Medication delivered transdermally in the form of skin patches is still a relatively new concept. Although there are many advantages of using these patches, there are also some inherent risks.
Not all people absorb medication from patches equally. Things like skin heat, and also skin tolerance can affect absorption. Tolerance has also been seen in patients using the patch for attention disorder, about 13% of these patients became tolerant of the medication, blocking the skin from absorbing it.
The U.S. Food and Drug Administration (FDA) has issued alerts for numerous transdermal medication patches due to potential increased risks for burns during magnetic resonance imaging scans. Some transdermal patches contain aluminum in their backing of the patch that does not come into contact with the skin. During a MRI scan, the metal can overheat and cause a skin burn over the area of the patch.
Despite these risks, transdermal patches have many advantages. The patch is a handy pharmaceutical tool, especially for those who may forget to take their medication or have difficulty swallowing tablets. Many people find the patch to be convenient, and since most patches allow the user to bathe and swim, they are not disruptive at all to daily life. Transdermal patches also offer a quicker and steadier delivery system than oral medications do.
Nurses have a vital role to play in educating patients about how to use the patch for maximum safety and effectiveness. It is especially important to encourage patients to disclose their medication patch use when sharing their medication history with a healthcare professional or scheduling an MRI. People often don’t consider the patch to be medication and may neglect to include them when questioned about current medications. In addition, patients often forget to remove used patches prior to applying new ones. This is a serious safety concern, as the amount of medication absorbed may be more than the amount prescribed. Cutting patches in half is also a dangerous practices that should be avoided. The correct disposal of used patches is necessary to protect young children and pets from inadvertently gaining exposure to the drug. In January 2010, a nursing assistant in Telford, Pennsylvania was caught peeling fentanyl pain patches off two female residents at a retirement home, to feed her drug habit. This reinforces the need to educate patients on the safe disposal of these patches.
Patch placement education is also needed to ensure safe and effective utilization. The purpose and possible adverse effects should be clearly explained to the patient prior to use. The patient should be instructed to select a clean, dry area of skin such as the upper chest. The area should not be shaved, as this can cause skin irritations and lacerations. The patch should never be applied to an area in which the skin is irritated or inflamed, or has scars or skin folds, or below the elbows or knees. Any previously used patches should be removed prior to applying a new one. Instruct the patient to remove the patch from its protective covering. Without touching the adhesive, the clear plastic backing should be removed, and the patch applied firmly to the skin, with pressure maintained for about 10 seconds. The patch should adhere well, especially around the edges.
The date and time of application should be recorded. Re-application of the patch should be performed as prescribed and on a regular basis to ensure the appropriate medication effect. To avoid irritating the skin, the application sites should be rotated, using the corresponding site on the opposite side of the body.
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