Applying transdermal patches in care homes

For all staff responsible for applying transdermal patches in care homes.

You can download a full pdf version of this document by following the link on the right.

What is a transdermal patch?

It’s a medicated adhesive patch placed on the skin. It delivers a specific dose of medication through the skin and into the bloodstream.

Background

There are several types of patches and the directions for use vary with each brand. It’s very important to read the patient information leaflet before use.

There have been several reported safety alerts related to transdermal patches. These include the potential for life-threatening harm from accidental exposure to transdermal fentanyl patches.

Aim

To support safer administration of transdermal patches and to highlight key issues for when care home staff administers a patch.

This guidance doesn’t cover contraceptive or hormone replacement therapy (HRT) patches. It doesn’t replace manufacturers’ instructions which you should read for patch specific advice.

The process of applying a patch

You should:

always wear a glove
clean the skin if needed with water only and make sure the skin’s dry (soap products can alter absorption)
remove any old patch or patches, dispose of safely before applying the new one and rotate the site of application
check the patch application record sheet as there may be multiple patches on the individual that should be removed.

Don’t:

take a drug patch out of its protective wrapper until you’re ready to apply to the skin site
use a drug patch if the seal is broken, altered, cut, or damaged in any way
use soaps, oils, lotions, alcohol, or other agents that might irritate or alter the skin site¹
expose the application site to direct external heat sources, such as heating pads¹
apply a new patch immediately after a bath or shower, or after using cream, talc or soap on the skin.

You must:

follow the ‘six rights’ of drug administration: Right Resident, Right Medicine, Right Route, Right dose, Right time and Resident’s right to refuse²
record the patch location on a patch application record sheet and MAR sheet. Use a patch application record sheet to show where the patch has been previously placed³
provide privacy for the resident, ensure good hand hygiene and explain the procedure
check the patch daily to make sure it’s still attached firmly in place.

Recommendations

The residents care plan should contain a clear indication for treatment and intended outcomes.

Use a personalised patch application record sheet for all patches (Appendix 1). Keep it with the residents current Medication Administration Record (MAR) chart.

Put a cross on the body map (Appendix 1) where the patch has been applied. Tis will help to locate and replace old patches, and to avoid new patches being applied on the same area.³

MAR sheets should clearly highlight the next due patch change. Cross through any days which don’t need a patch change clearly on the MAR sheet.

Communicate patch change information if a resident transfers to another care home unit or setting, for example hospital. Information should include the last patch change date, current location and the next patch change due date.

Wear gloves when applying a patch for a resident. Remove the old patch and dispose of it first before applying a new one.

Apply the patch to clean dry, non-inflamed, non- irritated, hairless skin on the upper arm or trunks. You can clip body hair but don’t shave. If the site needs cleaning before application, use only clear water and let the skin dry completely.

In cases where a resident needs more than one patch, place it on the same area of the body. The patches must not overlap.⁵

Remove the correct patch. Some residents may have more than one type of patch.

Write the date and time of the application of the new patch on the edge of the patch. Use a soft-tip permanent marker pen. Don’t damage or tear the backing liner. Make sure that it’s visible to all care staff.⁶

Bathing, showering, or swimming shouldn’t affect the patch, but water shouldn’t be too hot.

If a patch falls off, get it documented and signed by a witness in the care plan and behind the MAR chart. Apply a new patch and remove at the correct duration. You may need to order an interim prescription or talk to the resident’s GP about early ordering of the patch for the next medication cycle.

Avoid soaking the patch in a hot bath or sauna. Also, avoid sunbathing. Heat increases the rate of transdermal drug absorption and can cause toxicity. Avoid direct contact with heat, for example, a hot water bottle or heat pad.⁷

If a patient misses or has been non-compliant with their opioid patch, for example, Fentanyl or Buprenorphine, check with the GP before applying the next patch.

If the patient has an elevated temperature, tell the GP as the patch dose may need reviewing. Drug concentrations from opioid patches may increase if the skin temperature increases to 40C such as with Fentanyl patches.⁸

Used patches still contain active medicine which can be fatal if it accidentally touches or sticks to somebody else’s skin. After removal, fold the patch in half over on itself so that the adhesive side sticks together. Residential homes should dispose of used patches via their usual pharmaceutical waste arrangements for instant destruction. Nursing homes should put used patches into their CD denaturing kit.⁹

Talk to your GP or community pharmacist if the brand of a patch changes to another by the prescriber, in particular with controlled drugs such as Fentanyl patches. Drug concentration may vary between different brands.¹⁰

Avoid cutting patches if possible. It will make the use ‘off-licence’. It could also affect the release mechanism of the medicine, for example, releasing too much. Talk to the prescriber and get their authorisation if you need to cut a patch.

For a confused resident, apply the patch to the upper back (see appendix 1) to avoid unintended removal. Refer to local procedures on capacity and consent.