CCP Long-Term Care Pharmacy Services 3 — Questions and Answers
Question 1: Which CMS survey tag specifically addresses unnecessary drug use and the pharmacist's drug regimen review in nursing facilities?
- F757 (Correct answer)
- F600
- F309
- F689
Correct answer: F757
F757 (formerly F329) is the CMS survey tag addressing unnecessary medications and the requirement for the pharmacist's drug regimen review in LTC facilities.
Question 2: An LTC resident with dysphagia requires medication via feeding tube. The consultant pharmacist should recommend which formulation strategy?
- Use liquid formulations or verified crushable tablets, and flush the tube before and after (Correct answer)
- Crush all available tablets regardless of formulation type
- Switch all medications to transdermal patches
- Discontinue all oral medications until swallowing improves
Correct answer: Use liquid formulations or verified crushable tablets, and flush the tube before and after
Liquid formulations or verified-safe crushable tablets with proper tube flushing are the standard approach for enteral medication administration.
Question 3: A nursing home resident is on warfarin. The consultant pharmacist notes a new prescription for fluconazole. The primary concern is:
- Fluconazole inhibits CYP2C9, significantly increasing warfarin levels and bleeding risk (Correct answer)
- Fluconazole reduces warfarin absorption
- Fluconazole has no interaction with warfarin
- Fluconazole is contraindicated in all LTC residents
Correct answer: Fluconazole inhibits CYP2C9, significantly increasing warfarin levels and bleeding risk
Fluconazole is a potent CYP2C9 inhibitor that can dramatically increase warfarin plasma levels, necessitating close INR monitoring and possible dose reduction.
Question 4: What is the consultant pharmacist's role when a nursing facility receives a deficiency citation (F-tag) related to pharmacy services?
- Assist the facility in developing a Plan of Correction (POC) addressing the cited deficiency (Correct answer)
- Report the facility to the state attorney general
- Transfer all affected residents to another facility
- Suspend medication services until the survey is complete
Correct answer: Assist the facility in developing a Plan of Correction (POC) addressing the cited deficiency
The consultant pharmacist collaborates with facility administration to develop and implement a Plan of Correction that addresses the root cause of the deficiency.
Question 5: Which of the following best describes the 'brown bag' medication review in the context of LTC transitions of care?
- A review where all medications a patient is taking are brought in for reconciliation by the pharmacist (Correct answer)
- A method of packaging medications in brown paper for discreet dispensing
- An informal drug sampling program for new LTC residents
- A CMS-required audit of Schedule II controlled substances
Correct answer: A review where all medications a patient is taking are brought in for reconciliation by the pharmacist
The 'brown bag' review involves having patients bring all their medications for pharmacist reconciliation, reducing the risk of duplicate therapy or omitted drugs during transitions.
Question 6: A consultant pharmacist is reviewing the use of proton pump inhibitors (PPIs) in a nursing facility. Which of the following is a common inappropriate use that should be flagged?
- Long-term PPI use without a documented clinical indication or re-evaluation (Correct answer)
- Short-term use for H. pylori eradication therapy
- Use in a resident with documented erosive esophagitis
- Use alongside NSAID therapy in a high-risk resident
Correct answer: Long-term PPI use without a documented clinical indication or re-evaluation
PPIs are frequently prescribed without documented indications or periodic reassessment in LTC, making them a target for deprescribing initiatives.
Question 7: An LTC facility's emergency medication kit (E-kit) should be inspected by the pharmacist at what minimum frequency per CMS guidelines?
- Annually, or after each use (Correct answer)
- Daily by nursing staff only
- Every 5 years
- Only when a medication is dispensed from it
Correct answer: Annually, or after each use
Emergency kits must be inspected at least annually and after each use to ensure medications are not expired, quantities are complete, and the seal is intact.
CCP Long-Term Care Pharmacy Services 3
Which CMS survey tag specifically addresses unnecessary drug use and the pharmacist's drug regimen review in nursing facilities?