General advice - using transdermal patches in a health or social care setting

Mitigating risk

Using transdermal patches in a health or social care setting includes several steps, each associated with a risk of error.

The NHS Specialist Pharmacy Service have provided practical advice for healthcare professionals at the key stages in the application of transdermal patches (1)

• advice does not replace manufacturers instructions which should always be followed

Application and removal

Before applicationHealthcare professionals should make the following checks:

1. RIGHT person
2. RIGHT medicine
3. RIGHT route
4. RIGHT dose
5. RIGHT time
6. RIGHT documentation

Check the pharmacy label carefully

Confirm the correct frequency or interval on the pharmacy label on the product packaging, as this can vary from days to weeks.

Choose and prepare the application site

• rotate the site of application each time a patch is applied
  • refer to records to check the previous application site
  • some patches can cause a thinning of the skin
    • if routinely applied to the same area, the rate of absorption into the bloodstream can be higher
    • could lead to overdose
• ensure the skin is dry, intact and not irritated
• a flat area of hairless skin is suitable and you may need to clip the person's hair to give better adhesion
• the upper back may be preferable in a confused patient to reduce the risk of unintended patch removal

Healthcare professionals should not:

• expose the application site to oils, creamy soaps or moisturisers
  • these products may be irritant or cause allergic reactions when the patch is applied
• shave the hair as this may irritate the skin
• take the patch out of the wrapper until you are ready to apply it to the skin site

During application

Healthcare professionals should:

• wash hands before and after application
• always ensure old patches are removed before applying a new one
• follow manufacturers' product literature carefully for step-by-step instructions on the correct application technique
• instructions can be found on the product packaging or in the accompanying Patient Information Leaflet, or electronically via the Electronic Medicines Compendium (eMC).
• once applied, check the patch has adhered onto the skin properly, especially on the edges
• add a note in the electronic or written records that the patch has been applied, including the date and time.
• if possible, write the date and time of application on the patch itself using a soft-tip permanent marker pen, taking care not to damage or tear the backing liner.

Avoid during application

Healthcare professionals should not:

• apply a patch immediately after a person has had a bath or shower as heat can increase the absorption of medicines.
• touch the adhesive side of patches.

Multiple patches

• always consider the range of strengths available and if it is possible to use a higher strength rather than multiple patches
• when more than one patch is needed, apply to the same area of the body but do not overlap the patches

At removal

Healthcare professionals should:

• locate the patch (or patches) and check when it should be removed: ask the patient to show you the location, check the electronic or written records
• check that there is no indication that the patch has been tampered with since application
• ensure that you are removing the correct patch, as people may be using more than one type of patch
• carefully remove the patch to minimise skin reactions
• clean the application site with water to remove leftover adhesive
• add a note in the electronic or written records that the patch has been removed, including the date and time

Avoid at removal

Healthcare professionals should not:

• apply another patch until the previous patch or patches have been located and removed.

Magnetic resonance imagingMagnetic resonance imaging can heat transdermal patches containing metal components and cause a small increase in body temperature (1):

• can result in skin burns or drug toxicity
• Fentanyl and buprenorphine patches are known to result in serious overdose
• can be difficult to accurately confirm which patches contain metal

Advice for all transdermal patches during MRI (1):

• remove the transdermal patch before the patient enters the MRI scan room
  • significant blood concentrations may exist for short periods because of the reservoir of medicine within the skin
• replace with a new patch straight after the scan
  • ensure you follow our advice on before application and during application.
• update records when the replacement patch is applied
  • ensure you follow our advice under record and document.
• continue to change the patch on the usual day and time e.g. if you normally change the patch on a Monday and the scan is on Wednesday, replace it on Wednesday and change it as usual on Monday

For full details (including the management of other scenarios associated with using transdermal patches) then see Using transdermal patches safely in healthcare settings

Notes

• Fentanyl
  • in 2014, the MHRA highlighted the risk of life threatening harm from accidental exposure of fentanyl patches.
• Rivastigmine
  • the MHRA advise patients and carers on the correct use of rivastigmine

Reference:

1. NHS Specialist Pharmacy Service (May 2022). Using transdermal patches safely in healthcare settings