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What term describes a preventable event that could result in inappropriate medication use or patient harm while under the care of a healthcare professional, patient, or consumer?
performance deficit
knowledge deficit
prescription drug abuse
medication error
4- Medication errors may be the result of patient misuse, practitioner error, or an error in the pharmacy. Deficits in knowledge or performance may be underlying causes of medication errors. Prescription drug abuse implies that a person is taking a medication with the express purpose of getting high.
Which of the following procedures is recommended to prevent transcription errors in the pharmacy?
Require an independent dose double check.
Repeat back all phone orders before hanging up.
Always include a zero after a decimal point.
Require indications for all high-risk drugs.
Repeat back all phone orders before hanging up
Transcription errors result from incorrect data entry on the part of a human operator. Therefore, repeating back phone orders to the caller before hanging up would be the best approach to avoid this specific type of medication error. An additional precaution is always including a zero before, not after, a decimal point.
Note: In most states, technicians are not allowed to take over-the-phone prescriptions, but 17 states do allow this function by a pharmacy technician, with various restrictions. Therefore, knowledge of the procedure is important in case your job location changes.
Which of these is an example of unintentional medication misuse?
The patient takes a benzodiazepine three times a day every day instead of just “as needed” before flying.
The patient uses someone else’s prescription to self-medicate.
The patient uses his rescue asthma inhaler multiple times per day when the drug is only indicated for emergent shortness of breath.
The patient takes his opioid pain medication after it is no longer needed.
The patient uses his rescue asthma inhaler multiple times per day when the drug is only indicated for emergent shortness of breath.
In the case of an asthma inhaler, perhaps the patient’s asthma is undertreated and he is therefore experiencing shortness of breath more than expected. He is not necessarily dependent on the medication, but a referral to a prescriber would be appropriate so the necessary control medications can be ordered. On the other hand, when a patient intentionally continues drug therapy following discontinuation, uses another person’s medications, or takes a medication with addiction potential more often than prescribed, it may indicate that the patient is dependent on the medication and/or requires a larger dose than prescribed; this is considered intentional misuse.
What organization is the authority on high-alert medications across different healthcare settings?
Drug Enforcement Administration
Substance Abuse and Mental Health Administration Center for Behavioral Health Statistics and Quality
Food and Drug Administration
Institute for Safe Medication Practices
Institute for Safe Medication Practices
The Institute for Safe Medication Practices identifies high-alert medications and strategies to reduce errors and minimize harm. They are also responsible for maintaining lists of common look-alike/sound-alike drugs, error-prone abbreviations, and medications to avoid crushing.
What is the term used to describe “drugs that can cause significant and considerable harm when used in error”?
prescription drug abuse
adverse drug events
drug-drug interactions
high-alert medications
High-alert medications are defined by the Institute for Safe Medication Practices as “drugs that can cause significant and considerable harm when used in error.” Adverse drug events, drug-drug interactions, and prescription drug abuse may be associated with or result from use or misuse of these medications.
Tall man lettering may be most appropriate for which pair of look-alike/sound-alike drugs?
metoprolol/omeprazole
digoxin/warfarin
ritonavir/rapaglinide
hydralazine/hydroxyzine
hydrALAzine and hydrOXYzine.
Tall man lettering is used to highlight areas of similar-sounding or -looking words. In the case of hydralazine and hydroxyzine, the letters that differ between the two would be appropriate to capitalize so as to further differentiate them, i.e., hydrALAzine and hydrOXYzine.
Which of these scenarios represents a potential prescriber error?
use of floor stock instead of unit dose medications
illegible handwriting
borrowed medications from another patient
bypass of bar-coded medication administration system
illegible handwriting
When writing an order, illegible handwriting and incomplete or ambiguous orders are common causes of prescriber errors. All other scenarios presented are errors that may be caused by nursing staff.
Which of these medication orders is most appropriate to use?
Take one tablet by mouth daily.
Take one tab qd.
Tk 1 tab PO QD.
1 tab per os qd.
Take one tablet by mouth daily.
The Institute for Safe Medication Practices maintains a list of error-prone abbreviations, symbols, and dose designations, which includes Latin like “per os” and shorthand like “QD.” To minimize the risk of errors, it is best to avoid abbreviations altogether whenever possible in all medication communications.
Which of these includes a trailing zero?
0.5
5.2
500
5.0
4 - 5.0
For whole numbers, trailing zeros (e.g., 5.0) should be avoided because it could result in a 10-fold increase in the dose if the period is mistakenly overlooked. Instead, this should have been written simply as “5.” The other options are examples of appropriate use of zeros and/or decimal points.
Which of these medication orders is most appropriate to use?
10 mg twice daily.
Take 10 mg per os twice daily.
Take 10.0 mg PO BID.
Take 10 mg by mouth twice daily.
Take 10 mg by mouth twice daily.
The Institute for Safe Medication Practices maintains a list of error-prone abbreviations, symbols, and dose designations, which includes Latin like “per os” and shorthand like “BID.” To minimize the risk of errors, it is best to avoid abbreviations altogether whenever possible in all medication communications.
