Hospital Pharmacy Exam 2

clinical data repository

A type of database that contains patient information including lists of medications; allergies; laboratory and radiology testing results; vital signs documentation; clinical documents; demographic information such as age, gender, and address; and orders.

clinical decision support (CDS)

Tools that deliver guideline- or knowledge- based information to healthcare providers and patients as they interact with a clinical system.

computer-based documentation systems

Systems that prompt clinicians to provide complete information when documenting their clinical deci- sions and patient interactions. These
systems may require data fields to be completed or reviewed (e.g., allergies) before allowing clinicians to proceed with other tasks.

Computerized provider order entry (CPOE)

The process in which healthcare providers electronically create clinical orders (e.g., prescriptions, laboratory, radiology requests) using a specialized interface to a computerized orders database.

data standards

Predefined formats, structure, and content for information about patient or healthcare processes, such as that stored in a clinical data repository.

Electronic Health Record (EHR)

A clinical system designed to store, manage, and display healthcare-related records, including all clinical and administrative information entered by all practitioners involved in healthcare delivery.

Electronic Medical Record (EMR)

A clinical system containing computerized clinical documentation of a patient's medical care over time within a single institution (e.g., hospital, physician's office).

Electronic prescribing (e-prescribing)

Computerized clinical systems typically used in ambulatory care settings to manage and create medication prescriptions, sent electronically between prescribers, pharmacies, pharmacy benefit managers, and insurance plans.

functionality

Defined as the sum of all things (i.e., functions) that a software program or system can do for users.

Health Insurance Portability and Accountability Act (HIPAA)

Legislation enacted in 1996 to improve portability and continuity of health insurance coverage in the group and individual markets; to combat waste, fraud, and abuse in health insurance and healthcare delivery; to promote the use of medical savings accounts; to improve access to long-term care services and coverage; to simplify the administration of health insurance; to restrict unauthorized access to clinical data; and for other purposes.

Health Level 7 (HL7)

One of several data standards-setting organizations whose mission is to support interoperability for EHR systems.

interoperability

The ability of clinical information systems to exchange and use data from other such systems; it often relates to the usage of shared data standards.

meaningful use

A program introduced through the U.S. Health Information Technology for Economic and Clinical Health (HITECH) Act, to financially incentivize healthcare providers to use EHRs.

personal health record (PHR)

A clinical system accessible to and controlled by patients and their caregivers that contains information about their own medical care and insurance coverage. These may be web-based or app-based and can be standalone or tethered to an institution's EHR system. The PHR commonly contains person- friendly tools (e.g., weight control monitoring and guidance) to help individuals manage their personal health.

user interface

The point at which a user interacts (i.e., interfaces) with a computer program or device. The user interface is often at a stationary computer screen or on a mobile device.

false

(T/F) a personal health record (PHR) can contain computerized clinical documentation of a patient’s medical care over time within only a single institution.

false

(T/F)A passive CDS intervention in CPOE systems presents relevant patient-specific recommendations to the prescriber by interrupting their workflow.

true

CPOE has been widely adopted and implemented in U.S. hospitals.

d. All of the above

Why does the CPOE system implementation have a significant impact on the pharmacy?

a. Complexity of processing medication orders

b. Necessity of content management for medication-related decision support

c. Volume of transactions associated with medication orders

d. All of the above

meaningful use

________________ is a program introduced through the U.S. Health Information Technology for Economic and Clinical Health (HITECH) Act, to financially incentivize healthcare providers to use EHRs.

a. Interoperability

The following term describes the capability of different information systems to exchange and use data.

a. Interoperability

b. Data standardization

c. Functionality

d. None of the above

true

(T/F)Consolidated-Clinical Document Architecture (C-CDA) is a standard for clinical data sharing, and it is a meaningful use certification requirement for EHR systems.

e. All of the above

Which of the following organizations support CPOE adoption?

a. Centers for Medicare & Medicaid Services (CMS)

b. U.S. Department of Health and Human Services (HHS)

c. Institute of Medicine (IOM)

d. Office of the National Coordinator (ONC)

e. All of the above

false

(T/F) CPOE and e-prescribing are synonymous terms.

d. No alert generated for a clinically significant problem

There are four possible outcomes for any alert associated with CDS. Which of the following puts patients at greatest risk?

a. Alert for clinically significant problem

b. No alert generated because of no problem

c. Alert generated for a clinically insignificant problem

d. No alert generated for a clinically significant problem

accounting

A standard method for reporting the expenses, revenues, and accumulation of assets as well as other financial results.

