Implementing a Multidisciplinary Fentanyl Patch Verification Workflow Across a 12-Hospital Health System

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ID: 332363
2026
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Ranked #217 of 247 articles by views in American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

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Abstract
Abstract Purpose To describe the development, implementation, and early experience of a multidisciplinary opioid stewardship workflow designed to improve the safety of transdermal fentanyl ordering across a 12-hospital health system. Summary A systemwide gap analysis and baseline medication use evaluation (MUE) identified inconsistent documentation of opioid tolerance, variable Prescription Drug Monitoring Program (PDMP) review, and missed opportunities to assess fentanyl patch appropriateness before dispensing. A multidisciplinary team implemented a two-step electronic workflow across 12 hospitals that paired prescriber clinical decision support with mandatory pharmacist verification, centralized fentanyl patch dispensing, standardized education, and longitudinal MUE. In the baseline sample, 12 of 36 orders did not meet institutional criteria: 11 were for acute pain in opioid-naive patients and 1 had no documented pain indication. A later postimplementation review evaluated 135 orders; 125 (92.6%) met institutional ordering criteria and 10 (7.4%) did not. Eight documented pharmacist interventions were identified; 5 recommendations were accepted, resulting in discontinuation of the fentanyl patch and conversion to a short-acting opioid, while 3 recommendations were not accepted. Conclusion Embedding prescriber decision support and mandatory pharmacist review within the medication-use process created a reproducible fentanyl patch safety workflow across a large integrated health system. The experience supports a stewardship model that combines governance, electronic decision support, pharmacist verification, and iterative process improvement.
Reference Key
openalex_W7221810518 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Francis J. Zamora, Michelle Krichbaum, Devada Franco Singh, William R. Wolowich
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Journal American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
Year 2026
DOI
10.1093/ajhp/zxag345
URL
https://doi.org/10.1093/ajhp/zxag345
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