FIPP 6: Final Exam

Lectures after Spring Break

Human performance can be degraded by performance shaping factors (PSFs) that can be “personal PSFs” or “system PSFs”. Which of the following are considered System PSFs?

not getting a good night's sleep and coming to work tired

the telephone ringing every 2 minutes to interrupt the pharmacist reviewing the prescription

the light over the pharmacist’s workstation was broken and the pharmacist had to read prescriptions in dim light

the pharmacist was worried about his sick child at home and couldn’t concentrate on prescriptions

Human performance can be degraded by performance shaping factors (PSFs) that can be “personal PSFs” or “system PSFs”. Which of the following are considered System PSFs?

not getting a good night's sleep and coming to work tired

the telephone ringing every 2 minutes to interrupt the pharmacist reviewing the prescription

the light over the pharmacist’s workstation was broken and the pharmacist had to read prescriptions in dim light

the pharmacist was worried about his sick child at home and couldn’t concentrate on prescriptions

the telephone ringing every 2 minutes to interrupt the pharmacist reviewing the prescription

the light over the pharmacist’s workstation was broken and the pharmacist had to read prescriptions in dim light

Clinical decision support software provides pharmacists with information about drug-drug interactions, drug-disease interactions, duplicate medications, and so on. Which of the following is true regarding these clinical decision alerts for pharmacists? (Select the single best answer)

Too many can fatigue a pharmacist, desensitizing them to potentially useful information as they force past the system soft and hard "stops."

"Hard stops" require pharmacists to take action, which impedes their productivity and delays the timeliness of care for patients. 

Forcing functions have potential to de-standardize pharmacist-provided care, and allow mistakes to be made by bypassing required information (e.g., medication allergies documented before prescribing a medication)

Health information technology is often unavailable for independent health systems and pharmacies, giving an unfair advantage to large systems that create extensive drug libraries and clinical catalogs. 

Too many can fatigue a pharmacist, desensitizing them to potentially useful information as they force past the system soft and hard "stops."

An error is found in your pharmacy. A patient had been prescribed brand name Synthroid (levothyroxine), and the doctor wrote “Dispense as Written”, meaning the brand name medication (Synthroid) must legally be dispensed. When the pharmacy filled it, they accidentally substituted the brand name medication with a cheaper generic levothyroxine. Which of the following steps is most appropriate for you, as the pharmacist, to take after catching this error?

Select all that apply.

Focus on finding the person responsible for making the error, so a just punishment may be administered.

Conduct a root cause analysis to identify the cause of this error

Notify the patient of the error

Conduct a root cause analysis to identify the cause of this error

Notify the patient of the error

The first 2 steps in solving a problem are.... 

Define and solve

List the underlying issues and select the most important issue

Recognize and Define the problem

Recognize and Define the problem

Dr. Nau discussed a well-known model for describing how an error could penetrate multiple layers of defenses.  This model is known as the ______ cheese model. 

Gouda

Swiss

Cheddar

Mozzarella

Swiss

If you had the following data, what type of chart may best illustrate the data to help in selecting targets for improvement? 

            Frequency of errors by medication:

                        Cisplatin            5

                        Fluconazole      7

                        Heparin            45

                        Insulin              41

                        Vancomycin     11

                        All others         10

Fishbone diagram

Pareto chart

Spider Diagram

DMAIC chart

pareto chart

Proactive risk assessment in health care can be conducted by analyzing the potential failure points in a system and determining the probability of each failure point and the severity of consequences for each type of failure.

This proactive approach to risk assessment is known as:

Root cause analysis

Static mode analysis

Failure mode and effects analysis

case-control study

failure mode and effects analysis

True or false: The Joint Commission requires all hospitals to conduct Failure Mode and Effects Analysis in response to a sentinel event

False

The causes of medication errors are often categorized as "systems" or "people/human" factors.  Which of the following statements are true? 

Systems errors are often considered latent failures that occur at the blunt end of the system

Human errors are often considered active failures at the sharp end of the system

Latent failures are due to human error by front-line workers

Systems errors are often considered latent failures that occur at the blunt end of the system

Human errors are often considered active failures at the sharp end of the system

Dr. Nau (and ISMP) described the impact of fatigue on human error.  Which of the following are likely to reduce fatigue? 

Do not schedule a person more than 3 12-hour shifts in a row without a day off

During a 12-hour shift, allow 10 min breaks every 2 hours

Allow 30 minute meal break near the middle of the shift

Increase the number of prescriptions screened per hour in order to reduce the length of a shift

Do not schedule a person more than 3 12-hour shifts in a row without a day off

During a 12-hour shift, allow 10 min breaks every 2 hours

Allow 30 minute meal break near the middle of the shift

Which of the following abbreviations is error-prone and should be avoided?

u for units

BID for twice a day

q6h for every 6 hours

mg for milligram

u for units

Perhaps the most important part of preventing future medication errors is _________________.  (select the single best answer)

learning from past errors to identifying root causes and potential fixes

increasing reliance on vigilance to identify errors before they reach the patient

penalizing those who's actions result in errors in order to prevent future error

learning from past errors to identifying root causes and potential fixes

True or False: Current literature suggests that lawsuits from medication errors can be prevented by avoiding disclosure of the error or admitting fault to patients and their caregivers/family. 

False

Which of the following are one of the "5 rights" for patients?

Select all that apply

Right price

Right place

Right drug

Right dose

Right route

Right drug

Right dose

Right route

True or False: When a patient points out an error made in filling their prescription at your pharmacy, you should apologize for the error occuring

True

In addition to interviewing the patient, what other sources of information can be used to collect information when obtaining an admission medication history? (select all that apply)

Insurance claims data

Calling the community pharmacy

Asking the physician to clarify

Viewing previous discharge summaries

Insurance claims data

Calling the community pharmacy

Viewing previous discharge summaries

You determine a patient is taking an over the counter aspirin 81 mg PO once a day, that was not listed on their home medication list. What type of a discrepancy is this?

