meded101

I would never say to never do something. Context and clinical judgement should always be considered, however with that said if you don't have to make that decision on your own or there is a consistent trend that the patient is getting lows, take action and get appropriate changes in place from the provider. If lantus/levemir is given and there is justification for concern of lows in the next 24 hours, make sure everyone is aware and step up monitoring etc.

I'm noticing a disturbing trend of fentanyl Patches being stolen. While most facilities do a fairly good job of accounting for controlled substances, I can't help but realize that the only opioid we cannot keep locked under control at all times is fentanyl. Once applied to a resident, we have lost all controls that we have for other controlled substances that are locked up until immediate use. So I'd like to remind all nurses out there that we need to do our best to be accountable, and when a patch turns up missing - make sure you take it seriously and report it accordingly. Eric Christianson, Pharm.D.

Review of meds for nausea is a frequent request I get. There are a lot of meds that can contribute to nausea, and there is no shortage of medication use in LTC :) We need to exhaust all possible causes, nausea is awful - good work. I hope they weren't on an NSAID like Ibuprofen, Aleve, Mobic, Celebrex etc... Eric Christianson, Pharm.D.

I get this question all the time. Per Lexicomp, if there is difficulty with patch adhesion, the edges may be taped in place with first-aid tape. If there is continued difficulty with adhesion, an adhesive film dressing (eg. Bioclusive or Tegaderm) may be applied over the system. I would recommend that we make sure proper administration procedures have been tried first as I've run into that before, and if it continues to fall off the above may be tried. If continued problems even after using the above products, you might need to ask provider to consider alternative opioids? Hope this helps. Eric Christianson, Pharm.D. For daily drug info posts please stop by facebook.com/meded101