Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (Griffith and Jordan [110], E; NMC [257], C).
2. 2.Show
   Wash hands with bactericidal soap and water or an alcohol‐based handrub.
   To minimize the risk of cross‐infection (DH [64], C; Fraise and Bradley [98], E).
3. 3.Show
   Before administering any prescribed drug, look at the patient's prescription chart and check the following:

   1. the correct patient is being given the drug
   2. drug
   3. dose
   4. date and time of administration
   5. route and method of administration
   6. diluent as appropriate
   7. validity of prescription
   8. signature of prescriber
   9. the prescription is legible.
   To ensure that the correct patient is given the correct drug in the prescribed dose using the appropriate diluent and by the correct route (DH [61], C; RPS [317], C).

   To protect the patient from harm (DH [61], C; NMC [257], C).
   If any of these pieces of information are missing, unclear or illegible, do not proceed with the administration. Consult with the prescriber.
   To prevent any errors occurring. E

Procedure

1. 4.Show
   Put on a plastic apron and assist the patient into the required position.
   To allow access to the affected area of skin. E
2. 5.Show
   Close the room door or curtains if appropriate.
   To ensure patient privacy and dignity. E
3. 6.Show
   Take the medication and the prescription chart to the patient. Check the patient's identity by asking them to state their full name and date of birth. If the patient is unable to confirm these details, then check the patient identity band against the prescription chart. If an electronic identity check system for the patient and/or medicine identification is in place, then use it in accordance with hospital policy and procedures. Check the patient's allergy status by asking them or by checking the name band.
   To ensure that the medication is administered to the correct patient and prevent any errors related to drug allergies (NPSA [262], C).
4. 7.Show
   Expose the area where the patch, ointment, cream or paste will be applied. Where necessary, cover the patient with a towel or sheet.
   To gain access to the affected area and to ensure patient privacy and dignity. E
5. 8.Show
   Apply gloves and assess the condition of the skin. Do not apply to skin that is oily, burnt, cut or irritated in any way.
   To prevent local or systemic infection (DH [64], C; Fraise and Bradley [98], E).

   To prevent local or systemic effects and to ensure the patch will remain in place (DH [64], C; Perry [281], E).
6. 9.Show
   Where necessary, remove any used patch and fold it in half, adhesive side inwards. Place it in the original sachet (if still available) and dispose of it into clinical waste.
   To ensure that the release membrane is not exposed. E
7. 10.Show
   Remove any drug residue from the former site before placing the next patch.
   To avoid any skin irritation (Chernecky et al. [39], E).
8. 11.Show
   Carefully remove the patch from its protective cover and hold it by the edge without touching the adhesive edges (or touching the adhesive edges as little as possible).
   To ensure the patch will adhere and the medication dose will not be affected (Perry [281], E).
9. 12.Show
   Apply the patch immediately, pressing firmly with the palm of the hand for up to 10 seconds, making sure the patch sticks well around the edges.
   To ensure adequate adhesion and prevent loss of the patch, which would result in reduced dose and effectiveness (Perry [281], E).
10. 13.Show
    Date and initial the patch.
    To ensure all staff know when it must be changed (Perry [281], E).
11. 14.Show
    For ointment, creams and pastes, apply the prescribed quantity and gently rub until absorbed.
    To ensure the medication is applied. E

Post‐procedure

1. 15.Show
   Remove and dispose of waste in appropriate waste bags.
   To ensure safe disposal and prevent reuse of equipment. E
2. 16.Show
   Record the administration on the appropriate charts.
   To maintain accurate records, provide a point of reference in the event of any queries and prevent any duplication of treatment (RPS [317], C).