75 mcg Fentanyl patch a day early on lethargic patient?

Published

Specializes in NICU, Peds, Med-Surg.

Hello.....I am VERY curious what others will say about this....!!!

I went to put a new 75mcg Fentanyl patch on a new admit who was LETHARGIC, (ordered Q 3 days) but realized the one she already had on from her previous facility wasn't due to be changed for another day.... so, to me it was OBVIOUS not to put the new one on....

A nurse practitioner, pharmacist , AND my supervisor said it would have been FINE to put the new one on a day early, which surprized me! And I have to add that they ALL told me "as long as you had removed the old one"....okay, I KNEW that already!!!:banghead:

(**ALL my coworkers agreed they would NOT have put the new one on!!!**)

I still CANNOT believe that the pharmacist even seemed mad at the MONEY it cost when I wasted the patch.....(like it comes out of HIS paycheck??) Yes, it DID bother me to waste this lovely new patch I'd just opened....KNOWING it was probably expensive, but hellllooooo----the patient is more important!!!!!!!!!!!!)

She was ALSO on prn Norco, which I had recently given....ANOTHER reason I was NOT putting that Fentanyl patch on a DAY early!!! :banghead:

What would YOU have done? :nurse:

Up Vote Up Vote ×
Specializes in Med onc, med, surg, now in ICU!.

Why would it matter? Forgive me if I'm wrong, but I thought the point of fentanyl patches was to receive a continuous dose of fentanyl (in this case, 75mcg/hr) and that the patch contained enough fentanyl to provide this continuous dose for three days. It's not like they get a spike of fentanyl as soon as the new patch is applied - well, it shouldn't be, anyway.

I amy have the wrong end of the stick completely here, but I don't think it would have mattered, as long as you (sing it with me here) took the old one off first.

Anyone think anything different?

Up Vote Up Vote ×

Well, first of all, I think it's good that you are nervous. That means you have the patient's safety in mind.

Do you know why the patient is lethargic? Does the patient complain of pain? How are respirations and O2 sats? What is the source of the pain?

Sounds like the patient is being overmedicated, but there could be other pathology going on. I guess I would want to know more about this patient and the history of the pain.

Oldiebutgoodie

Up Vote Up Vote ×

It takes 8 hours for the effects of a fentanyl patch to wear off or to get relief once a new patch is placed. Whether you put a new one on and remove the old one or just leave th old one on for the extra day would have the same result.

Up Vote Up Vote ×
Specializes in ICU/Critical Care.

Yeah, a little history about the patient would help me decide what to do regarding the pain patch. Now if it was a hospice patient, I'd say yeah go ahead put the patch on but you only said the patient is lethargic. Lethargice from what? What's going on with the patient? Do let us know.

Up Vote Up Vote ×

yup, would have been fiscally resposible and now danger to patient to use new patch....out of curiosity was patient running a fever? been given a hot shower/bath sun bathing? anything the would have exposed the patch to heat?

Up Vote Up Vote ×
Why would it matter? Forgive me if I'm wrong, but I thought the point of fentanyl patches was to receive a continuous dose of fentanyl (in this case, 75mcg/hr) and that the patch contained enough fentanyl to provide this continuous dose for three days. It's not like they get a spike of fentanyl as soon as the new patch is applied - well, it shouldn't be, anyway.

I amy have the wrong end of the stick completely here, but I don't think it would have mattered, as long as you (sing it with me here) took the old one off first.

Anyone think anything different?

I thought this was the way fentanyl patches worked as well. Wouldn't the old patch be just as strong as the new patch, with the difference being that the old patch only had 24 hours left where the new patch has 72 hours?

Up Vote Up Vote ×
I thought this was the way fentanyl patches worked as well. Wouldn't the old patch be just as strong as the new patch, with the difference being that the old patch only had 24 hours left where the new patch has 72 hours?

theoretically yes...it s/b continuous, even dosage.

but it really isn't.

after 48-60 hrs, you can often observe the effects slowly wearing off.

and while it takes approx 8 hrs to take effect of a new patch, this only appliles in users who are naive to fentanyl.

with chronic users, you can see effect within a couple of hrs and as stated, wearing off prematurely.

w/o knowing more about this pt, you shouldn't be replacing a patch 24 hrs earlier.

and, they're expensive as all get out.

leslie

Up Vote Up Vote ×
Specializes in CVICU, Burns, Trauma, BMT, Infection control.

"She was ALSO on prn Norco, which I had recently given....ANOTHER reason I was NOT putting that Fentanyl patch on a DAY early!!!"

It sounds like(from the info here without knowing anymore hx) that you should've held the PRN Norco instead of holding or removing the patch if she was lethargic.

Up Vote Up Vote ×
theoretically yes...it s/b continuous, even dosage.

but it really isn't.

after 48-60 hrs, you can often observe the effects slowly wearing off.

and while it takes approx 8 hrs to take effect of a new patch, this only appliles in users who are naive to fentanyl.

with chronic users, you can see effect within a couple of hrs and as stated, wearing off prematurely.

w/o knowing more about this pt, you shouldn't be replacing a patch 24 hrs earlier.

and, they're expensive as all get out.

leslie

i wouldnt have purposefully replaced it either, but she had already opened it.....

Up Vote Up Vote ×
Specializes in Med-Surg/Tele, ER.

LOL.

I gotta say, my first thought was "I would have done what I thought was best for the patient and just moved on with my day". As in, relax.

Then I saw your screen name and decided it was spot-on. LOL.

Up Vote Up Vote ×
Specializes in Pediatrics (Burn ICU, CVICU).
Hello.....I am VERY curious what others will say about this....!!!

I went to put a new 75mcg Fentanyl patch on a new admit who was LETHARGIC, (ordered Q 3 days) but realized the one she already had on from her previous facility wasn't due to be changed for another day.... so, to me it was OBVIOUS not to put the new one on....

A nurse practitioner, pharmacist , AND my supervisor said it would have been FINE to put the new one on a day early, which surprized me! And I have to add that they ALL told me "as long as you had removed the old one"....okay, I KNEW that already!!!:banghead:

(**ALL my coworkers agreed they would NOT have put the new one on!!!**)

I still CANNOT believe that the pharmacist even seemed mad at the MONEY it cost when I wasted the patch.....(like it comes out of HIS paycheck??) Yes, it DID bother me to waste this lovely new patch I'd just opened....KNOWING it was probably expensive, but hellllooooo----the patient is more important!!!!!!!!!!!!)

She was ALSO on prn Norco, which I had recently given....ANOTHER reason I was NOT putting that Fentanyl patch on a DAY early!!! :banghead:

What would YOU have done? :nurse:

Well, personally, I would've changed the patch. Mainly because she came from another facility and I don't like continuing a medication that I, or my colleagues, @ my hospital didn't initially administer. This is completely a personal thing, nothing else.

Just curious though, if the pt was lethargic, why was the Norco administered?

Up Vote Up Vote ×
+ Join the Discussion