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

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.