QMAP Administering Controlled Substances 1 — Questions and Answers
Question 1: A QMAP and an off-going staff member are performing a shift-change count of a resident's controlled substances. They discover that the number of oxycodone tablets in the package does not match the number documented on the controlled substance record sheet. What is the immediate, priority action?
- Document the correct count on the record sheet and have both staff members sign it.
- Administer the next scheduled dose to avoid a delay in the resident's pain management.
- Report the discrepancy to the facility supervisor or nurse immediately before any doses are given. (Correct answer)
- Borrow a tablet from another resident's supply to make the count correct and report it later.
Correct answer: Report the discrepancy to the facility supervisor or nurse immediately before any doses are given.
Any discrepancy in a controlled substance count is a serious issue that must be reported to a supervisor immediately for investigation. This must be done before any further doses are administered to ensure accountability and resident safety, and to follow facility policy and state regulations.
Question 2: In compliance with Colorado regulations for assisted living residences, what is the proper storage requirement for a resident's Schedule II controlled substances, such as fentanyl patches or morphine?
- In a locked tackle box at the resident's bedside for their convenience.
- In a locked medication cart along with all other routine medications.
- In the facility administrator's office for maximum security.
- In a separately locked, fixed container located inside another locked storage area. (Correct answer)
Correct answer: In a separately locked, fixed container located inside another locked storage area.
Colorado regulations require that controlled substances be kept under a 'double-lock' system. This means they must be stored in a locked container or cabinet that is permanently affixed and located within another locked, stationary cabinet or room.
Question 3: Which of the following is a specific documentation requirement for administering a controlled substance that is different from documenting a non-controlled medication like an antibiotic?
- Recording the date and time of administration on the Medication Administration Record (MAR).
- Maintaining a perpetual inventory or running count on a separate controlled substance record sheet. (Correct answer)
- Documenting the resident's allergies before giving the first dose.
- Initialing the MAR after the medication has been successfully administered.
Correct answer: Maintaining a perpetual inventory or running count on a separate controlled substance record sheet.
In addition to documenting on the MAR, every dose of a controlled substance must be logged on a separate, dedicated record sheet. This sheet maintains a running count (perpetual inventory) that is physically verified against the remaining medication at least at every shift change.
Question 4: A resident has an order for 2.5 mL of a liquid controlled substance. The medication is supplied in a 5 mL single-use vial. After drawing up and administering the correct dose, what must the QMAP do with the remaining 2.5 mL?
- Pour the remaining liquid down the drain and document the waste by themself.
- Have another qualified staff member witness the wasting of the medication and co-sign the documentation.
- Recap the vial and save the remaining amount for the resident's next dose to prevent waste. (Correct answer)
- Place the vial with the leftover medication into the regular trash can.
Correct answer: Recap the vial and save the remaining amount for the resident's next dose to prevent waste.
The wasting or disposal of a partial dose of a controlled substance requires a witness to verify that the medication was properly discarded and not diverted. Both the person wasting the medication and the witness must document this action according to federal regulations and facility policy.
Question 5: To ensure accountability and prevent diversion, what is the standard, minimum frequency for conducting a physical count and reconciliation of all controlled substances in a facility?
- At the beginning of every work week.
- Once a month when the pharmacy delivery arrives.
- At the beginning and end of every shift. (Correct answer)
- Annually during the facility's state inspection.
Correct answer: At the beginning and end of every shift.
A shift-to-shift count is a standard and required practice in facilities that administer controlled substances. The on-coming and off-going staff count together to verify the inventory is correct and to formally transfer accountability for the medications.
Question 6: A resident with an order for a PRN (as-needed) controlled substance for pain refuses the dose when it is offered. Which of the following describes the correct actions by the QMAP?
- Leave the medication at the resident's bedside in case they change their mind later.
- Document the refusal on the MAR, return the medication to the double-locked storage, and ensure the count on the controlled substance record remains accurate. (Correct answer)
- Crush the medication and mix it in food to ensure the resident receives the needed pain relief.
- Discard the medication in a sharps container and document it as given to keep the count correct.
Correct answer: Document the refusal on the MAR, return the medication to the double-locked storage, and ensure the count on the controlled substance record remains accurate.
The QMAP must respect the resident's right to refuse medication. The refusal must be documented on the MAR. For a controlled substance, the medication must not be discarded or left out; it must be returned to secure storage, and the controlled substance count sheet must accurately reflect that the dose was not administered, leaving the physical count unchanged.
QMAP Administering Controlled Substances 1
A QMAP and an off-going staff member are performing a shift-change count of a resident's controlled substances.
They discover that the number of oxycodone tablets in the package does not match the number documented on the controlled substance record sheet.
What is the immediate, priority action?