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Fentanyl patch & witnessing

Specializes in Critical Care, Quality Imp, Education.

Hello

My facility does not require a 2nd RN to sign off when a fentanyl patch is removed and wasted. An RN today was surprised that this was the case and said everywhere she has worked, the removal of the patch needed to be witnessed. What are other facilities policies on this?

Thanks

nursenatalie, ADN, RN

Specializes in Surgical.

We have to witness waste with another nurse. Form comes with patch, we must cut patch in two and put in sharps container.

Hello

My facility does not require a 2nd RN to sign off when a fentanyl patch is removed and wasted. An RN today was surprised that this was the case and said everywhere she has worked, the removal of the patch needed to be witnessed. What are other facilities policies on this?

Thanks

Maybe that RN doesn't realize that fentanyl is a Schedule II drug. I work at a pain management clinic and we prescribe it all the time. Always make sure to tell your patients to stay away from heat sources (a heating pad placed over a fentanyl patch can kill a person). I had a patient last week who went to the beach with the patch exposed. Needless to say, he got all of his medication during a few short hours. Since he had been on opiates for years, he didn't OD. Unfortunately for him, the next 2 days he wasn't getting any drug and started going through withdrawal! Also, tell them to never cut the patch. It's okay to cut the backing, but never the patch. When I have a patient who is getting sick from the patch, I have them cut the BACKING in half and that way they are only getting half the medication.

Also, fentanyl lozenges/lollipops are very dangerous. I make sure my patients with kids keep those things under lock and key. They are loaded with sugar and would make a tasty treat for a little kid, but would kill them. Also, warn your patients to be careful filling Schedule II scripts. We have had people robbed while leaving the pharmacy. Oxycontin & fentanyl have a very high street value.

Actually my last job did not require that we had someone sign when changing patches. We flushed it down the toilet which probably isnt the best thing to do but I generally always told my patients to do this. That way you know a child or pet will not come into contact with it. Also as the above poster said people will do anything to get ahold of this medication. If somehow they found out this was in someone's trash they very well may break in and rob them.

Even a used patch has a significant amount of medication in it so I think it would be good policy to have someone witness the wasted patch.

vamedic4, EMT-P

Specializes in Peds Cardiology, Peds Neuro, PICU, IV Jedi.

It is not a good idea to cut those patches in half...get some on your hands and you could be in a bit of trouble. Flushing them down the toilet is a much better option, as is putting them in a sharps container.

vamedic4

Working all night

We have a container to waste meds in, cannot waste things in the sharps box or down the sink or in the toilet.

fgoff

Specializes in ER, Teaching, HH, CM, QC, OB, LTC.

Where I work we must have a witness to the flushing, & they must sign the control sheet.

We have a container to waste meds in, cannot waste things in the sharps box or down the sink or in the toilet.

Huh? That container must be worth a fortune! Who empties the container and do they drive a Mercedes?

I've worked in several different places and have not ever seen any policy of wasting the patches. There is little to no medication left in the patch when it is taken off so I've never seen a need.

jmgrn65, RN

Specializes in cardiac/critical care/ informatics.

we don't need a witness to change patches, we are to throw away in a sharps container or flush it.

needs to be discarded then signed for by 2 nurses.

leslie

indigo girl

Specializes in Too many to list.

It depends on where you work. In RI, never was an issue although in one facility I worked in as agency, you had to check with the on-coming nurse that each patient had their patch on. In CT, two nurses have to sign off when wasting. Not so, in Maine...I think it matters if there has been a problem highlighted in your state.

I am the only licensed person in our facility at noc - and it's my job to change patches, so I don't have anyone to waste them with.

I worked as a hospital surveyor/regulator for my state and the Feds for several years, and investigated a death due to acute fentanyl overdose on an inpatient psych unit a few years ago. In the course of doing the investigation and research necessary to resolve the case, I learned that the Federal DEA and my state DEA (and probably your state DEA, too) expect used fentanyl patches to be handled like any other partially used dose of a narcotic -- wasted/destroyed with the disposal witnessed/documented by two nurses. There is still a significant amount of fentanyl gel in the patch when you peel it off someone after three days, and a high potential for diversion and abuse. The patches (even used ones) are enormously popular with recreational and addicted narcotics users.

My state DEA office told me that the DEA rules (for hospitals and other healthcare facilities, that is, not private homes) require that the patches 1) be destroyed by cutting them in half and flushing them down a toilet (cutting so that the remaining gel will be diluted/washed out of the patch), the preferred method, or, if the local water authority objects to the hospital doing that, 2) storing them in a locked container to await removal and incineration by an authorized/regulated firm -- and specifically stated that the DEA does not consider a sharps box to be a "locked container" that is sufficiently secure for this purpose.

The hospital in which I was investigating the death got into serious trouble with CMS and the DEA because a psych patient died of an acute fentanyl overdose on the psych unit in the hospital and the hospital couldn't prove that the patient didn't have easy access to used patches, because they couldn't demonstrate that they were adequately controlling the used patches (patches were being used on several patients on the psych unit at the time of the death, so there were used patches "floating around" the unit) according to the rules/regs and accepted standards of practice.

indigo girl

Specializes in Too many to list.

