CCP Long-Term Care Pharmacy Services 2 — Questions and Answers
Question 1: Under OBRA '87, a nursing facility must ensure that each resident's drug regimen is free from what?
- Unnecessary drugs (Correct answer)
- Generic substitutions
- Over-the-counter medications
- Polypharmacy with fewer than 5 drugs
Correct answer: Unnecessary drugs
OBRA '87 requires that nursing facility residents be free from unnecessary drugs, defined as those used in excessive dose, duration, or without adequate indication.
Question 2: Which documentation is the primary tool a consultant pharmacist uses to track medication therapy changes in a long-term care facility?
- Medication Administration Record (MAR) (Correct answer)
- Pharmacy benefit manager (PBM) claim log
- Patient financial statement
- Hospital discharge summary only
Correct answer: Medication Administration Record (MAR)
The Medication Administration Record (MAR) documents scheduled and PRN medication administration and is central to the consultant pharmacist's review.
Question 3: A resident in a SNF is prescribed haloperidol for 'agitation.' The consultant pharmacist should first assess whether the resident has a documented diagnosis of what?
- A specific psychiatric or behavioral condition justifying antipsychotic use (Correct answer)
- Hypertension
- Diabetes mellitus
- Osteoporosis
Correct answer: A specific psychiatric or behavioral condition justifying antipsychotic use
Antipsychotics in LTC require documented clinical justification; CMS regulations target their inappropriate use in residents without qualifying diagnoses.
Question 4: A long-term care pharmacy dispenses medications in 30-day cycles. When a resident is newly admitted, what is the standard approach for the initial supply?
- Dispense a short supply (e.g., 3–7 days) to minimize waste if therapy changes (Correct answer)
- Dispense a full 30-day supply immediately
- Dispense a 90-day supply to reduce dispensing frequency
- Hold all medications pending physician confirmation
Correct answer: Dispense a short supply (e.g., 3–7 days) to minimize waste if therapy changes
Dispensing a short initial supply reduces medication waste and cost when orders may change during the admission adjustment period.
Question 5: Which federal regulation requires long-term care facilities to conduct a comprehensive assessment of each resident using the MDS?
- OBRA '87 (Correct answer)
- HIPAA
- Medicare Part D
- FDCA
Correct answer: OBRA '87
OBRA '87 mandated the Resident Assessment Instrument (RAI), which includes the Minimum Data Set (MDS), for comprehensive resident assessment in nursing facilities.
Question 6: When performing a drug regimen review (DRR), the consultant pharmacist identifies a potential drug interaction. The appropriate next step is to:
- Document the finding and communicate it to the attending physician and nursing staff (Correct answer)
- Immediately discontinue the suspect medication
- Notify the state pharmacy board only
- File a report with the FDA MedWatch program
Correct answer: Document the finding and communicate it to the attending physician and nursing staff
The consultant pharmacist must document findings and communicate recommendations to the prescriber and facility staff as part of the DRR process.
Question 7: A skilled nursing facility resident receives a prescription for a controlled substance. Under federal law, how must this medication be stored at the facility?
- In a locked cabinet or safe separate from other medications (Correct answer)
- In the resident's personal dresser drawer
- In an unlocked medication cart during the day shift
- Refrigerated with other Schedule III drugs
Correct answer: In a locked cabinet or safe separate from other medications
Federal and state regulations require controlled substances in LTC facilities to be stored in a securely locked, substantially constructed cabinet.
CCP Long-Term Care Pharmacy Services 2
Under OBRA '87, a nursing facility must ensure that each resident's drug regimen is free from what?