Cut to the Chase About Whether It’s Okay to Cut Patches

Dangerous errors with transdermal patches are still occurring...often due to mistakenly cutting them.

Recently, a child’s clonidine patch was accidentally cut in half...to provide a lower dose. The child experienced clonidine toxicity (bradycardia, somnolence, unresponsiveness)...but fortunately recovered.

Know which patches can and canNOT be cut. Most should NEVER be cut...since they release a constant amount of drug over time. Cutting may cause the drug to release too fast...which could lead to an overdose.

Remind nurses to NEVER cut patches that deliver exact dosing (fentanyl, contraceptives, etc)...since consistent med levels are crucial.

Reservoir patches, such as NicoDerm CQ, release drug in a rate-controlled membrane. These should also NEVER be cut, since it may lead to “dose dumping”...or quickly releasing large, toxic amounts of drug.

But be aware of a few exceptions.

For example, lidocaine (Lidoderm, ZTlido) patches CAN be cut...since the med is evenly distributed in the adhesive layer. Nurses should cut these patches BEFORE removing the liner.

Explore options if a patient needs a lower dose of a patch that can’t be cut, such as scopolamine. For example, some resources suggest it’s okay to leave the backing on half the patch to provide half the dose.

Nurses should place the patch cover over the patch if needed. If there’s no cover, secure loose edges with medical tape.

Know what to do if an inappropriately cut patch gets applied.

Instruct the nurse to remove the patch immediately...wash the area with soap and water...and monitor patients for any life-threatening symptoms (shortness of breath, unresponsiveness, etc).

Don’t be surprised to see naloxone ordered for patients getting discharged on long-acting opioid patches, such as fentanyl.

Emphasize standard safe-use strategies with patches.

Consider removing patches prior to MRI, due to burn risk with metal backings. Not all metal-containing patches have a labeled MRI warning.

If possible, leverage your EHR to include warnings on patch orders when appropriate, such as “Do not cut.”

Discard all patches with the sticky sides folded together. Follow your institution’s policy around proper patch disposal.

Counsel on proper application at discharge. Patients should apply patches to clean, dry, intact skin...rotate application sites...and remove old patches before applying new ones.

Review our Characteristics of Transdermal Patches chart for patch delivery systems, which patches can be exposed to water, and more.

• Chart: Characteristics of Transdermal Patches (US)
  
• Checklist: Dos and Don’ts With Patches