CCP Quality and Safety Practices 2 — Questions and Answers
Question 1: A consultant pharmacist performing a medication use evaluation (MUE) finds that 40% of residents on warfarin lack documented INR monitoring within the past 30 days. What is the MOST appropriate immediate action?
- Discontinue warfarin for all affected residents
- Present findings to the quality assurance committee and develop a corrective action plan (Correct answer)
- Notify the state board of pharmacy immediately
- Switch all residents to a direct oral anticoagulant
Correct answer: Present findings to the quality assurance committee and develop a corrective action plan
MUE findings must be reported to the QA committee, which then implements corrective action plans to address the monitoring gap.
Question 2: Which of the following best describes the purpose of a root cause analysis (RCA) in a long-term care pharmacy setting?
- To assign blame for a medication error to the responsible staff member
- To identify systemic factors contributing to an adverse event and prevent recurrence (Correct answer)
- To document incidents for malpractice litigation purposes
- To calculate the financial cost of a medication error
Correct answer: To identify systemic factors contributing to an adverse event and prevent recurrence
RCA is a non-punitive, systems-based process that identifies contributing factors to prevent future similar events.
Question 3: Under USP <797>, which beyond-use dating (BUD) category applies to a sterile compounded preparation made from non-sterile components under Category 1 conditions?
- 12 hours at controlled room temperature (Correct answer)
- 1 hour at controlled room temperature
- 24 hours refrigerated
- 72 hours at controlled room temperature
Correct answer: 12 hours at controlled room temperature
USP <797> Category 1 CSPs made from non-sterile components have a BUD of 12 hours at room temperature or 24 hours refrigerated.
Question 4: A facility's fall-with-injury rate has risen 25% after adding a new CNS medication to the formulary. Which quality tool is MOST appropriate to identify contributing factors?
- Pareto chart
- Fishbone (Ishikawa) diagram (Correct answer)
- Control chart
- Scatter diagram
Correct answer: Fishbone (Ishikawa) diagram
A fishbone diagram systematically maps potential cause categories (medication, environment, staff, process) contributing to an adverse outcome.
Question 5: When conducting a prospective drug regimen review in a skilled nursing facility, the consultant pharmacist identifies a resident taking both a benzodiazepine and an opioid. According to CMS guidelines, what is required?
- Immediate discontinuation of the benzodiazepine
- Documentation of the clinical rationale and a gradual dose reduction plan unless contraindicated (Correct answer)
- Automatic denial of the prescription
- Referral to a psychiatrist before any action
Correct answer: Documentation of the clinical rationale and a gradual dose reduction plan unless contraindicated
CMS F-tag guidance requires documented clinical justification and a gradual dose reduction plan for concurrent benzodiazepine-opioid use unless clinically contraindicated.
Question 6: A high-alert medication error involving concentrated electrolytes reaches a patient in a long-term care facility. After immediate patient care, which action BEST supports a culture of safety?
- Terminate the nurse who administered the medication
- Report the event anonymously to a voluntary reporting system and review storage protocols (Correct answer)
- Conceal the error to protect the facility's accreditation status
- Remove all concentrated electrolytes from the facility immediately
Correct answer: Report the event anonymously to a voluntary reporting system and review storage protocols
Reporting to voluntary safety systems and reviewing storage practices addresses systemic vulnerabilities while supporting a non-punitive safety culture.
Question 7: Which ISMP strategy is the highest-level intervention to prevent look-alike/sound-alike (LASA) medication errors?
- Affixing auxiliary warning labels to LASA drug containers
- Requiring verbal order read-back for all LASA drugs
- Removing one of the LASA drugs from the formulary when clinically feasible (Correct answer)
- Storing LASA drugs in alphabetical order
Correct answer: Removing one of the LASA drugs from the formulary when clinically feasible
Formulary removal eliminates the hazard entirely, representing the highest-level (most effective) error-prevention strategy on the hierarchy of controls.
CCP Quality and Safety Practices 2
A consultant pharmacist performing a medication use evaluation (MUE) finds that 40% of residents on warfarin lack documented INR monitoring within the past 30 days.
What is the MOST appropriate immediate action?