Hospital Pharmacy - November 2011 - (Page 854)

Hosp Pharm 2011;46(11):854–863 2011 Ó Thomas Land Publishers, Inc. www.thomasland.com doi: 10.1310/hpj4611-854 Original Article Pharmacist Documentation of Fentanyl Patch Orders in an Academic Medical Center Farivar Jahansouz, PharmDp; Judy Hsiao, PharmD†; Krishma Dhillon, PharmD‡; Pieter Helmons, PharmD, MASx; Jo Anna Lamott, RPh, MBA{; Shobha Kolan, PhD#; and Rabia Atayee, PharmDpp Abstract Purpose: The fentanyl transdermal patch label carries a boxed warning indicating that it should only be used in opioid-tolerant patients. Both prescribers and pharmacists must adhere to these recommendations to ensure safe use of the patches. Our goal was to determine the fentanyl patch documentation rate at our institution and evaluate the quality of documentation, and to make recommendations for improvement if appropriate to ensure patient safety. Methods: We conducted a retrospective data analysis to determine pharmacist adherence rate to medical center documentation practices for fentanyl patch orders at UC San Diego Medical Center between July 2009 and July 2010. Results: A total of 296 adult fentanyl patch orders were prescribed during the study period. Sixtyfour of these orders were new initiations and 232 orders were continued from outpatient regimens. Overall, pharmacist documentation rate, without regard to completeness of notation, was 97.0%, with no difference between new and continuing orders. Evaluation of the quality of documentation showed that the most important factor lacking in the majority of documentations was duration of previous opioid therapy. Conclusion: Examination of fentanyl patch documentation data suggests that the existing pharmacy notation system can be improved. We believe that a revised documentation template that includes source of information, chronic pain indication, opioid regimen, duration, daily oral morphine equivalent, pain assessment, and ﬁnal patch plan will help to ensure the safety of prescribed patches and completeness of documentation. These ﬁndings can be used to develop policies and procedures to achieve complete adherence to transdermal fentanyl’s boxed warning at any institution. Key Words—documentation, fentanyl, guideline adherence, hospital policy, long-acting opioids, pharmacists, quality improvement, REMs, retrospective studies, transdermal patch Hosp Pharm—2011;46(11):854–863 entanyl is a potent, synthetic opioid with low molecular weight and high lipid solubility.1-3 The combination of these physiochemical properties makes fentanyl an ideal agent for transdermal delivery.2,3 The transdermal administration of fentanyl has a prolonged serum half-life of 17 hours, F which requires 3 to 4 days for complete elimination from the body.1 Excessive dosage or the use of even low-dose transdermal fentanyl in opioid-naıve pa¨ tients has resulted in respiratory depression and death.1,4 Therefore, the US Food and Drug Administration (FDA) now requires a boxed warning on the *Health Sciences Associate Clinical Professor, UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences; †PGY1 Acute Care Pharmacy Practice Resident, UC San Diego Medical Center; ‡Doctor of Pharmacy Graduate 2011, UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences; xPharmacist Specialist – Pharmacoeconomics, Health Sciences Assistant Clinical Professor, UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego Medical Center; {Assistant Director, Pharmacy Services, UC San Diego Medical Center; #Programming Analyst, UC San Diego Medical Center; **Assistant Clinical Professor of Pharmacy, UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences. Corresponding author: Rabia Atayee, PharmD, UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, 9500 Gilman Drive 0719, La Jolla, CA 92093; phone: 858-822-3549; e-mail: ratayee@ucsd.edu. 854 Volume 46, November 2011 http://www.thomasland.com

Table of Contents for the Digital Edition of Hospital Pharmacy - November 2011

Hospital Pharmacy - November 2011
Contents
Editorial
ISMP Medication Error Report Analysis
ISMP Adverse Drug Reactions
Cancer Chemotherapy Update
Off-Label Drug Uses
RxLegal
Original Articles
Formulary Drug Reviews
Current FDA-Related Drug Information
Pharmacy Automation and Technology
Director’s Forum
Hospital Pharmacy Pulse
Index to Advertisers

Hospital Pharmacy - November 2011