Patches
Patches are thin pads with an adhesive back that are applied to the skin. They contain medicines that pass through the skin into the bloodstream.
Different types of medicine are available in patch form. These include:
- pain killers
- medicines to treat Parkinson's Disease
- hormones
- smoking cessation
- medicines to control nausea and vomiting
Applying patches
Applying and safe disposal of patches must be included in medication training for all provider staff as part of induction and refresher training.
Providers need to make sure staff use the correct application technique and frequency determined by the prescriber. The interval between patches can vary from once a day to once a week. It is important that staff have access to information and guidance on how often to apply patches for an individual service user.
It may be important to note that:
Specialist Pharmacy Service (SPS) released guidance for rivastigmine patches in March 2021. This guidance recommends writing the date the patch is applied in ballpoint pen on the back of the patch which could help with clarification if needed at a later date.
Normally, staff should apply patches to a dry, flat area of skin, usually the upper arm, chest or back.
Where more than one patch is needed, these should be applied to the same area of the body but should not overlap.
Staff must NOT cut or damage reservoir style patches. This will cause the medicine to leak from the patch. Staff MUST get clear guidance from the prescriber and pharmacist before cutting patches and ensure records are made, kept safe and audited with all other medication records.
Please note: Fentanyl patches (an opioid painkiller) should not be cut .
It is normally advisable to rotate the site of the patch each time a new one is applied. Manufacturer's instructions will vary from patch to patch and should always be followed before any patch is applied to the skin. 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. This could lead to overdose. Staff should be aware of the signs of overdose and seek medical attention if overdose is suspected.
Heat can increase the absorption of some medicines through the skin into the bloodstream. Patches should not be applied immediately after a person has had a bath or shower. People with a fever should be observed for signs of toxicity.
Disposing of patches
Remove and dispose of old patches before applying a new patch. This reduces the risk of leaving the old patch in place.
Used patches contain some residual drug. After use, patches should be folded so that the adhesive side of the patch sticks to itself. The folded patch should then be placed back into the original sachet. Used patches should be kept out of sight and reach of children - even used patches contain some medicine that may harm children and may even be fatal.
Records, checks and communication
Staff should record the application of a patch and include the specific location, for example front, right, chest. This could be recorded on a body map. This is important, so other staff can check that the patch is still in place.
It is also important to remove the old patch before applying a new one and document that the old patch has been removed as well as recording when a new one has been applied. This should include the date, time and where on the body the patch was applied.