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.

[Marie_LPN, RN, LPN, RN]

If you haven't seen it, then i don't call that "wasted". I call that "missing". Wasted would mean you both watched it go bye-bye.

Had the pt. had any gowns or sheets changed, i wonder? I found a patch rolled up in a gown once.

[leslie :-D]

i wouldn't sign a narc as wasted w/o seeing it for myself.

and yes, i would have filled out an incident report.

[StNeotser, ASN, RN]

I have come across this more than once. We have to check patch placement q shift. If it comes up missing, do an incident and record it so you can watch for a pattern of missing duragesics.

Just say no.

[vamedic4, EMT-P]

Perhaps it fell off and got bundled up during a linen change?? I've not seen a duragesic patch come off in a long time - unless a patient sweats a lot. They usually stick pretty darn well.

Yes, any time that happens - write up an incident report. That's one powerful med and even after 72 hours when they're changed they can still have an effect on someone not accustomed to narcotics.

Marie's right...this one's MISSING....not wasted.

vamedic4

Making life better for children.

[Ms.RN]

once i was walking down the hallway and i found a duragesic patch stuck on the floor!! i think duragesic patch is easy to come off especially while patient is taking a shower. what we do to prevent it is to put a tape over the duragesic patch and it doesnt come off easily. what we do when we cant locate patch is we circle in the mar where we are to check placement, then on the back of mar we write down "unable to locate patch", then we apply new patch.

[SmilingBluEyes]

It's not ok to verify by signature a waste you did not see. This will get you in the behind in the end. Make out an incident/occurence report. That is the proper procedure and will cover you in the end. Never give signature to that which you are unsure of. Learn this sooner than later....trust me.

[vamedic4, EMT-P]

once i was walking down the hallway and i found a duragesic patch stuck on the floor!! i think duragesic patch is easy to come off especially while patient is taking a shower. what we do to prevent it is to put a tape over the duragesic patch and it doesnt come off easily. what we do when we cant locate patch is we circle in the mar where we are to check placement, then on the back of mar we write down "unable to locate patch", then we apply new patch.

this is true...i wrap the patch in saran wrap (around an extemity if that's where it's located) and use tape around the edges. keeps it dry and intact in most circumstances.

[CHATSDALE]

bad call by preceptor---

patches are more likely to be 'lost' by men pts due to hairy area and i believe that men sweat more than women

but i read once of a cna [please hold your tummies] sucking the meds out of a used patch

you will need yur license for a long long time next time do everything by the book you will never regret it

[lsyorke, RN]

This is true...I wrap the patch in Saran Wrap (around an extemity if that's where it's located) and use tape around the edges. Keeps it dry and intact in most circumstances.

Not a good practice. Increased heat in the area of the patch can cause an overdose We just had an inservice on patches and this was a BIG topic!

[LoriAlabamaRN]

We've had the same problem here, and we don't use the ones with gel in them, so the potential for abuse is not as high. Our laundry guy has found them inside gowns before, patches have been found on the shower drain, in the hall, stuck on resident's bed, etc. We have one resident who sweats SO MUCH that I personally put on her patch after cleaning her back with alcohol, letting it dry, and then after placing the patch I put an opsite over it.

On the lighter side, one of our more "interesting" residents called 911 after mistaking his pain patch for a "plastitronic mind control device." That was an interesting night.

[GatorRN]

I sure wouldn't sign on a patch being "wasted" unless I actually wasted it. Wasted is one thing, and lost is another. Even noted on the MAR that you were "unable to locate," in my opinion, doesn't make it right. Each notation you made contradicts the other. I could see that biting you in the butt. I would say an incident report should have been written up.