Is there a fentanyl patch hidden on your patient?
Is there a fentanyl patch hidden on your patient?
Patients may not mention transdermal patches
Because a woman with chronic pain failed to tell ED nurses about the fentanyl patch she was wearing, she was given a second fentanyl patch and intravenous morphine for breakthrough pain. The woman became unresponsive and was intubated, but she recovered after the patch was removed.1
Patients sometimes forget to mention they are wearing transdermal patches, so you should specially ask about these when obtaining a medication history, says Hedy Cohen, RN, BSN, MS, vice president of the Institute for Safe Medication Practices. "A fentanyl patch is typically put on every three days. Since the patient isn't applying it every day, it just slips their mind," she says.
You probably will be seeing more patients with transdermal patches in the ED, as the numbers of patients with chronic diseases being treated as outpatients continues to increase, adds Cohen. Sometimes patients forget to remove transdermal patches and keep putting on additional ones, and they eventually are brought to the ED unconscious, she says. In one case, an elderly woman with cancer was unresponsive when she arrived at an ED, and nurses found five fentanyl patches on her body.
"It may be that family members are caring for the patient, and a daughter puts on a patch one day and a son puts one on another day but doesn't remove the other one," says Cohen. "When the patient becomes hard to arouse, they aren't sure whether it's the disease or something else. Finally, they can't arouse the patient, and they show up at the ED."
This scenario should raise a red flag that your patient might have on more than one patch. "If the patient is coming in from a nursing home or is unconscious, look in the grooves of the body for patches, under the breast and around the groin area," says Cohen.
Reference
- Institute for Safe Medication Practices. Patches: What you can't see can harm patients. ISMP Medication Safety Alert! Nurse Advise-ERR. April 2007; 5:1.
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