Using transdermal patches safely in healthcare settings

Using articles in this series

This series of articles is for healthcare professionals prescribing or administering transdermal patches in primary care, secondary care, or care home settings. They are not intended for patients using transdermal patches.

Risks with transdermal patches

Transdermal patches offer a convenient and consistent method of drug delivery. However, while serious incidents are uncommon, they can lead to significant harm or even death. In health and social care settings, each step of the process, from prescribing to disposal, carries potential safety risks.

Common risks include:

• prescribing errors
• confusion between formulations, including strength and frequency
• incorrect application
• adhesion issues and patch displacement
• skin reactions
• overdose from multiple patches or failing to remove used ones
• increased drug absorption from heat
• accidental exposure from improper handling or disposal

This article offers practical guidance on the safe prescribing, application, monitoring, removing, disposing, recording, documentation and storage of patches. It complements but does not replace manufacturer’s specific instructions available in the product literature.

Prescribing transdermal patches

Most patches do not have a daily administration schedule. Dose and frequency of application can vary between products. To prescribe transdermal patches safely: 

• check that the dose and frequency of application is correct
• use higher-strength patches where available instead of prescribing multiple patches  
• consider prescribing by brand to avoid patient confusion or accidental brand-switching – see our article Example medicines to prescribe by brand name in primary care
• counsel the patient or carer on the safe and effective use of patches

If a dose requires cutting or masking a patch and no licensed alternatives are available, follow our guidance Cutting or masking transdermal patches safely.

Applying transdermal patches 

Follow your organisation’s guidelines for administering medicines. This section describes patch specific issues you may encounter. 

Checks before applying a patch 

Before application: 

• confirm dose and frequency against the pharmacy label or prescription
• confirm presence and location of previous patch
• remove old patch before applying a new patch

The MHRA Drug Safety Update highlights that failing to remove rivastigmine patches on schedule or accidentally applying more than one at a time can cause serious harm.

Choosing an application site 

Rotate patch sites to reduce the risk of skin irritation. Refer to the product information for recommended sites of application.

Drug absorption can vary depending on location. Avoid areas such as skin folds, or wrinkled areas. Do not apply patches to irritated or damaged skin. This may lead to excess drug absorption and further irritation or damage to the skin.

It is best to choose an area that is clean, dry, flat and hairless. Avoid sites recently exposed to oils, creamy soaps, or moisturisers as these may interfere with drug absorption or affect patch adhesion.

For children or patients with cognitive impairment, the upper back may be a preferred site to reduce the risk of unintended removal. Refer to local policies regarding capacity and consent. 

Tips for application

If needed, trim hair with scissors instead of shaving, as shaving may cause irritation. Trimming also improves adhesion and reduces skin reactions.

Applying the patch 

To ensure safe application: 

• remove the patch from the wrapper and check it has not been damaged
• peel off the protective foil before application to expose the active adhesive side
• do not touch the adhesive side of the patch to avoid exposure to the medicine
• follow our advice on choosing an application site
• apply the adhesive side of the patch to the chosen site
• press firmly for least 30 seconds to increase adhesion
• check patch has fully adhered to the skin, especially around the edges

For multiple patches of the same medication, apply to the same area of the body without overlapping.

Record application

Record application and include the date, time applied and location of the patch. 

If needed, write the date and time of application on the edge of the patch itself. Take care not to damage or tear the patch. Use a soft tip permanent marker pen. Avoid use of biro or ballpoint pens as these may damage the patch. 

Monitoring during use 

Monitor the patient for application site reactions, missing, omitted or delayed application, exposure to heat or accidental exposure. See our article Managing problems when using transdermal patches.

The MHRA Drug Safety Update warns of unintentional overdose from patches due to dosing errors, accidental exposure, and exposure of patches to a heat source. 

Correct positioning 

Check for correct positioning regularly, preferably at least once a day.

If the patch is not in place, locate it. It may have fallen or be on a different part of the body.

Document the check using locally agreed procedures.

