Patches

[CoffeeRTC]

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?

[KellNY, RN]

I sign the patch itself.

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??

I'll either rub around the area with an alcohol pad to loosen the glue, or a warm soapy towel. I hate removing those damed things, especially when the nurse before me didn't sign or write on the patches...

Can I tell you how many times I've went to remove a patch, only to find 3 or 4 on the resident?! ***?

Kelly

[weirdRN, RN]

Can I tell you how many times I've went to remove a patch, only to find 3 or 4 on the resident?! ***?

Kelly

That completely ticks me off. I worked the shift after another nurse who did not take any of the Nitro patches off any of the residents that had them. I only work PRN at that job, so I wrote a note to the ADON. The other nurse asked why I didn't say something to her first.

my response: I said I shouldn't have had to say anything.. that is her responsibility and obligation to the patient.

[burn out]

At a local nursing home it was discovered that people ( nurses or cna's) were stealing the fentanyl patches off of the residents. The FBI was called in and all the patients receiving fentanyl patches were placed in locked in room requiring any staff member to sign in/out of the room and shift checks made on the patients patch just like they were the drug. I bit drastic but what a world we live in these days.

It is a shame our society has come to this. I remember my father telling we of war stories of being cold and freezing in the dead of winter during WWII and stealing the shoes off of dead soilders to keep his feet warm and feeling terrible for that. Now days people have no remorse of stealing pain medication off a terminally ill patients and their only way of escaping the pain until death takes over. Are we staying civilized?

[Chaya, ASN, RN]

Just curious, why the question about writing directly on the patches? Never occured to me to do otherwise although I will sometimes put a Tegaderm over it if the pt is diaphoretic and tends to have patches fall off. Is it considered to be damaging to the patch if you write on it?

[burn out]

I have heard that women using the birthcontrol patch are having problems with large doses being released into their bodies from exercising and excessive heat and sweating would this have the same effect on duragesic and nitro and other patch medicines since they are released the same way?

[KellNY, RN]

At a local nursing home it was discovered that people ( nurses or cna's) were stealing the fentanyl patches off of the residents. The FBI was called in and all the patients receiving fentanyl patches were placed in locked in room requiring any staff member to sign in/out of the room and shift checks made on the patients patch just like they were the drug. I bit drastic but what a world we live in these days.

That's more than a bit drastic, that is borderline abusive to the residents. Someone needs to take their headds outa their nether regions and come up with a better plan, because that's just not right.

[barbyann]

I have always written directly on the patch before applying it to the pt. I would never cover with tape or tegaderm for fear of affecting the dosing system.

[meownsmile, BSN, RN]

In our facility we date, time and initial directly on the patch. I have also come across patients with more than one nitro patch on at a time. That's just plain laziness and lack of proper documentation.

When we remove duragesic we are required to waste with a witness just as we would any injectable.