acuity

Variations in the healthcare needs of a patient based on his or her severity of illness.

assets

The real, intangible, and financial items that are owned by the health system.

balance sheet

A financial statement that lists the wealth of the institution at a specific point of time.

budget

A plan for future expenses and revenue, typically over a 12-month period.

capital budget

The part of the budget usually comprised of items that cost
more than a fixed threshold (e.g., an expense >$5,000) and have a useful life greater than 5 years.

capital expense

Costs of a physical improvement or a piece of equipment that will provide benefit over a number of years. Capital expenses are generally significant in size and scope.

case mix index (CMI)

An indicator of the average diagnosis-related group weight for all patients at an institution.

case rate

A negotiated payment that is based on a diagnosis-related group, a per diem (daily) amount, or other benchmark method to determine
the hospital's payment. The hospital receives the case rate payment for the complete patient care episode, irrespective of the individual charges posted to the patient's account.

chief executive officer (CEO)

The highest ranking executive in a health system, in charge of the total management, making the major corporate decisions.

Chief Financial Officer (CFO)

A corporate officer primarily responsible for managing the financial risks of a corporation.

diagnosis-related group (DRG)

A system to classify hospital cases into one of approximately 500 groups, also referred to as DRGs, expected to have similar hospital resource use. The patient's primary diagnosis is typically the basis for payment

direct expense

Expenses that are incurred by the pharmacy to deliver services and products.

double entry bookkeeping

A bookkeeping technique of entering a transaction on both sides of the balance sheet (as a debit on one side and a credit on the other) to keep income and expenses balanced.

equity

The net of assets and liabilities; also called net worth.

expense

A payment made by the health system to others for value received.

external benchmarking

A process of measuring costs, services, and practices and comparing them to the organization's peers or to industry leaders.

fixed expense

A category of direct expense that does not vary significantly in the short-term with the volume of activity.

general ledger

A detailed record of each financial transaction of the hospital.

income statement

A statement that lists the revenue, expense, and profit (or loss) of
the institution over a period of time.

indirect expense

Payments for services that support the pharmacy but are not directly paid by the pharmacy; also called overhead.

internal benchmarking

The process of measuring costs, services, and practices against the organization's prior performance.

liabilities

The debts (i.e., unpaid bills) the hospital owes to creditors, loans, and bonds issued.

operating budget

The part of the budget that represents a forecast of the daily expenses required to operate the pharmacy.

Return on Investment (ROI) or Return on Equity (ROE)

A mathematical model that measures how effectively funds invested in the firm by its owners or stockholders have been used.

revenue

Money received for products or services provided to customers.

time and motion study

A review of the activities and resources required to produce a good or service. A time and motion study is used to determine the resources necessary to complete a task or set of tasks and can be the basis to set goals for improvement or change.

variable expense

A category of direct expense that varies in the short term with the level of activity.

variance

The difference between the budgeted amount and the actual amount spent for a period, typically a month or for the fiscal year to date.

volume budget

The number of admissions, patient days, CMI, outpatient visits, emergency department visits, and other activities. The volume budget is prepared by the CFO and is the basis for budget calculations.

work volume

Work units and paid hours that are generally used to describe pharmacy work volume. Health-system pharmacy workload volume may include prescriptions filled, orders processed, or doses dispensed and combinations of these components.

b. Expenses incurred by the pharmacy to deliver services and products.

What is a direct expense?

a. Monies received by the hospital based on pharmacy services.

b. Expenses incurred by the pharmacy to deliver services and products.

c. Expenses covered by third-party plan payments such as a PBM.

d. Expenses paid by the hospital to support the pharmacy such as hospital administration salaries.

e. All of the above

Flaws of external benchmarking include which of the following?

a. The real cause of differences may result from factors outside the scope of the data collected and compared.

b. Because there is limited information about peer institutions, incorrect or inappropriate comparisons may be made.

c. External benchmarks can identify false improvement opportunities or set inappropriate performance goals.

d. a and c

e. All of the above

c. Most hospitals do not consider pharmacy supply cost to be variable based on volume.

Which of the following statements is NOT true of a variable direct expense in hospital pharmacies?

a. They are costs that rise and fall in the short term with the level of activity.