Which of these notations is on the Institute for Safe Medication Practice’s list of error-prone abbreviations, symbols, and dose designations?
HS
un
PO
daily
HS
Explanation:
“HS” may be interpreted to mean “half strength” or “bedtime”; as such, it is most appropriate to write out the term intended. “PO” is one of the few abbreviations supported by the Institute for Safe Medication Practice. Other options for “PO” include “by mouth” or “orally,” but not “per os.”
Which of these notations is on the Institute for Safe Medication Practice’s list of error-prone abbreviations, symbols, and dose designations?
mL
mcg
cc
units
cc
Cubic centimeters or “cc” may be mistaken for “u” as in “unit”; as such, it is most appropriate to write out the term intended. The notations “mL,” “mcg,” and “unit” are supported by the Institute for Safe Medication Practice.
The hospital Pharmacy and Therapeutics Committee determines that Drug X and Drug Y are equally effective, but Drug X is preferred because of cost. If a patient is admitted to the hospital on Drug Y and switched to Drug X, what is this an example of?
adverse drug event
over-the-counter recommendation
therapeutic interchange
misuse
therapeutic interchange
Therapeutic interchanges allow for the substitution of one medication to an alternative, more preferred medication. Patients should be informed if their medications are interchanged or substituted in this way.
A prescriber writes the following order: “Take one Zoloft tablet by mouth daily.” What order instructions are missing from this prescription?
strength
route
drug name
frequency
strength
Prescribers should write complete instructions to include the drug name, route, strength, frequency, quantity, and directions for use. In this case, the dose of Zoloft was omitted, which could contribute to a medication error if the incorrect dose was dispensed or administered.
If a caregiver forgets to give a patient his medication, this is considered an example of which of these?
intentional misuse
adverse drug event
missed dose
therapeutic interchange
missed dose
A missed dose is an example of unintentional nonadherence and can result from an error on the part of the patient or caregiver. The pharmacist can assist with determining when the next dose should be administered. If missed or skipped doses are intentional or frequently occur, then the pharmacist or prescriber may need to step in to identify the underlying reason(s) for nonadherence and to ensure that the patient is receiving appropriate treatment.
What is the primary purpose of continuous quality improvement (CQI)?
to punish employees that have made medication errors
to meet healthcare accreditation standards
to speed up workflow as much as possible
to help improve pharmacy practices
to help improve pharmacy practices
CQI is a set of methods to help improve pharmacy practices and should occur on a regular and continual basis. While important for accreditation, the focus is on the safe practice of pharmacy, not to just make sure all the correct boxes are checked. And while it may satisfy several pharmacy requirements, it is not centered on punishment.
What is the first step to complete when a quality-related event occurs such as a medication error?
Quality assurance should be used to identify what went wrong.
The error should be reported to a district manager.
The error should be documented.
Treat the patient for any adverse effects.
Treat the patient for any adverse effects.
Explanation:
Any problem or medical condition resulting from a quality-related event should be treated immediately. Treatment may be as simple as changing the prescription or giving a reversal agent but, since results can be severe in some cases, it may require emergency care.
Hint:
Be sure to consider describing words like first, next, before, and after in questions. They indicate that there is one particular correct answer, even if the other answer choices may be related to the question.
Which safety organization provides a list of inappropriate abbreviations for medication orders to help prevent medication errors?
USP
State Board of Pharmacy
ISMP
The Joint Commission
ISMP
The Institute for Safe Medical Practices (ISMP) is a national organization that supports a medication error reporting program and reviews reported errors in some states, such as Pennsylvania. They also provide lists of healthcare words and abbreviations to avoid, as well as a list of look-alike/sound-alike drugs.
The Joint Commission uses this list, but the ISMP actually creates it.
When it comes to quality assurance, what is the most important aspect of PPE related to compounding?
taking off jewelry after donning PPE
recapping your needle after compounding
starting with the facemask when donning PPE
appropriate hand washing
appropriate hand washing
PPE stands for personal protective equipment and hand-washing is one of the easiest, yet most important, aspects of infection control. Always wash your hands prior to any compounding procedure or pharmacy process that involves direct contact with the drug product. This includes washing your hands prior to donning PPE in accordance with USP 795 and 797.
Hint:
Look for words like most nearly, most likely, most important, and probably in questions. They indicate that you should look for the best answer, not necessarily the only possible one.
What is the most important benefit of using a barcode system in the pharmacy?
to improve workflow efficiency
to keep an accurate inventory of medications
to optimize the data entry process
to verify drug products before they reach the patient
to verify drug products before they reach the patient
The reduction of drug dispensing errors is the most important of the listed benefits of scanning barcodes in the pharmacy. Each drug’s barcode is unique and can be used to verify that the correct product is chosen. It is impossible to do this with the naked eye. The other answer choices are additional benefits, but not most important.
Hint:
HINT: Be alert for words like better, best, more, most/mostly, main/mainly, major/majority, higher/highest, greater/greatest, biggest, largest, strongest, significant, preferred, ideal/ideally, closest, special, especially critical, crucial, predominantly, definitely, absolutely, largely, key, and primary/primarily, specific/specifically in questions. They indicate that there might be other answers that could work, but the correct answer is the one that is the best of the choices given.
