Proper Use of Duragesic (Fentanyl) Patches
What You Need to Know About Duragesic (Fentanyl)
Fentanyl (Duragesic) patches are often used in the long-term care setting for residents requiring around-the-clock pain management. Over the past few years there has been an increase in fentanyl overdose and diversion so we want to provide you with additional information to keep your residents and nurses safe.
Site Placement and Preparation: The patch should only be applied to intact, non-irritated, and non-irradiated (not exposed to radiation) skin. Apply the patch to a flat surface (the chest, back, flank between the pelvis/hip and the last rib, or the upper arm). Hair at the site of application may be clipped, not shaved, prior to the application of the patch. If the application site is cleansed immediately prior to the application of the patch, do so with clear water only. Allow the skin to dry completely before applying the patch.
Duragesic Administration: Apply the patch immediately upon removal from the sealed package. The patch should be initialed and dated by the nurse prior to placement. The patch may not be cut or altered in any way. Press the patch firmly in place with the palm of the gloved hand for 30 seconds making sure the contact with the skin is complete especially around the edges. The patch is worn continuously for 72 hours. BEST PRACTICE: Placement is checked by the nurse assigned to the patient every shift and documented on the MAR.
Destruction: Upon removal of the old patch, it must be immediately destroyed by the nurse assigned to the patient and witnessed by another nurse. The adhesive side of the patch should be folded to itself and flushed. Both nurses should verify that the patch was definitely flushed (not stuck at the bottom or floating in the toilet). Gloves must be worn during the administration and destruction of Duragesic to avoid accidental exposure. Additional destruction tips: The patch may be placed on a flushable tissue then flushed. Another form of destruction is to place the patch in the RxDestroyer container, if it is used in your facility.
ADHESIVE CONCERNS: If adhesion problems are noted with Duragesic, the edges of the patch may be taped with first aid tape. If problems persist, the patch may be overlaid with a transparent adhesive film dressing.
Did you know that Duragesic levels may increase in patients with a fever? Monitor residents closely for signs and symptoms of elevated Duragesic levels (ex. difficulty breathing). Ask your Alixa Clinical Pharmacist for additional guidance.
References: Duragesic Full Prescribing Information; www.duragesic.com
This article was originally published in our monthly issue of From the Front Lines – a monthly publication that shares best practices and medication-related challenges faced by “front line” staff in long-term care and post-acute (LTCPAC) facilities.