ExCPT Medication Safety and Errors Questions and Answers — Questions and Answers
Question 1: A patient presents a new prescription for hydroxyzine. The pharmacy technician notices the patient's profile shows an active prescription for hydralazine. Which of the following is the MOST appropriate action for the technician to take?
- Dispense the hydroxyzine as written without question.
- Ask the patient what conditions they are being treated for.
- Alert the pharmacist to a potential look-alike/sound-alike (LASA) drug confusion. (Correct answer)
- Contact the prescriber directly to verify the prescription.
Correct answer: Alert the pharmacist to a potential look-alike/sound-alike (LASA) drug confusion.
Hydroxyzine and hydralazine are a well-known look-alike/sound-alike (LASA) drug pair that can be easily confused, leading to medication errors. The technician's primary responsibility in this scenario is to recognize the potential for error and bring it to the attention of the pharmacist for clinical resolution. The pharmacist can then take further steps, such as speaking with the patient and/or contacting the prescriber.
Question 2: Which of the following medications is considered a high-alert medication by the Institute for Safe Medication Practices (ISMP) due to its heightened risk of causing significant patient harm when used in error?
- Amoxicillin
- Lisinopril
- Insulin (Correct answer)
- Ibuprofen
Correct answer: Insulin
The Institute for Safe Medication Practices (ISMP) identifies insulin as a high-alert medication. While errors may not be more common with these drugs, the consequences of an error (e.g., severe hypoglycemia with an insulin overdose) are devastating. Amoxicillin, lisinopril, and ibuprofen are not typically classified as high-alert medications, although any medication can cause harm if used improperly.
Question 3: A pharmacy technician is performing medication reconciliation for a newly admitted hospital patient. What is the primary purpose of this process?
- To bill the patient's insurance for home medications.
- To create a comprehensive and accurate list of the patient's current medications to avoid discrepancies. (Correct answer)
- To provide the patient with a new supply of all their home medications from the hospital pharmacy.
- To determine which medications the hospital formulary will cover.
Correct answer: To create a comprehensive and accurate list of the patient's current medications to avoid discrepancies.
Medication reconciliation is the process of comparing a patient's medication orders to all the medications they have been taking to avoid errors like omissions, duplications, dosing errors, or drug interactions. A pharmacy technician's role is crucial in gathering this accurate medication history to ensure patient safety during transitions of care.
Question 4: To prevent a medication error involving the wrong drug being dispensed, which of the following is a critical step in the prescription filling process?
- Verifying the prescription by matching the National Drug Code (NDC) on the stock bottle to the NDC in the pharmacy computer system. (Correct answer)
- Ensuring the patient's address and phone number are correct.
- Placing a 'high-alert' sticker on every prescription vial.
- Checking the wholesale acquisition cost of the medication.
Correct answer: Verifying the prescription by matching the National Drug Code (NDC) on the stock bottle to the NDC in the pharmacy computer system.
Using the National Drug Code (NDC) is a precise method to verify that the medication being dispensed is the exact product (manufacturer, drug, and package size) specified in the prescription order. This is a key safety check to prevent wrong drug errors. While correct patient information is vital, and high-alert stickers are useful for specific drugs, the NDC check is a fundamental verification step for all prescriptions.
Question 5: A patient complains that they received the wrong medication. Upon investigation, the pharmacy technician discovers that a prescription for clonazepam was accidentally filled with clonidine. Which of the following factors is the MOST likely cause of this type of error?
- Incorrect dosage calculation.
- Failure to check for drug allergies.
- A look-alike/sound-alike (LASA) drug mix-up. (Correct answer)
- An expired medication was used.
Correct answer: A look-alike/sound-alike (LASA) drug mix-up.
Clonazepam and clonidine are a classic example of a look-alike/sound-alike (LASA) drug pair. Errors often occur because the names are phonetically and orthographically similar, leading to confusion during the prescription entry, selection, or verification process. The other options represent different types of medication errors.
Question 6: Which of the following is a strategy recommended by the Institute for Safe Medication Practices (ISMP) to reduce errors between look-alike drug names like hydrALAZINE and hydrOXYzine?
- Using a black marker to cross out the brand name.
- Storing the medications in different refrigerators.
- Only allowing the pharmacist to dispense these medications.
- Implementing the use of 'Tall Man' lettering. (Correct answer)
Correct answer: Implementing the use of 'Tall Man' lettering.
The use of 'Tall Man' lettering (e.g., hydrOXYzine vs. hydrALAZINE) is a specific strategy endorsed by the ISMP and FDA to help distinguish between look-alike drug names. By capitalizing dissimilar parts of the names, it draws attention to the differences and helps reduce the risk of selecting the wrong medication.
ExCPT Medication Safety and Errors Questions and Answers
A patient presents a new prescription for hydroxyzine.
The pharmacy technician notices the patient's profile shows an active prescription for hydralazine.
Which of the following is the MOST appropriate action for the technician to take?