Struggling as a pharmacist

Seeking tips for documenting controlled substances and wanted to reach out for guidance on handling controlled substance prescriptions.

Here’s a scenario I recently encountered and I’d appreciate your input on how to approach it:

I know that for opioid-naive patients we should aim to keep the prescription below 50 MME. However in this case the patient was already on a short-acting opioid (tramadol) for chronic pain. They had just undergone surgery and the surgeon prescribed another short-acting opioid (hydrocodone/APAP). The MME totaled around 90.

This raised a few questions for me:
- Should this situation be classified as acute pain from the surgery or chronic pain given the patients ongoing tramadol use?
- Would it still count as an initial fill since its their first time receiving hydrocodone/APAP even though theyre not opioid-naive?
- Should I call the provider to adjust the dosage to keep the MME below 50 or is it acceptable to fill it as prescribed?
- Would it be appropriate to suggest switching to a long-acting opioid instead of using two short-acting opioids?

Here’s what I did: I contacted the provider suggested a max daily tablet limit for the hydrocodone/APAP and asked if they wanted to hold tramadol. The provider agreed to hold the tramadol. Since Im a new pharmacist I wanted to err on the side of caution but Im wondering if I handled it correctly or if there’s a better approach.

Thank you so much for your help!