title: Inpatient prescribing and monitoring of fentanyl transdermal systems: adherence to safety regulations.
abstract: BACKGROUND
  National safety guidelines were developed to minimize the occurrence of serious adverse drug events (ADEs) associated with the use of the fentanyl transdermal system (FTS), however, reports of use in opioid-naïve patients for treatment of acute pain and associated ADEs continue to occur.
  
  
  OBJECTIVE
  To evaluate the prescribing patterns of the FTS for adherence to recent US regulatory recommendations and identify the impact of health information technology (HIT) on adherence rates.
  
  
  METHODS
  A retrospective pre- and postintervention analysis was performed in hospitalized adult patients receiving FTS. Electronic medication order instructions and text questions were incorporated into FTS electronic medication orders. The primary outcome measure was adherence of FTS medication orders to regulatory guidelines defined as (a) a new order in an opioid-tolerant patient for use in moderate to severe chronic pain or (b) continuation of the documented home dose in use for at least 7 days. Safety measures included respiratory rate and documented ADEs.
  
  
  RESULTS
  Adherence rates were significantly increased in the postintervention cohort as compared to the preintervention cohort (48.7% vs 85.0%; P < .0001). Incidence of ADEs was significantly lower post intervention (34.7% vs 23.3%; P = .043), including a lower incidence of respiratory depression (16.7% vs 8.3%; P = .043). Documentation was increased in the postintervention cohort (76% vs 100%). However, supporting documentation confirmed responses in only 59.2% of records reviewed.
  
  
  CONCLUSIONS
  Incorporation of HIT via electronic order text questions increased overall adherence rates to regulatory recommendations, increased documentation, and decreased the rate of associated ADEs.
authors.affiliation: Dr. McEvoy was a PGY-2 Drug Information Resident at The University of Kansas Hospital , Kansas City, Kansas , at the time the study was conducted.
authors.forename: Theresa
authors.initials: T
authors.lastname: McEvoy
authors.affiliation: Medication Safety Coordinator, Department of Pharmacy, The University of Kansas Hospital , Kansas City, Kansas.
authors.forename: Joann
authors.initials: J
authors.lastname: Moore
authors.affiliation: Clinical Professor, Emeritus, Department of Pharmacy Practice, University of Kansas, School of Pharmacy Kansas City/Lawrence , Kansas.
authors.forename: Joyce
authors.initials: J
authors.lastname: Generali
keywords: adverse drug event; fentanyl transdermal; health care informatics; medication safety