Fentanyl patches are easy to use…just slap it on right? I definitely see nurses ask for these patches fairly frequently, and they are much easier for administration and less time consuming than oral dosage forms that you might have to give one, two or three times a day, that is if all goes well. There are many cases I’ve seen where fentanyl patches are NOT appropriate. One such case is in the event of acute pain. Per Lexi, fentanyl has an onset of 6 hours, and may not begin to have near full effect for 12 to 24 hours. In one case I came across, a resident was sent to the ER for a fall, and prescribed a fentanyl patch with no prn pain med available…would you like to be that patient and wait at least 6 hours before the analgesic effects even start? Clearly in pain, staff had to call back and get an order for a prn opioid to go with the fentanyl.

One other important point I want to make on these tonight is that like I mentioned with Coumadin dosing, the frequency of changing the patch is a funky timeframe. They are usually changed every third day, or every other day. I frequently see medication errors in which the patch got left on or didn’t get changed appropriate – it’s another one of those cases where there isn’t a routine (i.e. daily) and it makes it easier to make an error.