Signs of overdose

Be vigilant for of signs and symptoms suggestive of toxicity from the prescribed medicine. Refer to the product information for details. 

If signs of toxicity present: 

• remove the patch and seek immediate medical attention 
• check for additional patches, which may have been applied accidentally or deliberately 
• consider whether deliberate or accidental overdose is possible
• consider if there has been exposure to heat – external heat sources and fever can increase medicine absorption

Internal and external heat sources

Heat causes vasodilation, which can increase the absorption of medicines from patches, potentially leading to an overdose.

Patients are also at risk during hot weather or if they have a fever. Monitor for signs of toxicity. 

To reduce risk with external heat sources: 

• advise patients to bathe or shower using warm instead of hot water
• avoid prolonged heat exposure from long hot baths, saunas, hot tubs or sunbathing
• avoid exposing the patch to external sources of heat such as heat pads, electric blankets, and hot water bottles

Removing transdermal patches 

Always remove old patches before applying a new one. Check which patches the patient is wearing and their locations. Confirm this with the patient or administration records. Be aware that some patches are transparent or skin coloured and patients may be wearing multiple patches.

Failure to remove patches as scheduled, or the accidental application of multiple patches, can lead to adverse effects. For example, the MHRA Drug Safety Update highlights cases of serious harm relating to administration errors with rivastigmine patches.

To reduce risks:  

• locate the patch, confirm its loss or verify time removed
• ensure the correct patch is removed 
• if multiples of the same patches are in use, confirm they have all been removed if necessary 
• if different patch types are in use, confirm the correct one is removed 

To remove a transdermal patch: 

• remove the patch gently to minimise damage to the skin
• do not touch the adhesive side to prevent inadvertent exposure to the medicine

Following removal: 

• clean the application site with water to remove any adhesive; if necessary an oil-based product such as petroleum jelly can be used
• avoid soap or alcohol-based cleansers as they may cause irritation or affect adhesion
• avoid scrubbing or rubbing the skin as this may cause further irritation or damage.
• inspect the patch for signs of tampering
• document the time and date of removal
• follow guidance on disposing of patches in the next section

Disposing of transdermal patches 

Used patches may contain residual medicine which can be harmful if mishandled.

To dispose of used patches safely:

• fold in half so the adhesive sides stick together
• wash hands thoroughly after handling patches

The MHRA Drug Safety Update warns of accidental patch transfer and ingestion of fentanyl patches. Appropriate disposal is essential. 

Follow local guidance or regulations for disposing of patches. This might involve disposal in a controlled drugs waste bin or sharps container. Patients at home can return any used or unwanted patches to their pharmacy.

Recording and documentation

Record key information about transdermal patches using a locally agreed method, such as: 

• medication administration record (MAR) charts or hospital medication charts 
• electronic prescribing and administration systems (EPMA) 
• transdermal patch application record sheets or body maps

Transdermal patch records should indicate where patches are currently located and previous placements. They do not replace the need to document administration in prescribing and administration systems such as MAR charts, medication charts, or EPMA. 

Key information to record includes:

• drug name, brand and strength of the patch
• date and time of application
• site of application such as upper right arm
• number of patches applied 
• frequency and interval between applications 
• date and time of removal 

Digital MAR charts will automatically cross out days when a patch change is not required. When charts are re-written, such as at the end of the month, take care to ensure continuity of treatment. 

For controlled drug patches, follow local procedures for documentation in the controlled drug register at the time of patch application and removal. 

Transfer of care

Communication and documentation of patches is essential when transferring patients between care settings to reduce the risk of medication errors. 

Use local procedures where these exist and provide copies of records such as transdermal patch application sheets or body maps. Communicate when the patch was last changed, the current location and when the next patch change is due.

Storage of transdermal patches

Follow the manufacturers recommendations for storage.

Store away from first-aid supplies to prevent confusion with plasters and dressings.

Patient information 

The NHS medicines patient leaflets are helpful if people would like to know more about their medicines or are being discharged home on a patch.

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