Reapply a Fentanyl Patch?

[wifeandmomoftwo]

First of all sorry for the miss spelling. Just noticed and can't figure out how to edit that part

About 30 minutes before the end of my shift I had a CNA come to me and say "Ms. Smith's patch came off. I tried to stick it back on." I knew that it was her pain patch and went to check on it. It was just barely on there and had just been applied the day before. This particular patient has had this happen before but it was just before she was due a new patch anyway so we just gave her PRN pain pills for about 12 hours until time to reapply the patch. She didn't have nearly the quality of pain control she normal does though. Anyway, the resident was not currently experiencing discomfort and I could not get the patch to adhere. I put it in a zip lock bag for the oncoming nurse and charted about this incident. The oncoming nurse didn't look thrilled and said she was just going to tape it back on. This was suggested to me by another nurse but I didn't think it would work.

I'm just a new grad LPN. I've been working LTC on 11-7 for six months. Thought I could learn something from this experience. I would have called the MD myself and gotten an order to change the patch earlier but didn't have time with other meds due, narcotics to count, and report to give. Thanks :)

[Havin' A Party!, ASN, RN]

We don't call the MD for this. We write the order Q72 hours/PRN just for this purpose.

[dudette10, MSN, RN]

Regardless of whether a patch that has fallen off is reapplied with an occlusive dressing or a new patch is used, it should be placed in the same location as the one that came off.

If the patch is placed in a new location, the patient will have to wait for a new skin depot of the drug to form before the medication is released into their system, causing a break in pain relief.

Source: Medscape News

I know this is an old thread, but I have a question about this. If we should apply a replacement patch in the same location to prevent a break in pain relief due to inadequate skin depot, wouldn't the same principle apply to regular patch changes?

[Havin' A Party!, ASN, RN]

I'd rotate the site.

[jeanbeth, MSN, DNP, RN]

At our facility it comes down to payment. Insurance company won't pay for an additional patch unless there is a specific order for it. 1 patch Q72H is all that's covered if that's the MD's order.

[elkpark]

Nurses eat their own because most nurses are unhappy and really don't like themselves. Lets turn this around by helping each more, and being more understanding instead on being judgmental. We are all part of the human race. Let's always make it about the patient. If nurses are good to each other, then that will always be good for the patient.

"Nurses eat their own because most nurses are unhappy and really don't like themselves"??? Jeez, who's being judgmental here? And, BTW, it is certainly not true that, if nurses are "good to each other, that will always be good the patient."

[JustBeachyNurse, LPN]

Nothing like re animating a 3 year old thread! I know regulations on narcotics have changed in 3 years

[KathySandersSoffos]

Adhesive spray will deactivate it. Use a bordered clear bandage 1 size larger and reapply it. wash hands well or you will test positive. it is absorbed thru skin and MM.

[heron, ASN, RN]

If there's no facility policy, read the manufacturer's direction's and go by that. The ziplock baggie is a good idea until you can get a witness to the waste if you need to replace it. CYA, dumplin'.

[Tenebrae, BSN, RN]

To prevent possible abuse.

People are that desperate for drugs that they will use a patch thats been on someone elses skin for 3 days.

When I was a student I did a placement with community alcohol and drug. I found out that people are that desperate for a fix they will pay for methadone that someone has had in their mouth but spat out