Automated profile review for transdermal fentanyl to verify opioid tolerance in the military health system

Describe a patient safety program designed to decrease use of transdermal fentanyl (TF) among opioid-naïve patients in the U.S. Military Health System (MHS). The program automatically reviewed patient profiles for prior strong opioid use when starting treatment with TF. New prescriptions for TF among users without a prior strong opioid generated a rejection message indicating that the patient may not be opioid tolerant and stopped the fill. However, pharmacists could override the rejection. We collected pharmacy claims data to measure the use of TF among seemingly opioid-naïve patients following implementation of the program in August 2007. During the first 10 months, 26,366 patients attempted to fill TF prescriptions in the MHS; 10,025 patients (38%) encountered a claim rejection, with a warning message advising the pharmacist to verify opioid tolerance. The majority of rejection messages were overridden by the pharmacist; however, 1,402 patients did not receive a TF prescription following the rejection, representing a 14% decrease in TF claims dispensed to patients who appeared opioid naïve in the MHS. A patient safety program with targeted pharmacy messaging reduced TF use among seemingly opioid-naïve patients in the MHS without disrupting treatment for patients whose rejections were overridden.