CCP Long-Term Care Pharmacy Services Questions and Answers 1 — Questions and Answers
Question 1: A consultant pharmacist is reviewing the medication regimen for a new 85-year-old resident admitted to a skilled nursing facility from a hospital. The hospital discharge summary lists one set of medications, while the separate patient care referral form contains conflicting dosage instructions for the resident's anticoagulant. Which of the following is the MOST critical initial action for the pharmacist to take?
- Select the medication regimen that appears most clinically appropriate and document the decision.
- Contact the discharging hospital's physician or pharmacist to clarify the correct and current medication orders. (Correct answer)
- Use the facility's standard protocol for anticoagulation until clarification can be obtained.
- Interview the resident and their family to determine which medication list they believe is accurate.
Correct answer: Contact the discharging hospital's physician or pharmacist to clarify the correct and current medication orders.
Medication discrepancies are common during transitions of care and are a significant source of potential patient harm. The most direct and safest action is to contact the original prescriber or pharmacy at the discharging institution to resolve the conflicting information and establish a single, accurate source of truth before the medications are administered.
Question 2: According to the Drug Enforcement Administration's (DEA) policy, controlled substances may be placed in an emergency drug kit at a Long-Term Care Facility (LTCF). Which statement accurately reflects the regulatory standing of these kits?
- The emergency kit is considered a separate entity and must have its own DEA registration.
- Only Schedule III-V controlled substances are permitted in the emergency kit, but not Schedule II.
- The kit is considered an extension of the servicing pharmacy, which is responsible for its control and accountability. (Correct answer)
- A physician's verbal order is sufficient to authorize withdrawal and administration from the kit, with a written prescription to follow within 30 days.
Correct answer: The kit is considered an extension of the servicing pharmacy, which is responsible for its control and accountability.
The DEA considers emergency kits containing controlled substances in LTCFs to be an extension of the DEA-registered pharmacy that supplies them. The pharmacy is responsible for the proper control, accountability, and record-keeping of the controlled substances within the kit. A valid prescription must be provided to the pharmacy before a controlled substance can be dispensed from the kit.
Question 3: A consultant pharmacist is participating in a skilled nursing facility's quarterly Quality Assurance and Performance Improvement (QAPI) committee meeting. Beyond conducting individual Medication Regimen Reviews (MRRs), what is a key role for the pharmacist in this setting?
- Prescribing alternative medications directly when a physician is unavailable.
- Analyzing aggregate drug-related data to identify trends and areas for system-level improvement. (Correct answer)
- Disciplining nursing staff who have made medication administration errors.
- Serving as the primary investigator for all resident grievances related to pharmacy services.
Correct answer: Analyzing aggregate drug-related data to identify trends and areas for system-level improvement.
The consultant pharmacist's role in QAPI extends beyond individual resident reviews. They are responsible for analyzing medication-related data in aggregate to identify trends, such as frequent adverse drug events, high use of psychotropics, or fall rates associated with certain medications. This analysis helps the facility implement system-wide improvements to enhance resident safety and quality of care.
Question 4: An 88-year-old resident with a history of falls, dementia, and anxiety has a medication regimen that includes donepezil, sertraline, lorazepam 1mg as needed for agitation, and lisinopril. During the monthly Medication Regimen Review, which medication should the consultant pharmacist flag as MOST likely contributing to the resident's fall risk?
- Donepezil
- Sertraline
- Lisinopril
- Lorazepam (Correct answer)
Correct answer: Lorazepam
Benzodiazepines, such as lorazepam, are strongly associated with an increased risk of falls in older adults due to their sedative effects, potential for causing dizziness, and impairment of balance and cognitive function. While other medications on the list can have side effects, benzodiazepines are a primary target for review and potential deprescribing in residents with a high fall risk.
Question 5: Recent updates to the Centers for Medicare & Medicaid Services (CMS) State Operations Manual have revised the guidance for surveyors regarding unnecessary medications. Which of the following best describes a key change related to F-Tag F757 (Unnecessary Medications)?
- F-Tag F757 has been expanded to include all instances of inappropriate psychotropic drug use.
- The guidance for F-Tag F757 has been revised to focus exclusively on non-psychotropic medications. (Correct answer)
- The requirement for Gradual Dose Reductions (GDRs) has been moved from F-Tag F758 to F-Tag F757.
- F-Tag F757 now requires facilities to obtain a pharmacist's approval before starting any new antibiotic.
Correct answer: The guidance for F-Tag F757 has been revised to focus exclusively on non-psychotropic medications.
CMS has streamlined its guidance to improve clarity. The guidance for F-Tag F757 has been revised to apply only to non-psychotropic medications. The regulations and guidance concerning the unnecessary use of psychotropic medications have been consolidated under other tags, primarily F605, to strengthen the focus on preventing chemical restraints.
Question 6: A consultant pharmacist identifies that a resident has been receiving an antibiotic for a urinary tract infection for 21 days, well beyond the facility's 10-day stop-order policy, without a documented reassessment or new indication. According to CMS criteria under 42 CFR §483.45, this situation would be classified as which type of 'unnecessary drug'?
- Excessive dose
- Without adequate indication for use
- Excessive duration (Correct answer)
- In the presence of adverse consequences
Correct answer: Excessive duration
CMS regulation 42 CFR §483.45(d) defines an unnecessary drug as one used for an excessive duration. Continuing an antibiotic for 21 days without reassessment or a new indication, especially when it exceeds the facility's own stop-order policy, is a clear example of excessive duration.
CCP Long-Term Care Pharmacy Services Questions and Answers 1
A consultant pharmacist is reviewing the medication regimen for a new 85-year-old resident admitted to a skilled nursing facility from a hospital.
The hospital discharge summary lists one set of medications, while the separate patient care referral form contains conflicting dosage instructions for the resident's anticoagulant.
Which of the following is the MOST critical initial action for the pharmacist to take?