Fentanyl patch

[nrsbetrn]

What is your policy or protocol for making sure Fentanyl patches stay on the resident? Do your nurses check every shift and sign off that the patch is still on the resident? Do you cover with a cosmopore dressing? What have you found that works? We have drug tested randomly when a patch is missing. We have found patches in dirty linen and in the shower stalls after showers. What works?

[NutmeggeRN, BSN]

Shift to shift check and sign off....then we flush the used ones....beyond me why they cannot go in a sharps container instead of contaminating the ground water.

[bluegeegoo2, LPN]

Visual check each shift and chart placement. (Which I think is an interesting "fix" to the problem. If the next shift were to remove it, they could easily say that it wasn't there which would make it appear that either I lied about placement or they did. I think that nurses should do "patch rounds" so that both can verify placement. No room for silliness that way.) Patch is usually covered with a Tegaderm. We also have to make sure CNA's know not to remove them for showers, which has happened. We have also found them rolled up inside clothing.

[Nascar nurse, ASN, RN]

FDA recommends disposing of used patches by folding them in half with the sticky sides together, and then flushing them down a toilet. They should not be placed in the household trash where children or pets can find them.

FDA recognizes that there are environmental concerns about flushing medicines down the toilet. However, FDA believes that the risk associated with accidental exposure to this strong narcotic medicine outweighs any potential risk associated with disposal by flushing. When the patches are no longer needed, disposing by flushing completely eliminates the risk of harm to people in the home.

FDA has included fentanyl patches on a list of medicines that should be flushed down a toilet because they could be especially harmful, and possibly fatal, in a single dose if used by someone other than the person for whom the medicine was prescribed.

http://www.fda.gov/forconsumers/consumerupdates/ucm300803.htm

Although this particular article deals with a private home situation, the FDA guidelines for all situations are that many narcotics are to be flushed.

[LadyFree28, BSN, LPN, RN]

FDA recommends disposing of used patches by folding them in half with the sticky sides together, and then flushing them down a toilet. They should not be placed in the household trash where children or pets can find them.

FDA recognizes that there are environmental concerns about flushing medicines down the toilet. However, FDA believes that the risk associated with accidental exposure to this strong narcotic medicine outweighs any potential risk associated with disposal by flushing. When the patches are no longer needed, disposing by flushing completely eliminates the risk of harm to people in the home.

FDA has included fentanyl patches on a list of medicines that should be flushed down a toilet because they could be especially harmful, and possibly fatal, in a single dose if used by someone other than the person for whom the medicine was prescribed.

http://www.fda.gov/forconsumers/consumerupdates/ucm300803.htm

Although this particular article deals with a private home situation, the FDA guidelines for all situations are that many narcotics are to be flushed.

This is how my facility disposes the used fentanyl patches.

If the clear barrier that comes with the patch isn't effective, maybe a tegaderm can help; usually the clear barrier works for my patients.

[CapeCodMermaid, RN]

We have two nurses sign off during narcotic count that they observed an intact patch on the resident. We occasionally have them go missing in the linen or in the shower. If the person is very sweaty or plays with the patch we use a tegaderm. We don't flush anything. We put them sticky side together in the sharps container.

When we destroy narcotics, we melt the tablets in hot water, mix in some Thick-It, and throw the whole thing in the trash.

[rn824]

We cover ours with tegaderm. Each shift has to sign off on placement. when removing we need to have another RN watch you disgard in the sharps container and both sign the narcotics log

[Cleake]

We have to check Q shift and sign oncoming shift and also both nurses have to sign patch when applied. We've had them come off a lot and find them in clothing and bed. If I'm not mistaken when I first started there were issues when we attempted to use tegaderm to place over to ensure it stayed on. State did not approve of this.

[CapeCodMermaid, RN]

The manufacturer of the Duragesic patch will send you clear coverings for the patch. The State can approve or not, but if it's from the manufacturer and in your policy, you're fine.

[pfongk]

Ours are covered with an adhesive dressing similar to the sticky stuff on primapore (blank on name sorry) with a hole cut in the middle so we can see what type of patch it is and the dressing is dated with when the patch was applied. The patch is then checked every shift by the incoming and outgoing RN/EEN

[LTCRN4LIFE]

Cover with Tegaderm, "Patch Check" at change of shift by 2 Nurses and it is documented.