Patients with consistent pain, particularly those with difficulty swallowing, are often prescribed a longacting fentanyl transdermal patch. Do not use a fentanyl transdermal system if the pouch seal is broken or the patch is cut, damaged or changed in any way. Nursing home found liable for fatal fentanyl overdose. People who struggle with addiction to fentanyl are less likely to use transdermal patches as they should be used because this is. The nurse checked the patch and noticed a large bubble in the middle such that. Last november, a 2yearold boy, blake, died after accidental exposure to a used fentanyl patch hastily discarded in a longterm care facility. This medicine may cause harm to the unborn baby if you take it while you are pregnant. The effectiveness of transdermal fentanyl in palliative care. The fentanyl in the patch diffuses through the skin and depots in the adipose tissue and provides sustained pain relief. These patches present a unique situation given the multiple boxed warnings, the potential for abuse, misuse and diversion, and the substantial amount of. Accidental exposure to transdermal fentanyl can occur if a patch is swallowed or. Transdermal patch application is easy, but as the nurse you must know how to properly remove and apply a patch. Fentanyl is a controlled drug and so within care homes its use must be entered into a controlled drug cd register and any stock must be stored in an approved cd cabinet. Highalert medications fentanyl patch learn more about highalert medications.
It is, however, not unusual for a dental patient wearing a fentanyl patch to be. A patient is opioidtolerant if oral narcotics have already been used for severe pain. John smith, a terminally ill lung cancer patient has pain that is well controlled on morphine sustained action, 90mg every 12 hours. A study led by camilla pimentel, mph, phd, of the university of massachusetts medical school analyzed a sample of medicare patients living in longstay facilities in 2011. Analgesic action of short duration during anesthesia and immediate postoperative period.
Sn instructed patient and caregiver about fentanyl patch. Fentanyl transdermal patch duragesic is a prescription medication used to treat severe chronic pain such as cancer. Frustrated with the nursing education process, jon started nrsng in 2014 with a desire to provide tools and confidence to nursing students around the globe. This patch would have analgesic properties similar to fentanyl, but be effective for 7 days. We are concerned because of the sedative effect of. Do not apply this medicine to areas that have received radiation treatment. Nursing intervention when using fentanyl georgehoy2s blog.
So, the pharmacist went to the patient care area to follow up and find out how. I use the fentanyl patch for my neck and back pain and my pain management doctor feels that it is okay for me to continue to wear the patch during surgery he is an anesthesiologist. Fentanyl is also available as a sustained release transdermal patch which when applied to a fleshy nonbony region of the body functions as a basal pain medication for 72 hours. However, few significant evidencebased guidelines for nursing practice have been introduced ling, 1997. The fda also issued a public health advisory to alert health care providers that. Is it feasible to taper from 25 by putting on a 12. The bureau of controlled substances and the office of continuing care. Transdermal individualize and regularly reassess doses of transdermal fentanyl. A patient with cancerrelated pain had been wearing fentanyl patches at home.
Those who take fentanyl via transdermal patches as prescribed may develop redness, irritation, or a rash around the site where the patch attaches to the skin. He is also an associate editor for the journal of hospice and palliative nursing and coordinates. Many health care professionals suggest that the patch should only be used for patients who are opioidtolerant and cannot successfully manage there pain with other dugs such as morphine. Another fatal case occurred in a 2yearold boy who was visiting his great grandmother at a nursing home. Excessive heat may increase absorption from patches so local heat should not. Sopalski, is a doctor of pharmacy candidate 2007 and student, university of washington school of pharmacy, seattle, wa. The fentanyl skin patch is only used for opioidtolerant patients. So, the pharmacist went to the patient care area to follow up and find out how the. If applicable, remove the old patch and dispose of it per facility policy. Fentanyl transdermal patches can be applied to the upper arm, chest, or back.