Purchase costs for drugs are an example of a variable direct expense.

b. The number of orders processed and prescriptions dispensed affect work volume and

may drive variable expenses.

c. Most hospitals do not consider pharmacy supply cost to be variable based on volume.

d. Pharmacy manpower is generally budgeted as a variable expense.

d. All of the above

Hospitals generally use return on investment (ROI) as a method to determine whether to make a purchase or start a new service. Which of the following is true regarding ROI?

a. ROI is a structured return-on-investment calculation that looks at the amount of time

it takes to “break even.”

b. ROI must be considered in light of other items (e.g., regulatory requirements) and may

not be the sole determinant of a decision.

c. ROI may not have a fixed threshold, but may be used to set spending priorities when

health systems have insufficient capital to pursue all proposed projects.

d. All of the above

e. None of the above

e. a and c

The case rate payment method is designed to do which of the following?

a. Encourage hospitals to provide care economically.

b. Limit cost overruns in pharmacy spending.

c. Allow the hospital to be the beneficiary of improved savings and efficiencies.

d. Encourage the use of costly medications when they limit the length of a hospital stay.

e. a and c

f. b and d

e. a and c

Indirect expenses are payments for services that support the pharmacy but are not directly paid by the pharmacy. Which of the following are examples of indirect expenses?

a. Hospital administration costs.

b. Non-drug supply items (e.g., IV bags, syringes, packaging materials used in pharmacy

preparations).

c. Information Technology (IT) (e.g., the hospital’s electronic medical record).

d. Licenses, taxes and fees related to regulatory compliance and accreditation.

e. a and c

b. Price inflation, drug utilization, drug mix, and a blend of utilization and mix of high-
cost medications.

Forecasting drug expense is a combination of four factors. Which of the following correctly identifies these factors?

a. Formulary status, medication error review, new drug factors, and generic substitution.

b. Price inflation, drug utilization, drug mix, and a blend of utilization and mix of high-

cost medications.

c. High-hazard medications, MTM requirements, clinic and hospital visit volume, and a

mix of high-cost medications.

d. Clinical service factor, medication utilization review, price inflation, and drug utilization.

c. The pharmacy director is typically presented with a preliminary budget based on the
prior year's operating expense.

The operating budget is a forecast of the daily expenses required to operate the pharmacy. Which of the following is a correct statement regarding the operating budget?

a. The operating budget is only a suggestion; it can be treated casually when considering

the pharmacy operation.

b. The pharmacy operating budget may include high-cost equipment items that have an

extended useful life, typically beyond 5 years.

c. The pharmacy director is typically presented with a preliminary budget based on the

prior year’s operating expense.

d. The pharmacy operating budget does not include drugs. They are included in a special

supply budget.

c. Real, intangible, and financial items owned by the health system including buildings,
equipment and inventory, and cash and accounts receivable.

What is an asset?

a. Anything of positive value about the operations of the health system including reputation, employee staff, and key programs such as oncology or transplant.

b. A statement of an amount of money owed to the health system by a payer or patient.

c. Real, intangible, and financial items owned by the health system including buildings,

equipment and inventory, and cash and accounts receivable.

d. Unpaid bills the hospital owes to suppliers, loans and bonds issued.

f. All of the above

The operating budget represents a forecast of the expenses required to operate the pharmacy. Which of the following are true statements?

a. The volume budget supplies the number of admissions, patient days, CMI, outpatient

visits, emergency department visits, and other activities.

b. Parts of the budget represent fixed costs that will not vary with activity for admissions, patient days, and other volume indicators.

c. The capital budget is usually comprised of items that cost more than a fixed threshold and a long useful life.

d. The development of a revenue budget is important, even though few payers actually pay full charge for pharmacy items and services.

e. a and c

f. All of the above

Code of Federal Regulation (CFR):

A set of general or permanent rules that are published in the Federal Register by the federal government. The regulation is divided into 50 titles encompassing executive departments and agencies covering broad areas subject to federal regulation.

Controlled Substance Act (CSA):

Also known as the Comprehensive Drug Abuse Prevention and Control Act of 1970, the CSA is the federal government's drug policy. It governs the manufacturing, importation, possession, and distribution of certain substances that have been classified into five schedules based on their potential for abuse and accepted medical use in the United States.

Drug Enforcement Administration (DEA):

A law enforcement agency under the Department of Justice that is responsible for enforcement of the U.S. drug policy as required under the CSA.

Failure mode and effects analysis (FMEA):

A systematic approach of examining and analyzing a process to determine potential areas where errors or failures may occur (failure modes) and determine the effects (effects analysis) of those failures on a process so as to identify opportunities for improvements.

