Medication: Transdermal Patch, Applying PDF

‡†‹ ƒ–‹‘ǣ”ƒ•†‡”ƒŽƒ– Šǡ’’Ž›‹‰ 569 ‡ ‘•–‹–—–‹‰‘™†‡”‡†‡†‹ ƒ–‹‘‹ƒ‹ƒŽ continued while holding the syringe with the medication dose vertically and at eye level. and discard any surplus. 17. After the correct dose is 19. Depending on facil...

‡†‹ ƒ–‹‘ǣ”ƒ•†‡”ƒŽƒ– Šǡ’’Ž›‹‰ 569 ‡ ‘•–‹–—–‹‰‘™†‡”‡†‡†‹ ƒ–‹‘‹ƒ‹ƒŽ continued while holding the syringe with the medication dose vertically and at eye level. and discard any surplus. 17. After the correct dose is 19. Depending on facility withdrawn, remove the policy, the third check needle from the vial and of the label may occur at carefully replace the cap this point. If so, recheck over the needle. If a filter the label with the CMAR/ needle has been used to MAR before taking the draw up the medication, medications to the patient. remove it and attach the 20. Lock the medication cart appropriate administra- before leaving it. tion device. Some facili- 21. Perform hand hygiene. ties require changing the needle, if one was used to withdraw the medication, before administering the medication. 22. Proceed with administra- 18. Check the amount of tion, based on prescribed medication in the syringe route.  ͕͔͙    The transdermal route is being used more frequently to deliver medica- tion. A disk or patch that contains medication intended for daily use or longer is applied to the patient’s skin. Transdermal patches are com- monly used to deliver hormones, opioid analgesics, cardiac medications, and nicotine. Medication errors have occurred when patients apply multiple patches at once or fail to remove the overlay on the patch that exposes the skin to the medication. Opioid analgesic patches are associ- ated with the most adverse drug effects. Clear patches have a cosmetic advantage, but they can be difficult to find on the patient’s skin when they need to be removed or replaced. DELEGATION CONSIDERATIONS The administration of medication via a transdermal patch is not del- egated to nursing assistive personnel (NAP) or to unlicensed assistive personnel (UAP). Depending on the state’s nurse practice act and the organization’s policies and procedures, the administration of a trans- dermal patch may be delegated to licensed practical/vocational nurses (LPN/LVNs). The decision to delegate must be based on careful analysis of the patient’s needs and circumstances, as well as the qualifications of 570 SKILL 105 the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A. EQUIPMENT Medication patch (CMAR) or Medication Disposable gloves Administration Record Scissors (optional) (MAR) Washcloth, soap, and water Additional PPE, as indicated Computer-generated Medica- tion Administration Record ASSESSMENT Assess the patient for any allergies. Check the expiration date before administering the medication. Assess the appropriateness of the drug for the patient. Review assessment and laboratory data that may influence drug administration. Verify patient name, dose, route, and time of administration. Assess the skin at the location where the patch will be applied. Many patches have different and specific instructions for where the patch is to be placed. For example, transdermal patches that contain estrogen cannot be placed on breast tissue. Check the manufacturer’s instructions for the appropriate location for the patch. The site should be clean, dry, and free of hair. Do not place transder- mal patches on irritated or broken skin. Assess the patient for any old patches. Do not place a new transder- mal patch until old patches have been removed. Verify the application frequency for the specific medication. Assess the patient’s knowledge of the medication. If the patient has a knowledge deficit about the medication, this may be the appropri- ate time to begin education about the medication. If the medication may affect the patient’s vital signs, assess them before administration. If the medication is for pain relief, assess the patient’s pain before and after administration. NURSING DIAGNOSIS Risk for Allergy Response Risk for Impaired Skin Integrity Deficient Knowledge OUTCOME IDENTIFICATION AND PLANNING Medication is delivered via the transdermal route. Patient experiences no adverse effect. Patient’s skin remains free from injury. Patient understands and complies with the medication regimen.  ‡†‹ ƒ–‹‘ǣ”ƒ•†‡”ƒŽƒ– Šǡ’’Ž›‹‰ ǦǦǦ 571 IMPLEMENTATION ACTION RATIONALE 1. Gather equipment. Check This comparison helps to identify medication order against the errors that may have occurred original order in the medical when orders were transcribed. record, according to facility The primary care provider’s policy. Clarify any inconsis- order is the legal record of medi- tencies. Check the patient’s cation orders for each facility. chart for allergies. 2. Know the actions, special This knowledge aids the nurse nursing considerations, in evaluating the therapeutic safe dose ranges, purpose effect of the medication in rela- of administration, and tion to the patient’s disorder and adverse effects of the medi- can also be used to educate the cations to be administered. patient about the medication. Consider the appropriate- ness of the medication for this patient. 3. Perform hand hygiene. Hand hygiene prevents the spread of microorganisms. 4. Move the medication cart to Organization facilitates error-free the outside of the patient’s administration and saves time. room or prepare for admin- istration in the medication area. 5. Unlock the medication cart Locking the cart or drawer safe- or drawer. Enter pass code guards each patient’s medication and scan employee identifi- supply. Hospital accrediting cation, if required. organizations require medica- tion carts to be locked when not in use. Entering pass code and scanning ID allows only autho- rized users into the system and identifies the user for documen- tation by the computer. 6. Prepare medications for This prevents errors in medica- one patient at a time. tion administration. 7. Read the CMAR/MAR and This is the first check of the select the proper medication label. from unit stock or the patient’s medication drawer. 