Which one of the following instructions should a medical assistant provide to a patient regarding transdermal patch use and care?

External medicines can include creams, ointments, lotions and patches.

These external medicines are often prescribed to people living in care homes or receiving care at home. To make sure that people are kept safe, these medicines need to be applied effectively. Information should be available to staff to help them to do this. Staff need to complete records to show when these medicines were applied, where and by whom.

People should be able to apply their own external medicines if they choose. You should assess whether the person is safe and has the capacity and dexterity to do so.  You need to review such decisions regularly.

Creams, ointments and lotions

Records

The person applying the external medication should be able to access information about:

• the frequency of use
• thickness of application
• where on the body the medicine should be applied

This could be a member of staff or the person for whom the medicine is prescribed.

You should keep records of any creams applied by staff, nurses, and if applicable carers. This could be in the form of an external or topical medicine administration record.

Storage and disposal

In residential services, store creams securely and record the date they're opened.

Some are subject to environmental contamination. Discard these according to the manufacturer’s directions.

Discard any product whose appearance suggests it is unfit for use.

Fire risk

Please be aware of the fire risk associated with emollients.

People and carers should understand the fire risk associated with the build-up of residue on clothing and bedding and take action to minimise the risk.

When you apply emollient products to people, you should instruct them not to smoke or go near naked flames because clothing or fabric such as bedding or bandages that have been in contact with an emollient or emollient-treated skin can rapidly ignite.

There is a fire risk with all paraffin-containing emollients, regardless of paraffin concentration. That risk cannot be excluded with paraffin-free emollients. A similar risk may apply for other products which are applied to the skin over large body areas, or in large volumes for repeated use for more than a few days.

Be aware that washing clothing or fabric at a high temperature may reduce emollient build-up but not totally remove it.

Patches

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

You must make sure your staff 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. Make sure your staff have access to information and guidance on how often to apply patches.

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, your staff should apply patches 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. Care 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.

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.

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