Improving Documentation of Transdermal Patch Application Sites in Older Adults: A Quality Improvement Project

Introduction

Transdermal patches are frequently prescribed for older adults and require accurate documentation of the application site to ensure appropriate site rotation and reduce the risk of medication administration errors. A baseline review on Elderly Care wards identified poor documentation of patch application sites within the electronic patient record (EPR). This quality improvement project aimed to improve documentation through simple educational interventions.

Methods

A completed audit cycle was undertaken across Elderly Care wards at Huddersfield Royal Infirmary. Patients prescribed transdermal patches were identified, and EPR medicines administration records were reviewed to determine whether the application site had been documented within the nursing administration comments. Baseline data were collected from 27 patients. Following analysis, ward-based teaching, reminder posters and engagement with nursing staff were introduced to reinforce documentation. A repeat audit was performed after implementation of these interventions.

Results

Baseline compliance with documentation of the patch application site was 0/27 (0%). Following the interventions, compliance improved to 4/28 (14.3%). Although documentation remained below the desired standard, the project demonstrated measurable improvement after a single quality improvement cycle. Discussions with nursing staff also identified uncertainty regarding where application sites should be documented within the EPR, highlighting an important systems-based barrier to consistent practice.

Conclusions

Targeted education and visual reminders improved documentation of transdermal patch application sites but did not achieve consistent compliance. This project identified opportunities for sustained improvement through continued staff education and optimisation of the electronic medicines administration system. The interventions are low-cost, easily reproducible and have the potential to improve medication safety for older adults across similar inpatient settings.