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 fentanylʼs boxed warning at any institution.