CCP Quality and Safety Practices 3 — Questions and Answers
Question 1: A consultant pharmacist reviews an assisted living facility's medication storage and finds insulin vials stored at 25°C in a medication cart. Which error does this represent?
- A near-miss event requiring RCA only
- An improper storage condition that may compromise insulin potency and patient safety (Correct answer)
- An acceptable storage practice per manufacturer labeling
- A documentation error requiring chart correction only
Correct answer: An improper storage condition that may compromise insulin potency and patient safety
Insulin in-use vials should be stored per manufacturer specifications; most require refrigeration until opened, and extended exposure above recommended temperatures degrades potency.
Question 2: Under the OBRA '87 regulations, how often must a consultant pharmacist perform drug regimen reviews in a Medicare/Medicaid-certified nursing facility?
- Every 90 days
- Every 60 days
- Monthly (Correct answer)
- Annually
Correct answer: Monthly
OBRA '87 mandates monthly drug regimen reviews for all residents in Medicare/Medicaid-certified nursing facilities.
Question 3: Which of the following is an example of a 'forcing function' in medication safety design?
- Training staff to double-check high-alert drugs
- Configuring IV pumps so concentrated potassium cannot be programmed without an override alert (Correct answer)
- Posting LASA drug lists at nursing stations
- Using tall-man lettering on medication labels
Correct answer: Configuring IV pumps so concentrated potassium cannot be programmed without an override alert
A forcing function physically or electronically prevents an action unless a safety step is completed, making the unsafe action impossible or very difficult.
Question 4: A long-term care facility asks the consultant pharmacist to evaluate its antibiotic stewardship program. Which metric BEST reflects appropriate antibiotic use?
- Total antibiotic prescriptions written per month
- Days of therapy (DOT) per 1,000 resident-days (Correct answer)
- Number of antibiotic resistance patterns identified
- Cost of antibiotics per resident per month
Correct answer: Days of therapy (DOT) per 1,000 resident-days
DOT per 1,000 resident-days is the standardized, facility-size-adjusted metric recommended by CDC for benchmarking antibiotic use in long-term care.
Question 5: When a pharmacist discovers a prescribing error during a prospective DRR, which action reflects the proper consultative approach per CMS expectations?
- Dispense the medication as written without intervention
- Contact the prescriber directly, document the recommendation, and follow up to confirm resolution (Correct answer)
- Withhold the medication until the prescriber revises the order independently
- Alert the resident's family before contacting the prescriber
Correct answer: Contact the prescriber directly, document the recommendation, and follow up to confirm resolution
CMS expects pharmacists to communicate recommendations to prescribers, document the interaction, and track resolution to close the loop.
Question 6: Which of the following quality indicators from the Minimum Data Set (MDS) is MOST directly linked to pharmacist medication review quality?
- Percentage of residents with pressure ulcers
- Percentage of residents with a fall resulting in major injury
- Percentage of residents receiving antipsychotic medications without a diagnosis of psychosis (Correct answer)
- Percentage of residents with documented advance directives
Correct answer: Percentage of residents receiving antipsychotic medications without a diagnosis of psychosis
Antipsychotic use without a psychosis diagnosis is a CMS quality measure directly targeted by pharmacist DRR under OBRA '87 and the National Partnership to Improve Dementia Care.
Question 7: A consultant pharmacist recommends discontinuing a potentially inappropriate medication per Beers Criteria. The physician disagrees. What should the pharmacist do next?
- Override the physician's decision and contact the pharmacy to stop dispensing
- Document the recommendation and physician response, then escalate to the QA committee if the safety concern persists (Correct answer)
- Accept the decision without further action
- Contact the resident's family to request a physician change
Correct answer: Document the recommendation and physician response, then escalate to the QA committee if the safety concern persists
The pharmacist must document both the recommendation and the prescriber's response; if the safety risk remains significant, escalation through quality channels is appropriate.
CCP Quality and Safety Practices 3
A consultant pharmacist reviews an assisted living facility's medication storage and finds insulin vials stored at 25°C in a medication cart.
Which error does this represent?