ISMP Safe Medication I 2 — Questions and Answers
Question 1: A nurse receives a verbal order for 'hydromorphone 4 mg IV.' What is the ISMP-recommended action before administering?
- Administer immediately to avoid delays
- Read back the order to the prescriber for confirmation (Correct answer)
- Ask a colleague to double-check the dose
- Document and administer per standing protocol
Correct answer: Read back the order to the prescriber for confirmation
ISMP requires a read-back (repeat-back) verification for all verbal and telephone orders to catch transcription errors.
Question 2: Which ISMP-recommended strategy best reduces errors caused by look-alike/sound-alike (LASA) drug names?
- Storing LASA drugs alphabetically on the same shelf
- Using tall-man lettering on labels and in computer systems (Correct answer)
- Relying on pharmacists to catch all errors at dispensing
- Requiring patients to verify their own medications
Correct answer: Using tall-man lettering on labels and in computer systems
Tall-man (mixed-case) lettering highlights the differing portions of similar drug names, reducing confusion at the point of prescribing and dispensing.
Question 3: A patient is ordered 'metformin 500 mg twice daily.' The pharmacy dispenses metformin 1000 mg tablets with instructions to take half a tablet. What is the primary concern per ISMP guidelines?
- Half-tablet splitting is always safe for any solid oral dosage form
- Scored tablets may be split, but unscored tablets should not be split as dose accuracy cannot be ensured (Correct answer)
- The patient's caregiver should perform all tablet splitting
- Splitting is acceptable as long as the pill splitter is sterile
Correct answer: Scored tablets may be split, but unscored tablets should not be split as dose accuracy cannot be ensured
ISMP cautions that only scored tablets are designed for splitting; unscored tablets may result in unequal doses and potential harm.
Question 4: According to ISMP, which practice increases the risk of a medication error when using automated dispensing cabinets (ADCs)?
- Requiring pharmacist review before all non-override dispensing
- Using override capability only for emergencies with documented justification
- Overriding the ADC without a pharmacist review for routine non-emergency medications (Correct answer)
- Limiting ADC access to nursing staff during off-hours
Correct answer: Overriding the ADC without a pharmacist review for routine non-emergency medications
Routine overrides bypass the pharmacist safety check and are a leading cause of ADC-related medication errors.
Question 5: A prescriber writes 'morphine 2-4 mg IV q2-4h PRN pain.' Per ISMP, what is problematic about this order?
- IV morphine should never be ordered PRN
- Range orders with dual ranges for both dose and interval create ambiguity that can lead to overdose (Correct answer)
- The dose is too low for effective analgesia
- PRN orders require an absolute maximum daily dose by law in all states
Correct answer: Range orders with dual ranges for both dose and interval create ambiguity that can lead to overdose
ISMP warns that range orders with variable doses AND variable intervals create confusion and risk of excessive cumulative dosing.
Question 6: Which of the following is an ISMP-recommended method to prevent errors with concentrated electrolytes such as potassium chloride concentrate?
- Store KCl concentrate vials in patient care areas for rapid access
- Remove KCl concentrate from patient care units and require pharmacy preparation (Correct answer)
- Label KCl vials with a yellow 'caution' sticker only
- Allow nurses to draw up KCl concentrate if a pharmacist is unavailable
Correct answer: Remove KCl concentrate from patient care units and require pharmacy preparation
ISMP's landmark recommendation is to remove concentrated KCl from floor stock entirely, as accidental IV push administration has caused patient deaths.
Question 7: What does the term 'failure mode and effects analysis (FMEA)' refer to in the context of ISMP medication safety?
- A retrospective review of sentinel events after harm has occurred
- A proactive process that identifies where and how a medication use process might fail before errors occur (Correct answer)
- A regulatory audit tool mandated by The Joint Commission
- A patient complaint tracking system for medication-related grievances
Correct answer: A proactive process that identifies where and how a medication use process might fail before errors occur
FMEA is a prospective risk assessment method used to anticipate failure points in a process before patient harm occurs.
ISMP Safe Medication I 2
A nurse receives a verbal order for 'hydromorphone 4 mg IV.' What is the ISMP-recommended action before administering?