ISMP Safe Medication Principles 4 — Questions and Answers
Question 1: A patient's home medication list includes 'metformin 500mg twice daily.' During admission, the prescriber orders 'metformin 500mg daily.' Per ISMP guidance, the nurse should:
- Administer as ordered since the prescriber has clinical authority
- Clarify the discrepancy with the prescriber before administering (Correct answer)
- Increase the dose to match the home regimen independently
- Document the discrepancy and administer the ordered dose
Correct answer: Clarify the discrepancy with the prescriber before administering
ISMP medication reconciliation principles require all discrepancies between home and ordered medications to be clarified with the prescriber before administration.
Question 2: Which environmental factor does ISMP identify as contributing most to medication administration errors?
- Overly bright lighting in medication rooms
- Interruptions and distractions during the medication preparation and administration process (Correct answer)
- Patient-to-nurse ratios above 1:4
- Using electronic medication administration records
Correct answer: Interruptions and distractions during the medication preparation and administration process
Interruptions during medication preparation are among the most consistently identified contributors to administration errors in ISMP research.
Question 3: ISMP advises against using error-prone abbreviations. Which of the following is on the ISMP 'Do Not Use' list?
- PO (by mouth)
- QID (four times daily)
- U (units) (Correct answer)
- mg (milligrams)
Correct answer: U (units)
The abbreviation 'U' for units is on the ISMP Do Not Use list because it can be misread as '0,' '4,' or 'cc,' causing dose errors.
Question 4: What is the primary safety benefit of smart infusion pumps with dose-error reduction software (DERS)?
- They eliminate the need for pharmacist review of infusion orders
- They alert clinicians when programmed doses fall outside evidence-based limits in the drug library (Correct answer)
- They automatically calculate weight-based doses without clinician input
- They prevent any unauthorized access to the infusion pump
Correct answer: They alert clinicians when programmed doses fall outside evidence-based limits in the drug library
DERS compares entered doses against pre-set soft and hard limits in the drug library, alerting the clinician to potentially harmful dose entries before infusion begins.
Question 5: An error involving a 10-fold overdose of a liquid medication in a pediatric patient is most commonly linked to which prescribing hazard?
- Using brand instead of generic names
- Weight-based dosing calculated in pounds instead of kilograms (Correct answer)
- Omitting the frequency from the order
- Using a trailing zero
Correct answer: Weight-based dosing calculated in pounds instead of kilograms
ISMP highlights the pounds-versus-kilograms error as a leading cause of 10-fold overdoses in pediatric patients because 1 kg ≈ 2.2 lb.
Question 6: Which of the following best describes ISMP's 'culture of safety' in the context of medication errors?
- A culture where errors are kept confidential to protect staff
- An environment where staff feel safe reporting errors and near-misses without fear of punishment (Correct answer)
- A policy requiring mandatory termination after serious medication errors
- A system where only managers are responsible for reporting errors
Correct answer: An environment where staff feel safe reporting errors and near-misses without fear of punishment
A just culture of safety encourages transparent reporting by distinguishing between human error, at-risk behavior, and reckless conduct rather than reflexively blaming individuals.
Question 7: ISMP recommends that automated dispensing cabinet (ADC) overrides be reserved for:
- Routine medications to save time on busy shifts
- Urgent clinical situations where the delay of pharmacy review would harm the patient (Correct answer)
- All medications when the pharmacist is unavailable
- Medications that do not require a physician order
Correct answer: Urgent clinical situations where the delay of pharmacy review would harm the patient
ADC overrides bypass pharmacist review and should occur only in genuine clinical emergencies; routine override use eliminates a critical safety check.
ISMP Safe Medication Principles 4
A patient's home medication list includes 'metformin 500mg twice daily.' During admission, the prescriber orders 'metformin 500mg daily.' Per ISMP guidance, the nurse should: