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I apologize, I can't quite follow your routine. But in any case, if her pain is not being adequately controlled, and it sounds like it isn't, she should probably have her dose increased - that is at the low end of doses for the patch.
Also, if she has more pain at some times, that may not be because there's something worng with the patch. People on long-acting opioids commonly have breakthrough pain at times - and it is generally recommended to have some fast-acting opioid to use for breakthrough pain, in addition to the patch. For example, oxycodone is a commonly used breakthrough med. There are also several types of fast-acting fentanyl available (Fentora is one, very good but expensive).
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