Omission

Commission

Therapeutic duplication

Omission

Dr. Nau described the Shingo model that contains 10 guiding principles for creating a high-quality organization.  Based on this model, Dr. Nau emphasized that the _____________ of an organization is the foundation for CQI. 

culture

In the context of Continuous Quality Improvement, the acronym PDSA stands for? 

Percutaneous Developmental Safety Actions

Plan, Do, Study, Act

Planning, Decoding, Safety, Accountability

Past Dangerous Safety Actions

Plan, Do, Study, Act

In the context of Donabedian's SPO model of healthcare quality, the requirement by a Board of Pharmacy that each pharmacy have at least 2 counting trays is an attempt to target which component of the SPO model? 

Structure

Process

Outcome

structure

True or False: A “Just Culture” is also a “blame free” culture

False

According to Dr. Lucian Leape, the single biggest impediment to error prevention in the medical industry is that .... 

we fail to adequately fund error prevention studies

we fail to discipline people who make clinically-significant errors

we punish people who make mistakes

we punish people who make mistakes

When employees start to drift from their job responsibilities and fail to complete a particular task that is important to the sterility of an IV Preparation Center, the most appropriate response from a manager is 

Immediately fire the person who failed to perform a task to send a signal to other employees that failing to complete a task will not be tolerated

Let the employees know that it is okay to occasionally skip the tasks if they are busy

Coach the employees to let them know that you notice they are not completing the important task and to remind them of why that task is important

Coach the employees to let them know that you notice they are not completing the important task and to remind them of why that task is important

Dr. Nau discussed quality measures (also known as "indicators") and described the difference between continuous measures and rate-based measures.  Which of the following statements describe a key advantage of a rate-based measure over a continuous measure?

The rate-based measure is mandated by CMS

The rate-based measure provides better context for quality when the volume of services/encounters varies over time

The continuous measure is too hard to measure

The rate-based measure provides better context for quality when the volume of services/encounters varies over time

The Medicare Part D star ratings contain how many performance measures related to medication adherence?

1

2

3

4

3

According to Dr. Nau, why do we measure quality? 

Select all that apply

The Ohio board of pharmacy requires that we achieve minimum scores on Part D star ratings

What gets measured, gets improved (i.e., bring attention to an issue)

Measuring quality ensures profitability

How do we know if we are improving if we aren't measuring quality

What gets measured, gets improved (i.e., bring attention to an issue)

How do we know if we are improving if we aren't measuring quality

Your pharmacy operates a diabetes management program that entails scheduled appointments with patients who have diabetes.  You track the number of patients who fail to show up for an appointment and have data on "no shows" for the past year.  What type of chart/graph would be the most useful way of displaying the trend in "no-show rate."

Pareto Chart

Run Chart

Fishbone Diagram

Run Chart

Medicare adjusts payments of several healthcare organizations/providers based on quality of care as measured by many specific quality measures.  Which of the following organizations/providers have their payment from Medicare adjusted based on quality measures?

Select all that apply

Acute care hospitals

Skilled nursing facilities

Community pharmacies

Physicians

Acute care hospitals

Skilled nursing facilities

Physicians

True or False: The Medicare ACO program has been a tremendous success wherein all ACOs have showed significant improvements in quality and value. 

False

True or False: Several health plans and PBMs have implemented financial incentives for community pharmacies based on quality measures for each pharmacy. 

True

Which of the following policies/tactics are commonly used by PBMs for Formulary management?

Prior authorization

Step therapy

Limiting the size of pharmacy networks

Applying DIR adjustments to pharmacy payments

A and B

All of the above

A and B (Prior authorization, Step therapy)

Which of the following companies is the largest PBM based on total prescriptions managed?

OptumRx

Express Scripts

CVS Health

Humana

Prime Therapeutics

CVS Health

True or False: Ohio state law prohibits PBMs from owning a pharmacy

False

The policy used by a PBM that requires a prescriber to provide written (or digital) justification for use of a drug before a PBM will approve the payment/coverage of the drug is known as:

Step therapy

Quantity limits

Prior Authorization

Step-Down Therapy

Prior Authorization

Pharmacy Services Administrative Organizations (PSAOs) represent which group of stakeholders?

Chain pharmacies

Independent pharmacies

Pharma Manufacturers

PBMs

Independent pharmacies

For reimbursement of pharmacies, a PBM will typically use which of the following parameters for setting the ingredient cost of multi-source GENERIC drug:

Maximum Allowable Cost (MAC)

Average Wholesale Price (AWP)

Average Manufacturer Price (AMP)

Average Sale Price (ASP)

Maximum Allowable Cost (MAC)

True or False: When a manufacturer provides a rebate to a PBM, the PBM must share a portion of the rebate with its network pharmacies

False

According to Dr. Nau, specialty pharmaceuticals account for what proportion of overall pharmaceutical expenditures in the US?

About 20%

About 25%

About 1/3 (33%)

About half (50%)

About half (50%)

Which of the following statements are true of specialty pharmacies and specialty pharmaceuticals?

The products are often biologics

The products are very expensive (>$600 per month)

Community pharmacies may obtain accreditation as a specialty pharmacy provider

Specialty product manufacturers must obtain a specialty NDA from the FDA before conducting clinical trials of biologics

The products are often biologics

The products are very expensive (>$600 per month)

Community pharmacies may obtain accreditation as a specialty pharmacy provider

True or False: The federal government prohibits manufacturers of specialty pharmaceuticals from limiting distribution of those pharmaceuticals; thus, any pharmacy may obtain any pharmaceutical it wants to purchase

False