Fentanyl patch dose

[Monkeyspawn]

Hi, can someone please tell me if this dose complies with cd regs for fentanyl "Apply patch every 72hrs". It doesn't actually quantify the number of patches, even though it clearly means ONE patch. The doctors here keep sending rxs with this dose and we keep sending them back to be amended to "Apply 1 patch every 72hrs".

[nicholass]

I don't think will worry too much, as long as all the legal requirements comply. I assume you can justify the dosage by contacting the prescribers, not necesarrily sending them back.

[DavidS]

Yes, it complies. patch = 1 singular patch. If it said "apply patches every 72 hours" then obviously it wouldn't.

[El-loco]

Yes but which patch - I mean there are several in those boxes. And if you apply it every 72 hours how long do you leave it on for? And when they say "apply" it does that mean that the patient has to nominate it as the patch in force at that time?

Surely to God pharmacists ought to be trusted to ascertain exactly what dose of fentanyl per hour the prescriber intends to be used for analgesia and for how long before that dose is reviewed and take charge of ensuring that this is what the patient receives along with suitable instructions for the use of this product. How low have we sunk in everyone's estimation that we cannot be trusted to use our expertise and have to return green bits of paper for a few more scribbles to be added to them.

Or is it that the world thinks we would knowingly or otherwise aid a mass murderer to achieve their aims.

"Just sit there Mrs. Smith while I cover you in these patches and then wait for a few hours until they take effect."

or maybe we are helping (very patient) drug abusers to get high - in a day or so.

Is there any other profession (assuming we can still call ourselves a profession) that is trusted so little.

If we put up with being treated in this way we are paving the way for all dispensing to be carried out by NVQ dispensers who are required only to follow sets of rules to the letter.

Sorry for the rant - but you can see what I am trying to say.

[DavidS]

"Just sit there Mrs. Smith while I cover you in these patches and then wait for a few hours until they take effect."

rofl

I suppose you could use one to roll a spliff with.

[Defblade]

We should never have to guess on a CD script (or any other, really, but that's another battle).

Ours are usually briefer - "Apply every 72 hours" - and I was told by one GP that that is because it's their computer's default instructions. I suggested they asked their IT supplier to change it to something legal...

After maybe 2 years of sending notes back, there seems to be some improvement!

I don't think we've sunk anywhere recently - it's been the same with CDs since I started. In fact, we've been given a little more leaway of late. I still don't see why we should knowingly break the law just because GPs don't do their job right. AND, if (OK, it's quite an "if" but it does happen) anything does go wrong, guess who out of the GP and the pharmacist is going to be in the pooh?

[El-loco]

But when did you start Defblade? It has certainly gotten worse since I did.

It used to be an offence for a doctor (in those days all prescribers were either doctors, dentists or vets) to issue an incomplete CD script (not that anyone would ever have had the temerity to take them to task over it) but now it is not, while the pharmacist is not trusted to do anything at all.

[Defblade]

But when did you start Defblade? It has certainly gotten worse since I did.

'93.

I'm annoyed too that offence of issuing an incomplete CD script has been removed - it used to be a bit of leverage with really arsey doctors (did you EVER hear of a Dr being done for it though? Unlike pharmacists who overstepped the rules ). But that went hand-in-hand with our ability to change a few bits on the scripts.

[lilly hunt]

can i just ask if prescription is written fentanyl patches "50" apply 1 patch as directed evry 72 hoursx5 patches is this legally written?i know the pharmacist can write the number five in words and initial the script.but does it have to say 50 "mcg"eventhough we know it only come sin that strength and there is no confusion which strenght the doctor wants us to give! help yhanks

[Defblade]

can i just ask if prescription is written fentanyl patches "50" apply 1 patch as directed evry 72 hoursx5 patches is this legally written?i know the pharmacist can write the number five in words and initial the script.but does it have to say 50 "mcg"eventhough we know it only come sin that strength and there is no confusion which strenght the doctor wants us to give! help yhanks

Well, tecnically it's 50mcg/hr....

Prescriptions for fentanyl patches can be written to show the strength in terms of release rate and it is acceptable to write "Fentanyl 25 patches" to prescribe patches that release 25 micrograms per hour. The dosage should be expressed in terms of the interval between applying a patch and replacing it with a new one, e.g. "one patch to be applied every 72 hours". The total quantity of patches to be supplied should be written in words and figures.

Each patch contains not only strength x 72 hours of fentanyl, but also some overage to ensure that over those 72 hours, the rate of fentanyl absorbtion remains constant. The amount will vary by manufacturer and patch technology. The upshot is, we really don't know how much fentanyl we're actually giving out!