Institute for Safe Medication Practices (ISMP):

A nonprofit organization with the mission of enhancing patient safety through education, collecting and analyzing adverse drug events, disseminating medication safety information, collaborating with health- care organizations, and conducting research.

Medication-use evaluation (MUE):

An examination of a specific medication, most often within the context of a defined healthcare system. It is a method usually incorporated into an organization's performance improvement program that examines the utilization of a medication and its effects on patient outcomes.

Policies and procedures:

A set of written requirements dictated by an organization (policies) that provide the foundation for the written procedural instructions in an organization (procedures).

Power of attorney authorizations:

A legal document that allows another person to act on one's behalf (i.e., allowing another pharmacist to order or receive controlled substances).

Stop order:

An order that automatically discontinues a medication based on pre- established parameters (e.g., time, clinical conditions).

Taper order:

An order that changes the dose of a medication; the dose is either progressively decreased or increased based on pre-established parameters (e.g., time, clinical conditions).

d. The DEA

Which of the following entities are responsible for the enforcement and implementation of the Controlled Substances Act?

a. The ISMP

b. The Joint Commission

c. The FDA

d. the DEA

false

(T/F)State laws and regulations regarding controlled substances are always the same as those requirements under the federal CSA.

true

(T/F)When any controlled substance medication is considered for inclusion into a formulary, a detailed evaluation of the medication should be conducted.

true

A controlled substance inventory system must allow for an audit trail of complete and accurate documentation of the controlled substance through the medication-use system.

false

(T/F)Schedule II controlled substances are obtained through the utilization of DEA Form 106.

true

(T/F)A biennial inventory is conducted following an initial inventory, with the same required information as in the initial inventory.

true

(T/F)Inventory of Schedule II controlled substances surrendered for disposal require the utilization of DEA Form 41.

A medication-use evaluation program and a surveillance program.

Name two programs that would assist a pharmacist in proper oversight in the utilization of controlled substances.

Federal and state laws, patient safety, and complexity of pharmacotherapy.

Name three factors that have been responsible for the increased scrutiny of controlled

substances in a hospital environment.

Appropriate inventory and record requirements, appropriate physical and storage requirements, and appropriate policy and procedures in the management of controlled substances.

Name three key requirements for the effective management of controlled substances.

Interface:

A physical or electronic connection that enables otherwise incompatible
computer systems to communicate and exchange data.

Medication-use process:

A multistep process consisting of five domains: (1) prescribing/medication determination; (2) medication preparation, dispensing, and counseling; (3) medication administration; (4) patient monitoring/assessment; and (5) purchasing/inventory management.

Radio frequency (RF) network:

Commonly used in the wireless communications industry to describe equipment using radio frequency waves to transmit sounds and data from one point to another.

Robotics:

Mechanical devices that perform programmed, complex, and repetitive manipulations without continuous input from an operator.

Smart pumps:

Infusion devices with clinical decision support software and drug libraries that perform a test of reasonableness at the point of medication administration.

Supply chain management:

Oversight of the process of moving products, information, and money among pharmacies, wholesalers, pharmaceutical companies, and other organizations in the supply chain.

Technology:

Anything that is used to replace routine or repetitive tasks previously performed by people, or which extends the capability of people.

Automation:

Any technology, machine, or device linked to or controlled by a computer and used to do work.

Bar-coded medication administration (BCMA):

A process that encompasses the use of bar-code scanning functionality into the medication administration phase of medication use and combines a number of hardware and software components to display,

Brad Ludwig and Jack Temple

receive, and chart real-time patient and medication information.

Carousel dispensing technology (CDT):

A medication storage cabinet with rotating shelves used to automate medication dispensing.

Computerized provider order entry (CPOE):

A computer application that allows providers to type prescriptions into a computer and send them directly to the pharmacy (instead of using orders sheets or prescription pads). Also known as computerized physician order entry (CPOE) and prescriber order entry (POE).

Decentralized automated dispensing devices:

Secure storage cabinets capable of handling most unit dose and some bulk (multiple-dose) medications. Also known as automated dispensing cabinets (ADCs), automated dispensing machines (ADMs), automated dispensing units (ADUs), and unit-based cabinets (UBCs).

Electronic medication administration record (eMAR):

A real-time, computer displayed medication administration record.

Human factors engineering:

The discipline of designing workplace facilities and tasks to meet the needs and optimize the performance of human beings.