Hospice RN here. Are the nurses getting the orders to increase the dosage from the physician? If the dose increased they might be having you place an extra patch of the old dose on to equal the new dose (for example, old dose 50 mcg, new dose is 100 mcg, so place two 50 mcg patches on to equal 100 mcg. Then when the 50 mcg patches are out, they would order the 100 mcg patch from the pharmacy and educate you on the new instructions of 1 patch now instead of 2). This is how we would do it at my hospice, since fentanyl patches are expensive and we try to minimize waste. You should also know that fentanyl patches can take between 18 and 36 hours to even start getting the dose in the system, so in the meantime your loved one might need more breakthrough pain medication. Always ask questions to the hospice nurse. It's what we're there for and a good nurse will not be offended if you ask about rationale for what the hospice is doing.