ExCPT Test Medication Safety 2 — Questions and Answers
Question 1: Which of the following is the most common type of medication error reported in pharmacy settings?
- Wrong drug dispensed
- Wrong dose dispensed (Correct answer)
- Wrong patient
- Wrong route
Correct answer: Wrong dose dispensed
Wrong dose errors are the most frequently reported category of medication errors in pharmacy dispensing.
Wrong dose errors occur when the correct drug is dispensed but at an incorrect strength or quantity. This is the most commonly reported medication error in community and hospital pharmacy settings. Contributing factors include look-alike label confusions between different strengths, transcription errors, and miscalculations. Verification steps, barcode scanning, and pharmacist double-checks are key prevention strategies.
Question 2: A pharmacy technician receives a prescription for metformin 500 mg but the label printed says metformin 1000 mg. What is the BEST action?
- Dispense the 1000 mg because it's a common dose
- Alert the pharmacist immediately before dispensing (Correct answer)
- Change the label manually to 500 mg
- Call the patient to confirm their dose
Correct answer: Alert the pharmacist immediately before dispensing
Any discrepancy between the prescription and the label must be flagged to the pharmacist before dispensing.
When a discrepancy exists between the written prescription and the printed label, the technician's responsibility is to halt the dispensing process and immediately notify the pharmacist. Only the pharmacist can make clinical decisions about whether the dose is appropriate. Manually altering labels or dispensing without verification are both unsafe practices that could result in patient harm and regulatory violations.
Question 3: Which system is widely used to classify medication errors by severity?
- ISMP classification
- NCC MERP index (Correct answer)
- FDA MedWatch scale
- ASHP error index
Correct answer: NCC MERP index
The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index categorizes errors from Category A (no error, circumstances) to Category I (error contributing to patient death).
The NCC MERP Index for Categorizing Medication Errors uses a nine-level classification (A–I) based on the outcome of the error. Category A represents circumstances that could cause an error; Category I is an error that contributed to or resulted in patient death. This standardized system helps facilities track, analyze, and prevent future errors by identifying the severity of each incident.
Question 4: Which of the following strategies BEST reduces the risk of look-alike/sound-alike drug errors?
- Storing drugs alphabetically
- Using TALL man lettering on labels (Correct answer)
- Dispensing all generics
- Limiting formulary to brand names only
Correct answer: Using TALL man lettering on labels
TALL man lettering (e.g., hydrALAzine vs. hydrOXYzine) uses mixed-case highlighting to differentiate similar drug names and reduce confusion.
TALL man lettering is an FDA-endorsed strategy where portions of similar drug names are capitalized to draw attention to distinguishing letters. For example, DOBUTamine vs. DOPamine. The ISMP and FDA maintain lists of recommended TALL man lettering pairs. Studies show this technique, combined with other safeguards like physical separation of look-alike drugs and barcode verification, significantly reduces dispensing errors.
Question 5: Which of the following is an example of a High-Alert Medication (HAM)?
- Amoxicillin
- Insulin (Correct answer)
- Ibuprofen
- Loratadine
Correct answer: Insulin
Insulin is classified as a high-alert medication because errors involving it carry a high risk of causing significant patient harm.
High-alert medications (HAMs) are drugs that bear a heightened risk of causing significant patient harm when used in error. The ISMP maintains a list of HAMs including insulin, anticoagulants, concentrated electrolytes, chemotherapy agents, and opioids. Pharmacies implement special safeguards for HAMs such as independent double-checks, special storage, auxiliary labels, and mandatory pharmacist verification before dispensing.
Question 6: A patient reports they accidentally took their spouse's blood pressure medication. This is an example of which type of medication error?
- Omission error
- Wrong patient error (Correct answer)
- Prescribing error
- Monitoring error
Correct answer: Wrong patient error
A wrong patient error occurs when a medication intended for one patient is taken or administered to another patient.
Wrong patient errors occur when a medication intended for one individual is administered to or taken by a different person. This can happen during dispensing (two patients with similar names) or at home (family members accidentally taking each other's prescriptions). Prevention includes clear patient identification (two identifiers), proper labeling, and patient counseling on keeping medications separate and properly stored.
ExCPT Test Medication Safety 2
Which of the following is the most common type of medication error reported in pharmacy settings?