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2014 ; 49
(10
): 942-9
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gab.com Text
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English Wikipedia
Inpatient prescribing and monitoring of fentanyl transdermal systems: adherence
to safety regulations
#MMPMID25477566
McEvoy T
; Moore J
; Generali J
Hosp Pharm
2014[Nov]; 49
(10
): 942-9
PMID25477566
show ga
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.