572 SKILL 105 ACTION RATIONALE 8. Compare the label with the This is the second check of the CMAR/MAR. Check expira- label. Verify calculations with tion dates and perform cal- another nurse to ensure safety, if culations, if necessary. Scan necessary. the bar code on the package, if required. 9. Depending on facility This third check ensures accu- policy, the third check of racy and helps to prevent errors. the label may occur at this Note: Many facilities require the point. If so, when all medi- third check to occur at the bed- cations for one patient have side, after identifying the patient been prepared, recheck and before administration. the labels with the CMAR/ MAR before taking the medications to the patient. 10. Lock the medication cart Locking the cart or drawer safe- before leaving it. guards the patient’s medication supply. Hospital accrediting organizations require medica- tion carts to be locked when not in use. 11. Transport medications to the Careful handling and close patient’s bedside carefully, observation prevent accidental and keep the medications in or deliberate disarrangement of sight at all times. medications. 12. Ensure that the patient Check agency policy, which may receives the medications at allow for administration within the correct time. a period of 30 minutes before or 30 minutes after the designated time. 13. Perform hand hygiene and Hand hygiene and PPE prevent put on PPE, if the spread of microorganisms. indicated. PPE is required based on trans- mission precautions. 14. Identify the patient. Identifying the patient ensures Compare the the right patient receives the information with medications and helps prevent the CMAR/MAR. errors. The patient’s room num- The patient should ber or physical location is not be identified using at least used as an identifier (The Joint two methods (The Joint Commission, 2013). Replace the Commission, 2013): identification band if it is missing or inaccurate in any way.  ‡†‹ ƒ–‹‘ǣ”ƒ•†‡”ƒŽƒ– Šǡ’’Ž›‹‰ ǦǦǦ 573 ACTION RATIONALE a. Check the name on the patient’s identification band. b. Check the identification number on the patient’s identification band. c. Check the birth date on the patient’s identification band. d. Ask the patient to state his This requires a response from the or her name and birth date, patient, but illness and strange based on facility policy. surroundings often cause patients to be confused. 15. Complete necessary assess- Assessment is a prerequisite to ments before administering administration of medications. medications. Check the patient’s allergy bracelet or ask the patient about aller- gies. Explain the purpose and action of each medica- tion to the patient. 16. Scan the patient’s bar code This provides an additional on the identification band, if check to ensure that the medica- required. tion is given to the right patient. 17. Based on facility policy, Many facilities require the third the third check of the label check to occur at the bedside, after may occur at this point. If identifying the patient and before so, recheck the labels with administration. If facility policy the CMAR/MAR before directs the third check at this time, administering the medica- this third check ensures accuracy tions to the patient. and helps to prevent errors. 18. Put on gloves. Gloves protect the nurse when handling the medication on the transdermal patch. 19. Assess the patient’s skin Transdermal patches should not where patch is to be placed, be placed on skin that is irritated looking for any signs of irrita- or broken down. Hair can prevent tion or breakdown. Site should the patch from sticking to the be clean, dry, and free of hair. skin. Rotating sites reduces risk Rotate application sites. for skin irritation. 20. Remove any old trans- Leaving old patches on a patient dermal patches from the while applying new ones may patient’s skin. Fold the old lead to delivery of a toxic level of patch in half with the adhe- the drug. Folding sides together sive sides sticking together prevents accidental contact with 574 SKILL 105 ACTION RATIONALE and discard according to remaining medication. Wash- facility policy. Gently wash ing area with soap and water the area where the old patch removes all traces of medication was with soap and water. in that area. 21. Remove the patch from its Touching the adhesive side may protective covering. Remove alter the amount of medication the covering on the patch left on the patch. Pressing firmly without touching the medica- for 10 seconds ensures that the tion surface. Apply the patch patch stays on the patient’s skin. to the patient’s skin. Use the Massaging the site may increase palm of your hand to press absorption of the medication. firmly for about 10 seconds. Do not massage. 22. Depending on facility policy, Most manufacturers recommend initial and write the date and against writing on patches due time of administration on a to insufficient data on the prac- piece of medical tape. Apply tice. Writing on the patch could the tape to the patient’s skin damage or tear it. Moreover, if in close proximity to the ink is used, it may leach through patch. Do not write directly and come into contact with the on the medication patch. medication, and it is not known whether ink might interact with a given medication or impede its delivery. 23. Remove gloves and Removing PPE properly reduces additional PPE, if the risk for infection transmis- used. Perform hand sion and contamination of other hygiene. items. Hand hygiene prevents the spread of microorganisms. 24. Document the administration Timely documentation helps to of the medication immedi- ensure patient safety. ately after administration. See Documentation section below. 25. Evaluate the patient’s response The patient needs to be evalu- to the medication within the ated for therapeutic and adverse appropriate time frame. effects from the medication. EVALUATION Medication is delivered via the transdermal route. Patient experiences no adverse effect. Patient’s skin remains free from injury. Patient understands and complies with the medication regimen.