Question about nitro patches

TheCommuter, BSN, RN · Dec 14, 2009

An additional 12 hours should be allowed before applying the next patch because a 12 hour nitroglycerin free period reduces the occurrence of tolerance to the effects (reduced effectiveness) of nitroglycerin.

http://www.medicinenet.com/nitroglycerin/article.htm

elkpark · Dec 15, 2009

If day shift is "forgetting" to take off the nitro patches, are these med errors getting reported and addressed? At the facility where I work (acute psych), our MAR system includes a separate entry for removing patches, so you see, when you're looking at what meds are due on your shift, that a patch needs to be removed, and you document that that's done the same as documenting any medication you give. Would something like that be helpful for your situation?

systoly · Dec 16, 2009

Do you have a site rotation schedule so everyone knows where to look?

NC Girl BSN · Dec 16, 2009

This was a big problem when I worked in LTC. Sometimes I would come back from the weekend and find 3 nitro patches on my patient. I would stick them all on a piece of paper and turn it in to the DON. Not sure if anything happened. At my facility, the dayshift put them on and the night shift would take them off so I don't have an answer to your question.

chevyv, BSN, RN · Dec 18, 2009

We just initial it in the mar along with our meds. I never even thought of it as a med error. 12 hours in between! Wow, thank you so much for letting me know. I think many of out lpn's think the cna's are removing the patch during cares. Some do and some don't. I let them know I take care of all of that. Otherwise, I'll end up with the same issues. I'll bring it up at the nurses meeting next week. Thanks to all!

elkpark · Dec 18, 2009

We just initial it in the mar along with our meds. I never even thought of it as a med error. 12 hours in between! Wow, thank you so much for letting me know. I think many of out lpn's think the cna's are removing the patch during cares. Some do and some don't. I let them know I take care of all of that. Otherwise, I'll end up with the same issues. I'll bring it up at the nurses meeting next week. Thanks to all!

My career has been in acute care, not LTC, but everywhere I've ever worked, not removing a patch is as much a med error as not giving a med, or giving a med without an order (which is basically what it is -- the client is continuing to receive the medication beyond what the physician has ordered). I know LTC is whole 'nother world, but -- CNAs removing patches?? Again, that's not any different, legally/realistically, than CNAs giving meds. Are your CNAs authorized to give meds??

I encourage you (your organization) to think seriously about the separate-entry-on-the-MAR-for-patch-removal system -- that would clear up the whole situation.

BlondieNH · Dec 18, 2009

Where I work, we use BCMA. It won't let you put a new patch on, unless the old one is marked electronically by removal. It would be a serious med error if someone failed to remove it. However, at the end of the shift, it would come up on the missed med report if it wasn't done, so it could therefore be done in time.

kathy313 · Dec 19, 2009

I had the same issue...I posted so many little sticky notes to remind the other shift. It is a med error and we had to write an incident note, notify the M.D., the family and the info went to the D.O.N....finally they got the idea!

elkpark · Dec 19, 2009

Where I work, we use BCMA. It won't let you put a new patch on, unless the old one is marked electronically by removal. It would be a serious med error if someone failed to remove it. However, at the end of the shift, it would come up on the missed med report if it wasn't done, so it could therefore be done in time.

We use a computerized med administration system, too, and it works the same way. Removal of the patch shows up on the screen the same as any other med that needs to be given that shift, and, if it's not charted, it gets highlighted as a missed "med." But the same system could be used on paper MARs, too.