BackMedicinal Patches Policy
Background
Patches are thin pads with an adhesive back that are applied to the skin. They contain a reservoir or matrix of 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
Staff must use the correct application technique. Staff must apply patches at the frequency determined by the prescriber. The interval between patches can vary from once a day to once a week. Staff must have access to information and guidance on how often to apply patches.
When a patch is applied it must be pressed firmly in place using the palm of the hand for a minimum of 30 seconds making sure the entire adhesive surface is attached to the skin.
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.
Patches should be applied to a dry, flat area of skin, usually the upper arm, chest or back. Staff may need to clip the person’s hair to give better adhesion.
Where more than one patch is needed, these should be applied to the same area of the body but should not overlap.
Do not cut or damage reservoir style patches. This will cause the medicine to leak from the patch.
Matrix patches are sometimes cut. This makes their use ‘off-licence’. Staff should get clear guidance from the prescriber and pharmacist before cutting patches. Fentanyl patches (an opioid painkiller) should not be cut.
Rotate the site of the patch each time you apply a new one. The manufacturer will have provided further instructions. These instructions vary from patch to patch. 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 and it should be disposed of via the client’s usual waste arrangements. 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. Regularly check that patches are being applied correctly and are still in place.
Old patches are occasionally left in place when applying a new patch, therefore it is encouraged to document that the old patch has been removed in a similar way to documenting when the patch is applied.
Staff must communicate information about patches when a person is transferred between settings. This should include the date, time and where on the body the patch was applied.
Date: January 2024
Version: 4 (Review)
Source: CQC
https://www.cqc.org.uk/guidance-providers/adult-social-care/external-medicines-such-creams-patches