Nottinghamshire Medicines Optimisation Team



[pic]

Guidance for the Safe Management of Transdermal Fentanyl Patches

Fentanyl is a strong opioid which is often used in the management of cancer pain. It is available as a self-adhesive patch that is changed every 72 hours (3 days). This allows a standard amount of fentanyl to cross each hour from the patch into the skin and provides a continuous delivery of fentanyl into the body over the 72 hour administration period.

Training

It is important that all staff involved in the administering of fentanyl patches have received adequate training and proven to be competent to undertake the task.

Storage and Record Keeping

Fentanyl is a Controlled Drug (CD) and should be stored in a CD cabinet that complies with the Misuse of Drugs (Safe Custody) Regulations 1973. Its use must also be documented in a CD register as well as recorded on the MAR chart.

Application and Removal of patch

As fentanyl is a CD it should be administered by two medicine trained staff members, one to administer and one to witness the correct administration and countersign all documentation.

• Staff must document the removal of the patch from the CD cupboard, in the CD register. They should also check the label on the box against the residents MAR chart to verify identity, dosage and date of application.

• It is important that disposable gloves are worn by staff applying patches as fentanyl is an extremely potent painkiller, and it is important that staff do not absorb any of the drug through their skin.

• Ensure the old patch is removed before applying a new one. If an old patch or patches cannot be found on the resident, the procedure below should be followed. A new patch MUST only be applied if the staff are satisfied that the resident does NOT have remaining patches on them.

• Check the site for signs of allergic reaction, redness, itching or blistering; any concerns should be highlighted to the residents GP. The old patch should then be disposed of as per below.

• 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 and the residents care plan when their patch should be changed. It is possible for a resident to wear more than one patch at a time; if this is the case then these should be changed on the same day to avoid confusion.

• Fentanyl patches should be applied to clean, dry, non-inflamed, non-irradiated, hairless skin on the upper arm or trunk.

• Patches should be pressed in place firmly with the palm of the hand for 30 seconds. Body hair may be clipped but do not shave. Some patients may need a semi-permeable dressing to ensure adherence.

• Gloves should be removed and hands washed thoroughly.

Important points to note:

• A new patch should not be applied immediately after a bath or a shower or immediately after using creams, talc or soap on the skin.

• Residents can bathe or shower (with care) whilst wearing a patch but the water should not be too hot.

• Ideally the underlying skin should be allowed to rest for 3-6 days before applying another patch to the same area.

• 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 fentanyl.

• An increased temperature / fever may also increase absorption and the resident should be monitored for side effects and toxicity. Advice from the resident’s GP should be sought.

• Site irritation, usually from the adhesive, may necessitate a change of brand and so should be discussed with the resident’s GP.

• Only fentanyl patches with metal backings would need to be removed during an MRI scan to prevent the risk of burns. No such fentanyl patches exist at this time.

• If a resident experiences hallucinations or confusion then the fentanyl dose may need reducing. If the pain is not controlled then alternative analgesia may need to be considered. In either of the above circumstances this should be discussed with the residents GP.

• Patches must be worn at all times, and must NOT be cut in an attempt to reduce the dose

• When ordering repeat fentanyl patches it is important to ensure the resident 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.

Loss of Fentanyl Patches

It is known that fentanyl patches still contain their active ingredient, which works for at least 48 hours and possibly up to 72 hours, after their removal. This can have serious and potentially fatal consequences, if they are found and touched by another patient, staff member or visitor.

If a residents patch or patches cannot be found, a thorough body search must be undertaken and also a search of the residents immediate surroundings. An incident form must be completed by the senior member of staff in charge and it must be clearly documented in the resident’s notes.

All staff must be notified including laundry, kitchen and cleaning staff to ensure they are aware of the procedure if found i.e. pick up with care, preferably using gloves.

Disposal of Fentanyl Patches

It is important to understand that used patches when removed still contain significant amounts of fentanyl which may be harmful to other people, as per above. Therefore safe disposal is essential.

• Gloves should be worn when removing patches

• As soon as the patch is removed, it should be folded firmly in half so that the sticky side sticks to itself.

• If staff touch the gel (sticky side) they must rinse their hands with water

• The old patch should be placed in the empty foil pack the new patch came out of and discarded in a sharps bin, clinical waste bin or for care homes without nursing they can be returned to the supplying pharmacy for destruction.

• Gloves should be removed and hands washed thoroughly.

Any unused patches should also be disposed of and documented appropriately in line with the care homes Controlled Drugs policy.

If you have any questions relating to the above guidance or would like further information relating to competency assessments and training in this area please contact Lisa Ryley – Governance and Social Care Technician, lisa.ryley@nottspct.nhs.uk or Coral Osborn- Senior Prescribing and Governance Adviser, coral.osborn@nottspct.nhs.uk.

This guidance has been adapted and with contributions from:

Lisa Ryley & Coral Osborn - NHS Nottinghamshire County, Social Care Medicines Management Team

Roger Knaggs- Advanced Practitioner - Anaesthesia & Pain Management, Nottingham University Hospitals NHS Trust

NHS Buckinghamshire & Oxfordshire Cluster - Good Practice Guidance 5: Use of fentanyl patches in Care Homes

NHS Lincolnshire Medication Procedure Guidance (Adult Care Homes)

Further information can be found in ‘A Guide to Good Practice in the Management of Controlled Drugs in Primary Care (England)’ on the NPC website (npc.nhs.uk)

-----------------------

Special Appendix Edition - December 2012

There have been a number of serious incidents relating to fentanyl patches recently including one case that has been heard at the coroners court. Incidents have included old patches not being removed at the time of a new application, lost patches and patches not being administered on the correct day.

The following guidance has been produced to remind staff of the procedures that need to be followed to ensure the safe administration and management of transdermal patches to all residents and service users. Please ensure that if you do not currently have a procedure in place you adapt the guidance below for your service requirements and incorporate it into your medication policy. One idea could be to place a laminated copy of your fentanyl patch procedure within your MAR chart folders, for easy access and reminder to staff.

ALL staff should sign to state they have read the guidance and staff involved in the direct management of fentanyl patches should be assessed to ensure competence.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download