Patches

[CoffeeRTC, BSN, RN]

Nitro and duragesics......do you write/ inital directly on them or do you put a piece of tape over it with your intitals and date?

[TazziRN, RN]

Piece of tape, especially with nitro, since what we use in the ER is just a piece of paper with the ointment on it. The tape ensures that it will stay where I put it.

[LilRedRN1973]

I had a patient last week who was receiving Nitro Q6h and used the bigger tegaderms we put over IV sites to secure it. I put my name, initials and what the medication was (even though it went on a piece of paper clearly labeled NitroBid) on the little sticker usually used to identify when the IV was inserted, by whom, etc. It worked great, especially since this patient was extremely agitated/restless and I was afraid a few pieces of tape wouldn't secure the Nitro patch.

For the fentanyl, we have these small clear adhesive patches that go over the fentanyl patch that have a place for you to label/identify on them. They work pretty well.

Melanie = )

[suzy253, RN]

Have used the clear patches as well...if they are available. If not then I use tape.

[weirdRN, RN]

Depending on the type of patch, I initial and date directly on them before I take them into the patient.

Nitrobid is messy and I hate working with it but when I have to I use a larger opsite over the paper. I inital, date and time the paper before I put the Nitro on it. I like the newer nitro patches much better

In my facility, we have to use an op site over the Duragesis and Fentanyl patches. We also have to have a second nurse witness placing the patch and counter sign on the MAR and there are daily checks that the patch is still on. This is a new policy b/c the administration was tipped that one of the aids was stealing the patches from several residents.

[vampiregirl, BSN, RN]

While we're on the subject of patches... in one of the above posts, it referred to policies in place when administering the patches. Used patches still contain a significant amount of the drug, and unfortunately there is an increase in abusing used patches if they are not properly disposed of (a sharps container is a great place for the used patches).

Here is an article that identifies some of the risks:

http://info.jems.com/jems/exclus04/e0404h.html

I work for a small rural EMS service and we have run across several occurances of fentanyl patch abuse. In addition to the methods in this article, I've also had a patient who smoked a fentanyl patch.

[StNeotser, ASN, RN]

I write on the patch itself because it is part of facility protocol for duragesics, as well as disposal with two nurses because of the unused narcotic content.

[indigo girl]

While we're on the subject of patches... in one of the above posts, it referred to policies in place when administering the patches. Used patches still contain a significant amount of the drug, and unfortunately there is an increase in abusing used patches if they are not properly disposed of (a sharps container is a great place for the used patches).

Here is an article that identifies some of the risks:

http://info.jems.com/jems/exclus04/e0404h.html

I work for a small rural EMS service and we have run across several occurances of fentanyl patch abuse. In addition to the methods in this article, I've also had a patient who smoked a fentanyl patch.

Just moved to Connecticut, and the common practice here is to check every shift for Fentanyl patch placement. When removing a patch, you must countersign with another nurse before wasting it, usually into the sharps container. I never had to do all of this until moving here, but that's the reality of nursing in this state.

[sabRN2b05, BSN, RN]

Just moved to Connecticut, and the common practice here is to check every shift for Fentanyl patch placement. When removing a patch, you must countersign with another nurse before wasting it, usually into the sharps container. I never had to do all of this until moving here, but that's the reality of nursing in this state.

I don't know that we have to do that in MS....can anybody enlighten me?

I date, time, and initial patches, dressing changes, IV changes. Guess it was ingrained (sp?) in me in nursing school to do that. Do you know how aggravating it is to look up a date of an IV placement because the

nurse(s) before couldn't take the extra minute to label it? As far as daily NTG patches (not q 6* Nitrobid), I not only initial those, but I also write on the MAR to "remove @ HS")...just helps the night shift RN remember to take it off. As far as patches that stay on for a period of days (e.g. Catapres), I will date/initial and put "replace on ____" (date)

[WOLFE, BSN, RN]

Standard practice where I am is to date, time, and sign directly on the patch.

[CoffeeRTC, BSN, RN]

What I do is date and sing and make a huge circle on the patch so that you can see it (esp now that they are clear). I was told by another nurse....oh no...you can't write directly on them. Huh....I've been doing this for years?

As far as another dressing over the duragesics.....I was under the imperssion that you shouldn't put an opsite over them??

[weirdRN, RN]

Hey, does anyone else hve a really hard time getting the patches off, especially on the elderly with thin skin???

I gave a resident a skin tear while taking a nitro patch off last night. Any suggestions for the adminstering nurse or me taking it off to prevent this kind of thing??

Anyone know if the manufacturer would put like a tab kind of thingy that we would be able to pick up w/o skin?