Which of the following will not improve medication safety?
standardization of pharmacy workflow
punishing staff who make a medication error
automation and computerization
personal health and hygiene
punishing staff who make a medication error
A punishment culture will reduce the number of errors reported (not the number that occur) and will keep the CQI process from improving on areas in the system that need help. As a result, more medication errors are likely to occur.
Hint:
Be alert for words like not, except, false, incorrect, least (likely), and other negative word forms in questions. These words change the purpose of your search for the correct answer.
Which of these is appropriate regarding the use of PPE?
Gloves should be the first item used when donning PPE.
Wearing a watch is okay as long as it fits inside your glove.
Start by putting on your facemask when donning PPE.
Work dirtiest to cleanest when donning PPE.
Work dirtiest to cleanest when donning PPE.
PPE is required for all compounding procedures and differs based on the type of compounding and the drug products being compounded. When using PPE, it is important to follow a specific order to reduce the potential of contamination. In general, you should work from “dirtiest” to “cleanest” parts of the PPE attire. For example, you wouldn’t put shoe covers on after putting on your sterile gloves. Follow the general order listed here and make sure to check the procedures outlined by your specific pharmacy.
Remove outer garments, jewelry, make up, artificial nails, piercings, etc. before putting on any PPE.
Start with shoe and hair covers including any facial hair.
Put on the a face mask or face shield.
Wash your hands with appropriate hand washing technique.
Use a compounding specific gown.
Don sterile gloves and use alcohol to continue to sterilize your gloved hands between drug products.
Which member of the pharmacy staff is legally able to ask patients if they would like to be counseled by a pharmacist about their medication?
all of these
pharmacy technician
pharmacy intern
pharmacist
all of these
While only the pharmacist can actually provide counseling to patients, in most states, any member of the pharmacy staff can ask patients if they would like to talk to the pharmacist about their medication(s). However, at least one state requires counseling by the pharmacist for all new prescriptions and no other staff member may ask the patient about this. So, be sure to verify this regulation for the state in which you plan to work.
Which of these can be performed by the pharmacist only?
compounding a prescription product
entering new prescriptions into the computer
transferring a prescription via an unshared network
maintaining medication inventory
transferring a prescription via an unshared network
Pharmacy technicians are able to perform all tasks in the pharmacy except: drug utilization review, patient counseling, transferring prescriptions (unless using a shared network), ordering and record keeping (all need pharmacist signature), and prescription verification (some states do allow tech-check-tech on a limited basis, however).
In which of these scenarios would you report information to the FDA MedWatch website?
A patient requests a refill too soon.
A patient reports an unusual or dangerous side effect from a medication.
A patient brings you a prescription that appears forged.
A doctor prescribes a medication that is dangerous for a patient to take.
A patient reports an unusual or dangerous side effect from a medication.
MedWatch is a program used to report adverse events and side effects of medications to the FDA.
A technician using a pharmacy computer system can perform all of the following except ____.
send a prior authorization request to a doctor’s office
bill an insurance company
verify a prescription is correct
request a refill from a doctor’s office
verify a prescription is correct
Only a pharmacist can verify a prescription. Neither a computer system nor a technician can perform this function.
Hint:
Be alert for words like not, except, false, incorrect, least (likely), and other negative word forms in questions. These words change the purpose of your search for the correct answer.
A patient reports to a pharmacy technician that he or she is allergic to a food or medication. What step should the technician take?
Dispense an Epipen® to the patient.
Nothing needs to be done because the doctor is responsible for avoiding prescribing anything to which the patient may be allergic.
Enter the allergy into the patient’s profile.
Alert the pharmacist about the patient’s allergy.
Enter the allergy into the patient’s profile.
A patient’s profile should include all food and medication to which a patient is allergic.
Which of the following can be performed by a pharmacy technician and does not require pharmacist intervention?
adverse drug event reporting
drug utilization review (DUR)
OTC recommendation
prescription data entry
prescription data entry
Data entry of prescription information into a pharmacy’s computer system is one of the many duties of a pharmacy technician, which does not require pharmacist intervention. OTC recommendations, DUR, and ADE reporting are not duties of the pharmacy technician and require pharmacist intervention.
Where should an adverse event to a vaccine be reported to?
VAERS
MedWatch
RCA
REMS
VAERS
Adverse events related to any vaccine should be reported promptly to the Vaccine Adverse Event Reporting System (VAERS). Medwatch is the FDA’s safety information and adverse event reporting program. RCA simply stands for root cause analysis. Lastly, REMS is another FDA program that encompasses risk evaluation and mitigation strategies.
An error in which of the following element(s) of a prescription could result in patient harm and lead to legal action against the pharmacy?
drug
dose
patient
all of these
all of these
Dispensing a prescription with the incorrect drug, dose, or to the wrong patient could result in significant patient harm and lead to legal action against the pharmacy. It is important to stay vigilant when performing data entry duties to minimize the risk of a medication error occurring.
