As the practice of overdose fatality review (OFR) evolves, techniques for recommendation development, prioritization, and implementation to help prevent overdoses are emerging. To assist communities with overdose prevention strategies through public health and public safety partnerships, the Centers for Disease Control and Prevention (CDC) and the Office of National Drug Control Policy (ONDCP) support the Overdose Response Strategy (ORS). ORS teams of public health analysts, working with the CDC Foundation, and drug intelligence officers, working with the High Intensity Drug Trafficking Area (HIDTA) programs, participate in and support local reviews. After reviewing approaches from Philadelphia, Pennsylvania, Winnebago County, Wisconsin, and other jurisdictions, the OFR team in Lexington County, South Carolina, created a unique approach for developing recommendations and applying Lean Six Sigma process improvements, facilitated by the ORS public health analyst. This presentation will describe the team’s process for identifying gaps/needs, generating and prioritizing solutions, and creating action plans. The presentation describes results of two prioritization exercises and recommendations that were implemented, including adding members for new sectors; educating members about Handle With Care protocols for referring children experiencing trauma to additional support; and seeking strategic partnerships and resources for community outreach, mobile services, and linkage to care. By describing methods and results of the process in Lexington County, attendees will be able to apply tools like a benefit-effort matrix and voting techniques for focusing partner resources and identify ways this process can achieve system improvements to prevent overdoses.