ISMP Medication Administration Safety 1 — Questions and Answers
Question 1: According to ISMP guidelines, what is the primary purpose of independent double-checks for high-alert medications?
- Speed up medication dispensing
- Catch errors before they reach the patient (Correct answer)
- Reduce pharmacist workload
- Document nurse competency
Correct answer: Catch errors before they reach the patient
Independent double-checks are a redundancy strategy designed to intercept errors before they reach the patient, particularly for high-alert drugs with narrow therapeutic windows.
Question 2: ISMP recommends that concentrated potassium chloride (KCl) solutions be stored in patient care areas under which condition?
- Kept at the nursing station for easy access
- Removed from patient care units unless absolutely necessary (Correct answer)
- Stored in unlocked medication cabinets
- Available in standard IV stock
Correct answer: Removed from patient care units unless absolutely necessary
ISMP recommends removing concentrated electrolyte solutions like KCl from patient care units to prevent accidental direct IV administration, which can cause fatal cardiac arrhythmias.
Question 3: Which practice does ISMP strongly discourage when documenting medication doses?
- Using generic drug names
- Writing a trailing zero (e.g., 1.0 mg) (Correct answer)
- Spelling out units such as 'milligrams'
- Including the route of administration
Correct answer: Writing a trailing zero (e.g., 1.0 mg)
A trailing zero (e.g., 1.0 mg) can be misread as 10 mg if the decimal point is missed, potentially causing a 10-fold dosing error; ISMP recommends never using trailing zeros.
Question 4: Bar-code medication administration (BCMA) technology is primarily used to verify which of the five rights at the bedside?
- Right route and right time only
- Right patient, right drug, right dose, right route, and right time (Correct answer)
- Right prescriber and right pharmacy
- Right storage and right expiration date
Correct answer: Right patient, right drug, right dose, right route, and right time
BCMA systems scan both the patient's wristband and the medication package to electronically verify all five rights simultaneously, reducing administration errors.
Question 5: ISMP considers smart infusion pumps with drug libraries a critical safety tool primarily because they:
- Eliminate the need for nursing oversight
- Set dose limits that alert clinicians to potentially unsafe orders (Correct answer)
- Automatically adjust infusion rates based on patient weight
- Replace pharmacist review of IV orders
Correct answer: Set dose limits that alert clinicians to potentially unsafe orders
Smart pump drug libraries contain pre-programmed dose limits (soft and hard limits) that alert or prevent nurses from programming potentially unsafe infusion rates.
Question 6: When a patient has a known drug allergy, ISMP recommends that the allergy be verified at which point in the medication administration process?
- Only at the time of hospital admission
- Before every dose administration (Correct answer)
- Once per nursing shift
- Only when a new medication is ordered
Correct answer: Before every dose administration
ISMP recommends allergy verification before every dose to ensure no new information has been added and to reduce the risk of administering an allergen.
Question 7: Which of the following is an ISMP-recommended practice to prevent wrong-route errors with oral liquid medications?
- Store oral syringes with IV supplies for convenience
- Use only oral/enteral syringes that cannot connect to IV tubing (Correct answer)
- Draw up oral liquids using standard luer-tip syringes
- Label oral syringes with the drug name after drawing up the dose
Correct answer: Use only oral/enteral syringes that cannot connect to IV tubing
ISMP recommends using oral/enteral-specific syringes with connectors incompatible with IV lines to prevent accidental intravenous injection of oral medications.
ISMP Medication Administration Safety 1
According to ISMP guidelines, what is the primary purpose of independent double-checks for high-alert medications?