Because its costly, some practitioners limit the use of transdermal fentanyl to patients who cant take oral pain medications. Fentanyl transdermal patches are a controlled substance commonly used in nursing homes for pain medication. Owens, phd, achpn, cns, is clinical assistant professor and director of palliative care, university of washington harborview medical center, seattle, wa. An illinois jury has found that a nursing homes negligence was responsible for a 66year old patients fentanyl overdose and death. The family was visiting the boys greatgrandmother at a nursing home. We ordered a 12 mcg fentanyl patch for our bedbound end stage parkinsons disease and dementia pt who was taking 3gms of tylenol daily for generalized pain. If your patient is very young or confused, choose a site on his back so he cant remove the patch. It works in the brain to change how your body feels and responds to pain. Indications analgesic action of short duration during anesthesia and immediate postoperative period. Before calling transport, the nurse applied a prescribed fentanyl patch of 75. The pain care plan must be flexible to respond to the constantly changing challenges of. This tutorial will cover the application of a fentanyl transdermal patch. What should i know to use fentanyl safely with palliative care patients. Learn everything you need to know about fentanyl sublimaze and its nursing considerations incluing classification and common side effects.
Fentanyl interferes with respiratory function and pupil reaction, both of which are essential parts of neurological assessment. In addition, after removing the patch it is vitally important to have another nurse witness the disposal of the patch because it is a controlled substance. Coggins, pharmd, cgp, fascp todays geriatric medicine vol. Fentanyl is a potent opioid analgesic that increases pain threshold, alters pain reception and inhibits ascending pain pathways by binding to stereospecific receptors within the cns.
License suspended for billings clinic nurse fired for. Transdermal fentanyl, or the fentanyl patch, is commonly prescribed for. Smith is now unable to swallow and so the morphine needs to be converted into a transdermal fentanyl patch. Because fentanyl patches therefore are contraindicated for treatment of acute. A patient from whom a diverted fentanyl patch is removed is made to suffer. Jon haws rn began his nursing career at a level i trauma icu in dfw working as a code team nurse, charge nurse, and preceptor. Check with your doctor if you have questions about this.
If you are 65 or older, use fentanyl transdermal patch with care. The boards notice said mills reported he began using fentanyl left over from patient procedures in november 2016 and later used syringes to remove fentanyl from vials and replaced it with saline. A nurse or other trained health professional will give you this medicine after. Fentanyl patch not adhering properly during use article. Multiple risks for patients using the transdermal fentanyl patch. Two days after the visit he was found unconscious, in respiratory arrest. Fentanyl patch in the use of chronic pain nursing essay. Pain control, one of the central goals of hospice care, is a top priority in endoflife care. Scottish palliative care guidelines fentanyl patches. Fentanyl sublimaze nursing pharmacology considerations. Always have another nurse witness you disposing of the old fentanyl patch and dispose according to your hospitals protocol. Dear administrator fentanyl alert department of health. This medicine is only for use by people who have been taking pain drugs opioids and are used to their effects.
Fentanyl side effects tolerance, withdrawal, hallucinations. Another patient at this hospital had the actavis fentanyl patch fall off after 24. Converting from oral morphine to fentanyl transdermal patch. This problem has affected two patients and involved three fentanyl strengths. Every employer has specific guidelines for how this is done. A new patch using sufentanil, a form of fentanyl, is under development. While wearing a fentanyl patch, do not expose the site to heat from a heating pad, electric blanket, sauna, hot tub. I talked to the pharmacist today and he said that i absolutely should take off the patch, and even should take it off a few hours before since the medicine is still in the body and releasing so i dont. If you are pregnant or you get pregnant while taking fentanyl transdermal patch, call your doctor right away. Fda has since 2005 warned about the risks of transdermal fentanyl patches, particularly among opioidnaive patients, but nursing homes have not completely phased out the longacting analgesics. Its extended action is designed to treat patients with moderate to severe chronic pain. They are medicated sticky, adhesive patches wore on the skin.
