Missing Duragesic Patch, where is it??

[Party-of-Five-NY]

Hello,

I am a new grad going through a 10 week orientation at an inner city hospital medical teaching floor.

While passing my 2 pm meds, my patient's MAR had a "location check" for her pain patch. Well, I searched her back, then her arms and chest, and it was nowhere to be found. I asked the patient about it, and she said that the night nurse checked it, and it was there, on her back. OK, so where did it go??? I looked in the bathroom, and all through her bed and gown, it was done.

My preceptor just went and got another, and we both had to sign that the patch was "wasted", AND noted in the MAR that the patch was unable to be located.

Is this OK??? I don't feel that this is right. Shouldn't there be an incident report for this kind of thing?? What if another patient, or an aide, or another nurse took it???? I just don't know how the patch disappeared.

I'd love some feedback on this. Am I just being overly suspicious? Please help.

[Party-of-Five-NY]

Thanks everyone for your help and input. I really felt like there should have been an incident report done, especially since the nurse's aide was in the room, and repeatedly said that the patches come off easily, and because i did not see the patch being "wasted".

Anyway, I don't want to "rock the boat", being new on the floor, but I also want my license for "years to come", so I guess I'll get another opinion from our charge nurse, without causing a problem for the preceptor.

Thanks again.

[BabyRN2Be]

Anyway, I don't want to "rock the boat", being new on the floor, but I also want my license for "years to come", so I guess I'll get another opinion from our charge nurse, without causing a problem for the preceptor.

Thanks again.

I believe that's a good idea. I know the feeling of not wanting to "rock the boat", but you've worked hard for that license. Check with the charge nurse and see what can be done now, and what should be done in the future.

[Antikigirl, ASN, RN]

This happened quite freqently at the ALF I use to work for (we had 140-160 residents and this pain control was the latest rage...LOL!). What we did was consider it missing after looking for it, alerting housekeeping to keep an eye for it (in case it was in linens), and such. It was documented in their charts, and a mark was placed (little star) next to the signed MAR spot, and on the reverse side explained the situation (like a PRN explanation).

The reason we came up with this is because it happened all the time, and an IR every time was beyond unreasonable because of the time it took to complete one. We started just doing med error forms but this wasn't a true med error...so that didn't work well either.

At the end of the month, we had people that came in at NOC shift and went through all the MAR's looking for missing signatures (this was protocol every month) so we had them tally stars while they were looking through the MAR anyway. Then the tally was reviewed by Nursing staff and investigated.

Only once did anything pop up. We found out that one lady who was wearing one on her knee actually was taking them off and hording them for her more painful days. She would also take the old ones out of the trash and tried to re-use them! SO just a little advice to look for...we took ours out of the room to dispose of after we found out this. Sad thing...many a caregiver/nurse was written up for a missing patch (as if they didn't give it) before this was found !

Other than her, that was about it...all others were gone innocently that we can see (like in linens, found some in recliner crevices, under furnature from being kicked by a scooting walker/elderly, or in clothes.). Or residents found them off and threw them away or in the toliet and forgot they had.