CSA Medication Management Oversight 3 — Questions and Answers
Question 1: An administrator is required to report a medication error that caused serious harm to a resident. Under OBRA regulations, this report must be made to:
- The state survey agency and, if applicable, the ombudsman program (Correct answer)
- Only the attending physician and the family
- The CDC national medication error database
- The pharmacy that dispensed the medication
Correct answer: The state survey agency and, if applicable, the ombudsman program
Serious adverse events, including harmful medication errors, must be reported to the state survey agency and potentially the long-term care ombudsman per OBRA requirements.
Question 2: Which federal regulation governs the pharmaceutical services requirements in Medicare/Medicaid certified nursing facilities?
- 42 CFR Part 483 Subpart B (Correct answer)
- 21 CFR Part 211
- 45 CFR Part 164
- 29 CFR Part 1910
Correct answer: 42 CFR Part 483 Subpart B
42 CFR Part 483 Subpart B establishes the requirements for long-term care facilities, including pharmaceutical services standards.
Question 3: A resident experiences a suspected adverse drug reaction (ADR) following a new medication. The administrator's responsibility includes ensuring that:
- The medication is quietly discontinued without documentation
- The event is documented, the prescriber is notified, and an incident report is filed (Correct answer)
- The pharmacy is solely responsible for investigating the reaction
- The family is notified only if the reaction is life-threatening
Correct answer: The event is documented, the prescriber is notified, and an incident report is filed
Suspected ADRs require thorough documentation, immediate prescriber notification, and completion of an incident report as part of the facility's quality assurance process.
Question 4: The Beers Criteria is a clinical tool used in long-term care to:
- Determine pharmacy billing rates for high-cost medications
- Identify medications that are potentially inappropriate for older adults (Correct answer)
- Rank prescribers based on prescribing accuracy
- Approve new medications for facility formulary inclusion
Correct answer: Identify medications that are potentially inappropriate for older adults
The Beers Criteria is an evidence-based list of medications that are potentially inappropriate for use in older adults due to increased risk of adverse effects.
Question 5: Under CMS F-Tag F758, unnecessary medications in a nursing facility are defined as medications that are used:
- Without adequate monitoring, in excessive dose, for excessive duration, or without a clinical indication (Correct answer)
- Without the resident's written consent on file
- For more than 30 days without a physician review
- Only when prescribed by a non-attending physician
Correct answer: Without adequate monitoring, in excessive dose, for excessive duration, or without a clinical indication
F758 defines unnecessary medications as those used without adequate indication, in excessive dose, for excessive duration, without monitoring, or in the presence of adverse consequences.
Question 6: A consultant pharmacist conducting a medication regimen review (MRR) in a nursing facility is required to report irregularities to:
- Only the Director of Nursing
- The attending physician and the Director of Nursing (Correct answer)
- The state board of pharmacy exclusively
- The administrator and the regional CMS office
Correct answer: The attending physician and the Director of Nursing
Regulations require the consultant pharmacist to report medication irregularities to the attending physician and the Director of Nursing for follow-up action.
Question 7: When disposing of unused controlled substances in a long-term care facility, the regulatory requirement is to:
- Flush medications down the toilet after nursing home hours
- Witness the disposal with a second authorized staff member and document in the controlled substance log (Correct answer)
- Return all unused medications to the pharmacy without documentation
- Allow the attending physician to take unused medications for reuse
Correct answer: Witness the disposal with a second authorized staff member and document in the controlled substance log
Controlled substance disposal requires witnessed destruction by two authorized staff members with complete documentation in the controlled substance log to prevent diversion.
CSA Medication Management Oversight 3
An administrator is required to report a medication error that caused serious harm to a resident.
Under OBRA regulations, this report must be made to: