Curraheen, Co.Cork. SOP Title: Management of Transdermal Patches SOP No: 19 Version number: 2 Date of Re-approval: 28 th July, 2015 Revision due: 28 th July, 2018 Index Code No: CLIN041/SOP NO 19 Disclaimer: The information contained within this policy is accurate and up-to-date at date of approval. This standard operating procedure forms part of the Medication Management Policy for Marymount University Hospital & Hospice Ltd. Page 1 of 9
Title: Management of Transdermal Patches Version 2 Reviewed by: Ann Carmichael Aileen Barry Superintendent Pharmacist Senior Pharmacist Approved by the Executive Committee on: : 24 th June, 2015 Approved by the Quality, Risk and Audit Committee on: : 15 th July, 2015 Approved proved by the Board of Directors on: 28 th July, 2015 Signed by: Chief Executive Officer, Marymount University ity Hospital & Hospice Ltd Date: Page 2 of 9
CONTENTS: PAGE NO. 1.0 Aim of Procedure 4 2.0 Scope of Procedure 4 3.0 Definition / Abbreviations 4 N/A 4.0 Responsibilities 4 5.0 Procedure 5/6 6.0 Appendices 7/8 Page 3 of 9
1.0 Aim of Procedure To ensure the safe and effective use of transdermal patches prescribed for patients/residents in Marymount University Hospital & Hospice Ltd. To ensure the safe destruction of used patches, that may still contain a significant quantity of active ingredient. 2.0 Scope of Procedure All healthcare professionals involved in the management of transdermal patches. All patients/residents prescribed transdermal patches in Marymount University Hospital & Hospice Ltd. The principles outlined in the Procedure on the Administration of Medicinal Products (SOP 3) should be followed by a registered nurse when applying any transdermal patch. All opioid transdermal patches are MDA Schedule 2 controlled drugs, therefore the storage, administration and recording of the opioid patches must be in accordance with the Procedures on the Management of MDA Schedule 2 drugs (SOP s 12 and 13) 3.0 Definitions/abbreviations N/A 4.0 Responsibilities All healthcare professionals involved in the management of transdermal patches are responsible for adhering to this procedure. All pharmacists and ward managers are responsible for monitoring adherence to this procedure. Page 4 of 9
5.0 Procedure Transdermal patches are medication-impregnated patches designed to be applied to the skin and to release the active ingredient at a constant hourly rate over the specified time period. The prescription for a transdermal patch should state the name and strength of the patch to be applied and the duration of application. If any details are omitted, the prescriber should be contacted for clarification before a patch is applied. All transdermal patches should be prescribed ribed by brand name to avoid confusion. Gloves should be worn when applying and removing transdermal patches. Patches should be applied to dry, non-inflamed, non-irradiated, hairless skin on the upper arm or trunk (with the exception of Scopalmine (Scopaderm ) patches which are applied behind the ear and lidocaine (Versatis ) patches which are applied to the specific area which is painful.) If necessary, body hair should be clipped not shaved prior to patch application. The use of soap or creams in the area should be avoided prior to patch application. The patch should be removed from the outer packaging, the date and time of application written on the patch then the protective backing removed. The patch should be pressed against the skin firmly for approximately 30 seconds, especially around the edge of the patch to ensure good adherence. (For opioid transdermal patches, should extra fixation be required, a Tegaderm dressing may be applied over the whole patch.) Transdermal patches containing an opioid are Schedule 2 Controlled Drugs therefore a second registered nurse must witness application of the patch to the patient. Both nurses should sign the patient s Drug Prescription and Recording Chart and document the administration on the appropriate page of the ward MDA Schedule 2 Drug Register. For each patient prescribed a transdermal patch that is to remain in situ for more than 24 hours, a Transdermal Patch Nursing Record Chart (appendix 1) should be completed. This chart should be used to record the type, strength and number of patches applied as well as to document the site of application used. This ensures that different sites are used each time a patch is applied. Full patient details should be recorded on this form by the registered nurse in accordance with the Hospital Patient Identification Policy (CLIN015). It is not necessary to complete one of these charts for patches which are changed daily e.g.: nicotine patches. A check to ensure that a transdermal patch is in place should be made once a day by a registered nurse to ensure that medication is being administered as prescribed. If any problems with the patch are noted, for example, extra fixation required, this should be documented in the comments section. If a patch is found not to be in place at the recorded site of application, a new patch will need to be applied. The patch recording chart should be updated accordingly. A thorough check should be made to try and locate the patch which has become unstuck or has been removed, with the intention of ensuring its safe disposal. If continued treatment with a transdermal patch is prescribed, a new patch should be applied at the intervals specified by the prescriber. The new patch should be applied immediately after removal of the existing patch but at a different site so as to rest the underlying skin (3-6 days site rest for fentanyl patches, 9 days site rest for buprenorphine patches). Any patch already in situ should not be removed until a new patch is ready to be applied, unless the transdermal patch therapy has been discontinued by the prescriber. Page 5 of 9
For opioid containing patches, removal of the old patch and its subsequent disposal must be witnessed by a second registered nurse. Both registered nurses must sign the Transdermal Patch Nursing Record Chart to confirm the removal and destruction of the patch. The date and time of removal should be documented. Patches should be removed carefully so as to minimise local skin irritation. Absorption of the drug from a transdermal patch may be enhanced by an external heat source applied over the patch so patients should be advised not to place heat packs near to the site of application. Patients may shower but should not soak in a hot bath. Used patches still contain a significant quantity of active medication and should be disposed of by folding in half, adhesive side inwards, and placed in the ward sharps bin for incineration. The administration of some doses of transdermal medication may require the use of two patches of the same or differing strengths. The fact that two patches have been applied should be indicated on the Transdermal Patch Nursing Record Chart and in this instance extra care should be taken to ensure both patches are removed when due for change. Transdermal patches should not be cut to facilitate the administration of smaller doses unless advised specifically by the prescriber and after having checked with a pharmacist that the patch formulation is suitable for cutting. Completed Transdermal Patch Nursing Record Charts should be filed in the patient s chart with the relevant Drug Prescription and Recording Chart. Page 6 of 9
6.0 Appendices Appendix 1 Page 7 of 9
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All relevant staff must date and sign this page, after they have read and understood this policy. Revision No: 2 Date: 28 th July, 2015 Title: : Management of Transdermal Patches CLIN041/SOP NO 19 Re-approved by The Executive Committee: Date: 24 th June, 2015 Date Print Name Signature Page 9 of 9