I worked as a hospital surveyor/regulator for my state and the Feds for several years, and investigated a death due to acute fentanyl overdose on an inpatient psych unit a few years ago. In the course of doing the investigation and research necessary to resolve the case, I learned that the Federal DEA and my state DEA (and probably your state DEA, too) expect used fentanyl patches to be handled like any other partially used dose of a narcotic -- wasted/destroyed with the disposal witnessed/documented by two nurses. There is still a significant amount of fentanyl gel in the patch when you peel it off someone after three days, and a high potential for diversion and abuse. The patches (even used ones) are enormously popular with recreational and addicted narcotics users.

My state DEA office told me that the DEA rules (for hospitals and other healthcare facilities, that is, not private homes) require that the patches 1) be destroyed by cutting them in half and flushing them down a toilet (cutting so that the remaining gel will be diluted/washed out of the patch), the preferred method, or, if the local water authority objects to the hospital doing that, 2) storing them in a locked container to await removal and incineration by an authorized/regulated firm -- and specifically stated that the DEA does not consider a sharps box to be a "locked container" that is sufficiently secure for this purpose.

The hospital in which I was investigating the death got into serious trouble with CMS and the DEA because a psych patient died of an acute fentanyl overdose on the psych unit in the hospital and the hospital couldn't prove that the patient didn't have easy access to used patches, because they couldn't demonstrate that they were adequately controlling the used patches (patches were being used on several patients on the psych unit at the time of the death, so there were used patches "floating around" the unit) according to the rules/regs and accepted standards of practice.

That's interesting. The facility I work in most, and have seen patches wasted, where do we waste them? In the sharps box, no cutting, just throw them in.

My state DEA office told me that the DEA rules (for hospitals and other healthcare facilities, that is, not private homes) require that the patches 1) be destroyed by cutting them in half and flushing them down a toilet (cutting so that the remaining gel will be diluted/washed out of the patch), the preferred method, or, if the local water authority objects to the hospital doing that, 2) storing them in a locked container to await removal and incineration by an authorized/regulated firm -- and specifically stated that the DEA does not consider a sharps box to be a "locked container" that is sufficiently secure for this purpose.

Is it just me or does this not sound right? Why would the DEA demand that a new narcotic patch be kept under double lock, but then announce a used one, with significant potency, only be kept under single lock container? Do the nurses have to count off the used patches at shift end? And are there firms out there that actually charge to incinerate these patches? Is this a scam or what?

Call me old fashioned, but I prefer the old flush twice method. I am sure the wastewater treatment facility in my town is not concerned about a few pieces of plastic causing a problem?

Over the past two weeks I found one patient biting and licking his fentanyl arm patch (then told me it was defective and needed a new one), another patient kept asking for a hot pack for lower back pain (guess where those hot packs ended up) I documented and educated on each instance. These patches work well but do create problems on the floors.

Huh? That container must be worth a fortune! Who empties the container and do they drive a Mercedes?

It's taken care of by EVS like the sharps boxes and is destroyed as contaminated waste. Impossible to get into, like the sharps containers. It's for any amount of pourable/usable medications. The sharps containers are for sharps only, and meds can't be wasted in any sink or toilet because of contamination of the sewage system (like it's not already contaminated???). If we pull narcs out of a vial then the wasted amount can be left in the vial and tossed in this container. If it's from a glass ampule then the entire amount is to be drawn up, the excess squirted into this container instead of down the sink (not easy!), and the ampule tossed in the sharps box.

This is per OSHA.

And are there firms out there that actually charge to incinerate these patches? Is this a scam or what?

Call me old fashioned, but I prefer the old flush twice method. I am sure the wastewater treatment facility in my town is not concerned about a few pieces of plastic causing a problem?

I was referring not to firms that specialize in incinerating fentanyl patches, but the firms that are licensed/regulated to incinerate "regular" hospital biohazard waste -- every hospital has a contract with a firm that regularly hauls away all their biohazard waste and burns it in accordance (we hope!) with EPA standards, and gets paid by the hospital to do so. (That's why hospitals always make a fuss about wanting everyone to be sure that only "real" biohazard trash (not regular, ordinary trash) goes in the biohazard containers -- becaue they pay by the pound to have that stuff specially handled and disposed of).

Like you, the DEA prefers the "cut 'n flush" method of disposal, as I noted, but the DEA official I spoke to did say that the water authorities in some communities object to this -- because of the fentanyl going into the water supply, not because of the "pieces of plastic" -- and, if that is the case for a particular hospital, then it is also acceptable to store the used patches in an "inaccessible" locked container to await incineration.

vamedic4, EMT-P

Specializes in Peds Cardiology, Peds Neuro, PICU, IV Jedi.

I've worked in several different places and have not ever seen any policy of wasting the patches. There is little to no medication left in the patch when it is taken off so I've never seen a need.

This is absolutely not the case...depending on how often you are changing patches. And as I posted before, if you are NOT on LT narcotic therapy, getting ANY of this med on your hand could spell disaster for you. Typically these are, of course, given to chronic pain patients at high dosages...please be careful when handling this medicine.:nono:

vamedic4

1:1 again :wink2:

I work in a substance abuse facility & when someone comes in with a patch on I have my tech watch me remove & waste it- it's not required but you know the saying -CYA!

-Sara

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