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TRANSDERMAL DRUG (skin patch) administration provides consistent, continuous drug delivery through the skin into the bloodstream. Other advantages include fewer adverse reactions, steady plasma levels, convenience, and improved patient adherence. Whether a transdermal system is the reservoir or the matrix type, it has these four elements: a backing, the drug itself, adhesive, and a release liner. Follow these general guidelines to apply the skin patch; some variations may occur depending on the drug being used and its manufacturer.
* Follow the "five rights" of drug administration.
* Provide privacy, perform hand hygiene, and explain the procedure.
* Don gloves. If applicable, remove the old patch and dispose of it per facility policy.
* Select a new site for the patch on a flat surface such as the chest, back, flank, or upper arm. If your patient is very young or confused, choose a site on his back so he can't remove the patch. Rotate sites throughout therapy. Make sure the skin is intact, nonirritated, and nonirradiated. Avoid hairy areas if possible, or clip excessive hair. If the site needs to be cleaned before application, use only clear water and let the skin dry completely.
Remove the patch from its pouch and peel off half of its protective liner.
Place the adhesive side on the skin, then peel off the other half of the liner. Press the skin patch firmly with the palm of your hand for at least 30 seconds, making sure it adheres to the skin, especially at the edges.
* Remove your gloves and perform hand hygiene.
* Document the medication administration per facility policy.
* Don't take a drug patch out of its protective wrapper until you're ready to use it.
* Don't use a drug patch if the seal is broken, altered, cut, or damaged in any way.
* Don't use soaps, oils, lotions, alcohol, or other agents that might irritate or alter the skin site.
* Don't expose the application site to direct external heat sources, such as heating pads.
Duragesic (Fentanyl Transdermal System). Full prescribing information. http://www.fda.gov/cder/foi/label/2005/19813s039lbl.pdf. Accessed February 11, 2008.
Oertel W, et al. Rationale for transdermal drug administration in Alzheimer disease. Neurology. 69(4, Suppl. 1):S4-S9, July 24, 2007.
Once-daily Exelon Patch (rivastigmine transdermal system). http://www.exelonpatch.com. Accessed February 11, 2008.
Peterson TA. Transdermal drug formulation and process development. Pharmaceutical Technology. 27(6, Suppl.):18-;21, January 1, 2003. http://pharmtech.findpharma.com/pharmtech/data/articlestandard//pharmtech/232003. Accessed February 8, 2008.
Schulmeister L. Transdermal drug patches: Medicine with muscle. Nursing2005. 35(1):48-;52, January 2005.
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