Standard Operating Procedure for Use of Opioid Transdermal Patches in homes within NHS Sutton CCG

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1 Standard Operating Procedure for Use of Opioid Transdermal Patches in homes within NHS Sutton CCG Introduction This procedure is intended to encourage good practice in the management of opioid transdermal patches to ensure that they are correctly stored correctly, administered, recorded and disposed of. These opioids patches are strong opioids e.g fentanyl and buprenorphine. They are available as a self adhesive patch. This allows a standard amount of drug to cross each hour from the patch into the skin and provides a continuous delivery of drug into the body over the duration administration period. All health and social care organisations are accountable for ensuring the safe management of controlled drugs (CD s) within care homes. Organisation within which the SOP applies: All Care homes receiving medicines from community pharmacies and/or whose service users are registered with GP practices within NHS Sutton CCG Objectives / Purpose To ensure that opioid transdermal patches are administered correctly and the administration appropriately witnessed according to CD procedure 26. To ensure that opioid transdermal patches are received, stored, handled and disposed of correctly To ensure w r i t t e n records of all opioids transdermal patch products received, administered and disposed of, are made and kept in a suitable register within the home. To define accountability and responsibilities of individual members and to ensure practice is in line with the regulatory frameworks Scope This Standard Operating Procedure applies to Managers, Nurses and care staff working within Care Homes in NHS Sutton CCG who have responsibility for medicines Responsibilities Staff working in the areas who have a responsibility for the safer management of medicines in care homes within NHS Sutton CCG Related Guidelines and Standing Operational Procedures NHS Oxfordshire Guidelines on the use of Transdermal Fentanyl Patches and NHS Blackburn and Darwen The use of fentanyl patches for severe chronic pain guidance for care homes and domiciliary care. Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities 2009) Regulation 2010 THE HANDLING OF MEDICINES IN SOCIAL CARE Royal Pharmaceutical Society November 2007 The Health and Social Care Act 2008 (regulated activities) Regulations Safe Care and treatment. Regulation 12 NHS PrescQIPP Bulletin 75: Guidelines on the management of controlled drugs (CD) in care homes: December 2014 Review Period

2 January 2019 (or earlier if indicated) Validation process: This guidance has been approved by Sutton and Merton MMC for use in care homes within NHS Sutton Clinical Commissioning Group Author and contributors: Hai To, Care Home Pharmacist, NHS Sutton CCG Acknowledgement: Tania Cook, Specialist Senior Medicines Management Technician Social Care Lead, NHS Nottingham City CCG Date Approved: January 2017

3 Process Actions There are currently 2 different opioids available as transdermal patches. They are fentanyl and buprenorphine. Fentanyl and buprenorphine are CDs and their use must be entered the CD register and stock must be stored in an approved CD cabinet. Further information on controlled drugs is available in Care Home Procedure 26 - Controlled Drugs It is important that disposable gloves are worn by staff applying patches as fentanyl and buprenorphine are extremely potent painkillers, and it is important that staff do not absorb any of the drugs through their skin. The patch should be applied to a clean, dry area of skin which is non hairy; if necessary, the hair may be clipped with scissors but not shaved. Do not apply the patch to irritated, recently irradiated or shaven skin, or on lymphoedematous areas. Press in place firmly with the palm of the hand for 30 seconds. Some patients may need a semi-permeable dressing to ensure adherence. If more than one patch is applied they should be applied at the same time and placed far enough apart so they do not overlap. Refer to the patient information leaflet (PIL) for information as to where the patch may be applied. Service users can bathe or shower (with care) whilst wearing a patch but the water should not be too hot. When a new patch is to be applied, it should not be applied immediately after a bath or a shower or immediately after using creams, talc or soap on the skin. The skin should be completely dry before application of the patch. Remove the old patch before applying a new one. The new patch should be dated and a patch chart used to indicate the date and position of the patch on the resident so that sites can be rotated. It should also be clear on the MAR chart when a service user s patch should be changed Ensure all patches are removed prior to the application of a new patch - it is important to remember that some drug remains in the patch after the duration period specified e.g. 72 hours has elapsed. Overdose may occur if patches are not removed appropriately Ideally the underlying skin should be allowed to rest for 3-6 days before applying another patch to the same area. The site of application should be rotated in accordance with the manufacturer s guidance The patch should be checked each day to ensure that it is still in place. Heat (e.g. hot baths, electric blankets, hot water bottles) should NEVER be applied over the top of the patch as it may enhance the absorption of these drugs and therefore cause the Responsible Person Designated nurse (for nursing clients) or Home Manager/Senior Carer

4 patient to receive a higher dose An increased temperature / fever may also increase absorption and the resident should be monitored for side effects and toxicity. Seek advice from the service user s GP. Site irritation, usually from the adhesive, may necessitate a change of brand and should be discussed with the service user s GP When ordering repeat opioid patches, it is important to ensure the service user has enough for continued therapy but it is also important not to over-order the patches as the dosage of the patch may need to be changed Used patches still contain the drug, therefore it is important to ensure these are disposed off correctly as described below: After removal, fold the patch in half and stuck together with the adhesive sides inwards discard in a sharps bin or, for care homes without nursing, they should return to the supplying pharmacy for destruction Remove gloves and wash hands thoroughly Any unused patches should also be disposed of appropriately in line with the care homes medicines waste disposal procedure 18.

5 Appendix 1: Patch application record Name of resident Date of birth Drug name: Strengths(s): No. of patches: DAY DATE TIME ACTION/COMMENT SIGNATURES Drug name: Strengths(s): No. of patches:

6 The old patch should be removed before applying the new patch. The old patch must be folded in half and stuck together before disposal. The site of application should be rotated in accordance with the manufacturer guidance. Use a cross (x) to indicate where the new patch has been applied. Use a new section each time patches are applied. The patch should be checked on a daily basis to make sure it is still in place.

7 I have read and understood this standard operating procedure and agree to work to it. Name Job Title Signature Date Home Manager