Lady keeps "losing her pain patches"

loriangel14, RN · Mar 5, 2015

Yes. I ways put a big clear Tegaderm over the oatches to keep them in place. I would let the MD know this is happening.

llg, PhD, RN · Mar 5, 2015

Is it possible that someone (e.g. other staff member or visitor) is taking them?

BloomNurseRN, ASN, BSN, RN · Mar 5, 2015

Is she A&Ox3? Is it possible she's taking them off and forgetting? I usually put them on the shoulder blade area to prevent patients from pulling them off if they are not oriented. I also use a large Tegaderm to keep the small patches under control, so to speak.

I would also give a lot of thought and consideration to the possibility that someone is diverting. It being the same patient and such a high dosage, as far as patches go, would give me pause as far as someone taking it.

heron, ASN, RN · Mar 5, 2015

The three day duration is not written in stone. She could be trying to manage breakthrough pain in the last day of her current patch. This does not equal abuse. If staff are too rigid to consider that her pain may not be well managed, preferring instead to accuse her of "seeking" in the pejorative sense of the term, then lying about losing the patch may be her only alternative to get her pain treated.

Why is she on the patch to begin with and could that condition be worsening?

How long has she been on the 100mcg dose and could she have developed tolerance?

Direct care staff could be diverting it right off her back ... it's happened a lot and that's why, in one facility, we had to cut old patches into a sharps container with a witness. Who supervises her showers or does direct care? Do the med nurses have to document that they actually visualized the patch qshift? Is she selling them to staff or visitors?

I know that we're supposed to be nice about all this, but without more information - which could be a problem d/t HIPAA - there's no way to think the question through. To jump from a resident who regularly asks for early medication directly to the assumption of abuse, with no other information, is some mighty sloppy thinking.

bluegeegoo2, LPN · Mar 5, 2015

Some time ago we had a resident whose patch came up missing frequently. Q shift checks were implemented, which only helped to determine that it was gone. After a short time, we figured out that they kept getting pulled off into her clothing. We then started to either tegaderm or mefix them and haven't had that problem since. We also always place them on her back out of her reach, just in case.

NutmeggeRN, BSN · Mar 5, 2015

We have to visualize the patch @ shift change and document, both incoming and off going nurse. No one leaves until the narc book is reconciled. Is it possible that family is taking it?

Blackcat99 · Mar 5, 2015

Thanks to all for your comments. When she first start using the pain patch she would allow us to tape it down(no tegaderm available) and she didn't have any problems with it. However, for the past 2 weeks, she has been refusing the tape stating "I don't need it" despite the fact that she is losing it. She is also on narcotic pain pills and she takes these pills every 4 hours on the dot. She is a younger resident and is alert and oriented. We put it on her back. She doesn't have any visitors or family. We are going to call the doctor today and report the situation.

BloomNurseRN, ASN, BSN, RN · Mar 5, 2015

Thanks to all for your comments. When she first start using the pain patch she would allow us to tape it down(no tegaderm available) and she didn't have any problems with it. However, for the past 2 weeks, she has been refusing the tape stating "I don't need it" despite the fact that she is losing it. She is also on narcotic pain pills and she takes these pills every 4 hours on the dot. She is a younger resident and is alert and oriented. We put it on her back. She doesn't have any visitors or family. We are going to call the doctor today and report the situation.

Yeah, with those details it definitely seems like something else is going on. If she is oriented, then she could tell you if someone else was taking it. Definitely something to make sure her doctor is aware of.

icuRNmaggie, BSN, RN · Mar 5, 2015

Please consider that is nearly impossible to keep any kind of patch, or EKG lead, on a patient who has used body wash bath products or some of the disposable bath cloths. I also use a biocclusive dressing over the patch to help it stay in place.

trinitymaster · Mar 5, 2015

Thanks to all for your comments. When she first start using the pain patch she would allow us to tape it down(no tegaderm available) and she didn't have any problems with it. However, for the past 2 weeks, she has been refusing the tape stating "I don't need it" despite the fact that she is losing it. She is also on narcotic pain pills and she takes these pills every 4 hours on the dot. She is a younger resident and is alert and oriented. We put it on her back. She doesn't have any visitors or family. We are going to call the doctor today and report the situation.

These details should have been included in your initial post:

My AN assessment is past IV drug user who is removing the patch and using it in a non-prescribed manner. Although you said that she has no visitors, it is possible that she is trading the patch for street drugs.

heron, ASN, RN · Mar 6, 2015

You still haven't mentioned any reassessment of her pain or the condition causing it. Google "pseudo-addiction".