Covering up Medication Patches

  1. Hello friends,

    Just wanted to get your take on how you handle medication patches that won't stay on, or get missed when they should be taken off.

    I find with nitroglycerin, fentanyl patches, etc. they often get lost. Either lost on the patient, or lost off the patient. Meaning they should be taken off, but are left on because they are not seen, or you go to take on off, but can't find it... not knowing how long it may have been off.

    I've been told to never totally cover medication patches because it can cause them to heat up and increase the rate of absorption. Others say tagederm is ok because the patch can breathe through this. I've also seen covers come with some patches. Personally I have taken to getting about a 2 inch piece of silk tape and writing the med and date on it, then taping it to about 1/3 of the patch itself. My pharmacy seems to think this is ok, but recently I had a doc question it. I like it b/c you can't miss it, and it does help hold the patch on, but doesn't cover it completely.

    Just seeing if there are any better, safer, ideas out there.
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    Joined: Mar '07; Posts: 217; Likes: 218


  3. by   CrazyGoonRN
    Where I work we only cover Fentanyl patches. We use a clear op-site cover.
  4. by   BrandonLPN
    The nurse who applies the patch should document in the MAR where he applied it. That way the nurse who has to remove it knows where to look. And we cover it with an opsite, too. Saying that increases absorption by increasing heat is splitting hairs. There's a million ways one could increase heat. Should the pt not wear a sweater? Should we forbid her from sitting in the sun? Some people like to fabricate problems where there are none.
  5. by   classicdame
    I don't see why a window frame of tape would be an issue with absorption but I am going to look up the info on Micromedex. Agree with BrandonLPN that id of site is impt and worrying about heat may not be as impt.
  6. by   loriangel14
    We use opsite or Tegaderm to cover patches.
  7. by   tnbutterfly
    Moved to Nursing and Patient Medications for more response.
  8. by   tamadrummer
    Sandoz will send the patient free bioclusive patch covers if they send away for them. My mom and dad are both on the fentanyl patch and they both get them sent for free. If the manufacturer recommends covering them I can't see how anyone else can go wrong with covering them.
  9. by   moorefun11
    Never cover a patch. had a patient code once because someone covered high dose fent patch with a telemetry pad pre op. please leave the visable.
  10. by   tamadrummer
    Quote from moorefun11
    Never cover a patch. had a patient code once because someone covered high dose fent patch with a telemetry pad pre op. please leave the visable.
    There is a huge difference between a clear cover and a tele patch that you cannot see through. I would question the person putting a flipping tele patch on top of anything but skin. How exactly did they expect the lead to work and once the person got into the operating theater and the arm or leg lead didn't work, didn't someone question it?

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  11. by   canned_bread
    I either use opsite (clear so date/time placed is showing) or micropore if patch due for a change soon and it's only a little bit coming off. I find patches that are placed on the back seem to stay longer, I presume because the patient is usually sitting down against the back of a chair, or is laying in bed on the back.
  12. by   PediLove2147
    Usually use tegaderm but I agree there should be some documentation of where it was placed in the first place. Also, patients usually know where they are, just ask!
  13. by   BrandonLPN
    Double post
  14. by   BrandonLPN
    What gets me is that we are told once we initial patch placement verification in the MAR, we are responsible for it for that shift. So day shift and I check Mary Sue's patch together when i come in at 3pm. At 11pm the night nurse and I check again and the patch is missing. Now, according to management, this is narcotic diversion on my part same as if a norco were missing from the narc box. Seriously? Nothing else could have happened in the last eight hours? It could have fallen off. She could have peeled it off. Grandson could have taken it off for all I know. Am I supposed to keep Mary Sue next to me all shift to watch? I refuse to take responsibility for patches residents wear. I'm only "responsible" for it for the 5 seconds I looked at it at shift change.