Abstral fentanyl dose, indications, adverse effects. It is very important to always remove the previous patch before applying the new patch. A patient with cancerrelated pain had been wearing fentanyl patches at home, prior to being admitted to the. Fentanyl transdermal patch is a prescription medication thats used to treat chronic pain in opioidtolerant people. Analgesic supplement in general or regional anesthesia. The use of transdermal fentanyl the use of transdermal fentanyl has been suggested as an alternative to oral morphine for the management of cancer pain when the oral route is no longer viable. The patients primary care physician called the pharmacy and prescribed a. Care home transdermal patch placement chart adapted by john dicomidis and beth walton, complex care, abuhb and alex kelleher, care inn ltd the patch should be checked on a. Do not change fentanyl patches to another opioid in a dying patient, continue the fentanyl patch and use an additional opioid as required via csci.
In anesthesia and critical care, fentanyl is often preferred to morphine due to its ability to attenuate hemodynamic responses and maintain cardiac stability. While using fentanyl patches, discuss with your health care provider your pain treatment goals, length of treatment, and other ways to manage your pain. Fentanyl is a hospice medication used to help relieve severe, ongoing pain such as that caused by cancer. Further investigation at this longterm care facility found used medication patches in other patient. Always wear gloves when removing and applying a fentanyl patch. The longacting transdermal fentanyl patch formulations are not to be used when a patient is opioidnaive.
A nurse applied a prescribed fentanyl patch, at a dose of 75 mcghour, to the. Ongoing, preventable fatal events with fentanyl transdermal. This medicine is not for mild pain or pain that only lasts a short time like headaches, toothaches, or pain after surgery. Nursing considerations repeated intraoperative doses can cause respiratory depression to persist into the postoperative period.
If adhesion of patch to skin is a problem, use an adhesive film dressing over the patch e. The patient was converted from a morphine pump to a fentanyl patch. Dispose of the unused part of the patch safely as described in the fentanyl patch care section. This cpg is not meant to be a replacement for training, experience. Proper disposal of fentanyl patches is critical to prevent. Withdrawal symptoms, drug interactions, dosage, and pregnancy and breastfeeding safety are provided. This is moderately common, although it should be reported to a doctor. Pain management in hospice care todays geriatric medicine. When administering a new patch, always remove the previous patch before applying the new one. These patches present a unique situation given the multiple boxed warnings, the potential for abuse, misuse and diversion, and the substantial amount of fentanyl remaining in the patch after use.
Assess the therapeutic response and in breakthrough cancer pain consider adjustment of background analgesia where this is appropriate. Fentanyl is an opioid pain medication, sometimes called a narcotic fentanyl patches are a strong prescription pain medicine. Extra care is needed because fentanyl is a highalert medicine. This medication also can be dispensed in a dissolving, underthetongue tablet. Transdermal fentanyl, or the fentanyl patch, is commonly prescribed for patients with cancer pain or moderate to severe chronic, persistent pain. Highalert medications fentanyl patch consumer med safety. Fentanyl belongs to a class of drugs known as narcotic opiate analgesics. Each fentanyl transdermal system is sealed in its own protective pouch. Nursing nursing intervention when using fentanyl journals american society of registered nurses. Read nursing medical journals online massachusetts general hospital department of nursing title the effectiveness of. The patches are used to treat moderate to severe chronic pain around the clock fentanyl patches are used when other pain treatments such as nonopioid pain medicines or immediaterelease opioid medicines do not treat your pain well enough or you cannot tolerate them.
Healthcare professionals should use sound clinical judgment and individualize patient care. A hospital pharmacist reported issues with transdermal fentanyl patches from actavis stating that the patches do not maintain contact with the patients skin. Select a new site for the patch on a flat surface such as the chest, back, flank, or upper arm. Do not remove a fentanyl transdermal system from the pouch until you are ready to use it.
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