While ISMP has repeatedly published reports of errors associated with transdermal patches, we now provide details about the error types we discovered during our recent analysis of patch errors. ISMP received 10 reports associated with an error in the frequency of patch application or removal.
Four of these errors involved estradiol patches. In two of the cases, a weekly estradiol patch was prescribed, but a twice weekly formulation was dispensed with directions to apply one patch weekly, which resulted in underdoses. In another case, a physician prescribed a twice weekly estradiol patch with directions to change the patch weekly, also resulting in an underdose.
In the fourth event, a prescriber ordered a twice weekly estradiol patch, but the pharmacy dispensed a weekly patch with directions to apply the patch twice weekly. Some dispensing errors continued for several refills. Three of the 10 frequency errors involved dispensing fenta NYL patches with the wrong directions for application, sometimes due to a transcription error in the pharmacy.
We also received two error reports associated with removing a patch at the wrong time—one involving the removal of a fenta NYL patch instead of a lidocaine patch after 12 hours, and the other involving the removal of a nitroglycerin patch after 24 hours instead of after hours.
Five of these events involved fenta NYL patches. In one case, two patches were found on an unexpectedly somnolent patient during rounds. One health system reported an increase in reports of patients with an applied fenta NYL patch that was missed upon admission and not found on their skin until days later. Because many patches are clear or beige, they might easily be missed on the skin of some patients.
ISMP received seven error reports related to confusing the dose expression on the label of scopolamine patches. The technician also checked the electronic health record, order sets, medication administration record MAR , and an electronic drug information resource, and found that the dose was expressed as 1.
On the back of the Perrigo scopolamine carton, the technician noticed that the patch actually contains 1. This label confusion has led to prescribing, dispensing, and administration errors.
In one reported event, a prescriber ordered 1 mg of a 1. Scopolamine patches should not be cut. In another case, a prescriber ordered a 1. Using a patch bypasses the stomach and delivers medicine into your blood through your skin.
There are two types of medicated patches: reservoir and matrix. The reservoir type has a liquid core surrounded by a membrane controlling how fast the drug moves into the skin. Newer patches use a matrix that combines the drug with the adhesive into a single layer. Drugs available as a patch include nicotine, methylphenidate, nitroglycerin, estrogen, and the analgesics lidocaine, ketoprofen and fentanyl. It needs to stick to your skin without taking off a couple of layers when you remove it.
Finally, because the patch stays on for hours or days, some people develop irritation at the site of the patch. The most common problem reported with patches is redness and itching where the patch was applied. There are 2 types of skin reactions caused by wearing a patch: irritant dermatitis and allergic dermatitis.
The process can be summarized as induction of protons by a magnetic field, followed by excitation with radio frequency pulses and subsequent readout with receiver coils. Thorough screening of each patient for any implantable devices and foreign bodies, pregnancy, and other potential issues is mandatory prior to scanning.
Others include drug-delivery patches which may contain a metallic coil , cardiorespiratory cables, and tattoos which may contain iron oxide pigment. Transdermal patches are self-contained discrete dosage forms that deliver drugs through the skin to the systemic circulation. In some instances, the drug and penetration enhancers or solubilizers are included in the adhesive layer.
Health care professionals should advise patients wearing medication patches about procedures for proper removal and disposal before MRI and replacement afterwards. She is based in the deep South. Webber specializes in articles on greener living. Her work has appeared in various online publications.
She holds a Bachelor of Arts in education from Converse College. By: Cricket Webber. Use a mild soap and lukewarm water to wash the olive oil from your skin. Dry the area with a clean, dry towel and check to see that all of the adhesive has been removed.
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