Catch the Patch

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Catch the Patch

• Mary C. Allen RN
• Maureen Sheakley Rph

Center for Clinical Effectiveness and
Patient Safety
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Transdermal Delivery Systems

• A transdermal patch or skin patch is a medicated
  adhesive patch that is placed on the skin to
  deliver a time released dose of medication
  through the skin and into the bloodstream.
• Transdermal medication delivery has been utilized
  over the last 20 years and contributes over 3
  billion dollars annually to the pharmaceutical
  industry
• Well reported by FDA and ISMP

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Advantages of Dermal Absorption

• Avoidance of first-pass liver metabolism,
• Decreased chemical and biological conditions of
  the gastrointestinal tract,
• Improved patient compliance,
• The ability to provide a controlled delivery of
  drugs with short half-lives and/or narrow
  therapeutic windows

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Components of a Transdermal Patch

• Transdermal systems are comprised of several
  layers or components.

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Medications Administered by Patch

• Smoking cessation, Nicotine
• Hormones, Estradiol, Testosterone
• Anti-hypertensives, Catapres/Clonidine
• Cardiac Nitroglycerine
• Pain medication Fentanyl/Duregesic
• ADHD
• Alzheimers
• Anticholinergics Scopolomine, Hyoscine
• Herbals, Weight loss remedies
• Future - Vaccines

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Patch Adverse Effects

• Nicotine perceived arrythmias
• Birth Control blood clots, DVT, Stroke
• Anti-hypertensives - hypotension
• Nitroglycerine hypotension, headache
• Fentanyl patch - respiratory arrest, Death
• ADHD change in mental status
• Alzheimers change in mental status
• Anticholinergics hyperthermia, LOC, dry mouth
• Herbals, Weight loss remedies not studied by FDA

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A Word about Fentanyl Patches

• FDA is investigating reports of serious effects
  and death.
• Fentanyl patches are strong opioids. Prescribe at
  the lowest dose possible.
• Should not be used to treat opioid naïve patients
  or patient with short term pain.
• Pt/family needs education on safe use and
  disposal.
• Pt/family should be aware of signs of overdose
• A sudden rise in level of Fentanyl may occur
  withalcohol consumption, fever, exposure to
  heat, interaction with other meds.

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Did you Catch the Patch?

• Assess and document on admission and each shift.
  Dermal patch medications are often unrecognized
  (skin toned, clear, decorative)
• Patients may not consider them as medication
• May be worn in hidden/private areas
• Include on PMH, MAR or medication reconciliation
  documentation

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MAR

• Some patches may be High alert
• May require locked storage
• Document when old patch removed and new patch
  applied
• Document if Patch not given
• Watch out for Look-alike and Sound alike Patches.

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Transdermal Patches
HERE'S HOW TO USE THEM SAFELY AND EFFECTIVELY
1. Don't apply a new patch without first
removing the previous patch. 2. Don't get
medication on your hands or touch the patch's
adhesive side. 3. Don't shave the area. 4.
Don't apply a patch to damaged or irritated skin
or to an area with skin folds or scars. 5. Don't
apply a medication patch below your patient's
elbows or knees. 6. Do take your patient's vital
signs or check other assessment parameters, as
indicated. 7. Do list on the patient HP, MAR
and Med reconciliation forms 8. Do consider
effects of the patch. Local reaction redness,
irritation, burn, Systemic reaction
anaphylaxis, arrest, changes in mental status. 9.
Use caution when sunbathing, when febrile, while
exercising or overheated. 10. Burn notice.Watch
out if patched patient goes to MRI.
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Potential for Overdose

• What about PCA and other analgesia?
• 2004-Use of a transdermal patch to deliver pain
  medication was found to be equivalent to
  medication delivered by an intravenous pump for
  controlling pain following surgery, according to
  a study in the March 17 issue of The Journal of
  the American Medical Association (JAMA).

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Patient Education

• Document drug name, dose, application location
• Indication
• Precautions, Warnings, Adverse events and who to
  contact
• When to apply, when to remove
• Have patient use teach back method to ensure
  patient understanding.

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Nicotine Patches
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Patches May be Hidden
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Dressing or Patch?

• This patch is marketed as an herbal patch that
  claims to detoxify the body of unwanted chemicals
  
• Instructions state to wear on the foot

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Buy from Established Pharmacies
Counterfeit
REAL
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Nitroglycerine Patch
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Over absorption and Under absorption

• Catapres/Clonidine past report that some
  batches contained no medication
• Fentanyl Pt applied a fresh patch and went to
  the beach. She became lethargic and required
  medical attention. The patch heated in the high
  temperature and released a high dose of opioid.

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Patch Disposal

• Watch for signs of hoarding or misuse
• At Home instruct patients to fold sticky sides
  together and flush down the toilet.
• In Hospital/Clinic setting fold sticky sides
  together and place in needle box

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SUMMARY

• P - Past Medical History and patch use
• A - Assess the patient on admission for patches,
  skin condition and decubiti
• T - Transcribe patch orders correctly
• C - Communicate transdermal use to others
• H Hand-off communication- pass the information
  on patient patched to the next care giver. Help
  the patient remove old patches
• E - Educate the patient to prevent adverse events
• S Standardize documentation of transdermal
  medications