moisture from the skin and is semi-permeable there is the good chance the pt is getting some of that drug. Also what if a patient or caregiver decides to take the tegaderm off and stick the remainder to the skin or the tegaderm loosens with bathing or sweating and a portion off the supposed blocked off area sticks on the skin. I would not do this.....there has to be a better solution than this.
ABSOLUTELY NOT!!!!!!! Duragesic patches are made to dispense the medication transdermally over a period of time usually 72hrs. Cutting the patch will never ensure that the patient is getting the correct dosage. Also some duragesic manufacturers make the patches with the liquid medication visible in the patch and cutting it would release this med. The solution to the problem would be fill the RX for the 12.5 mcg patches. Apply 2 patches in the same area so as not to froget to remove them and change both at the same time. Cover the entire patches with the tegaderm to ensure that the patches do not fall off.
I worked in pharmacy for 15 years. Although the pharmacy can dispense 2 x 12.5mcg/hr boxes rather than 1 x 25, they must still bill for the product they are dispensing so that won't solve the insurance problem. The dr just needs to submit for prior authorization through the insurance company. That process is a pain but is usually successful.
Good luck!
You are correct that this is not a safe practice and you should not participate. If the doctor wants to assume responsibility for that...okay...but not on your license! As well, you must not cut the patches!
The entire issue of the physician ordering one thing and the insurance company deciding that they won't pay for that prescription is an excellent example of profit getting between doctors and patients. The insurance decision to refuse the 12mcg patches is based exclusively upon cost and profit and has nothing to do with what is safer or more appropriate for the patient.
We need health insurance reform to make this common situation very uncommon. Can you imagine anything more sickening than the pain management of an 8 year old being manipulated to insure the profits of the insurance company rather than to insure the safe provision of comfort for the child?!?
Kim Valentine, BSN, RN
3 Articles; 22 Posts
Recently a pediatric oncologist ordered 12.5mcg of durgesic on an 8 year old home care client of ours. This family is not covered for the 12.5mcg patch but is covered for the 25mcg patch. The oncologist ordered us to place half of the patch on tegaderm and half on the skin. I have a huge problem with this practice. Certainly tegaderm is permeable and could have absorption of some of the duragesic. I believe there is potential for overdose. According to this physcian, this is common practice in their clinic. Anyone else have experience with this?