ISMP Safe Medication I 4 — Questions and Answers
Question 1: Which labeling practice does ISMP recommend to differentiate look-alike IV bags at the bedside?
- Use only manufacturer labels and avoid any auxiliary stickers
- Apply brightly colored auxiliary labels and physically separate LASA infusions in storage (Correct answer)
- Place all IV bags in identical clear bags to minimize visual clutter
- Use handwritten labels on all IV bags for personalization
Correct answer: Apply brightly colored auxiliary labels and physically separate LASA infusions in storage
Auxiliary labels and physical separation of look-alike IV products reduce the risk of selecting the wrong infusion at the bedside.
Question 2: A patient taking warfarin is admitted and reports taking 'a blood thinner.' The nurse does not reconcile the dose because it is not listed in the EHR. Per ISMP, what is the greatest risk?
- The patient is protected because the EHR would alert to any interaction
- An omission error — the warfarin is not continued or monitored, risking thromboembolic events (Correct answer)
- The patient will likely self-report if they feel symptoms of a clot
- Warfarin is always held on admission as standard protocol
Correct answer: An omission error — the warfarin is not continued or monitored, risking thromboembolic events
Medication reconciliation failures frequently result in omission errors, which are especially dangerous with anticoagulants.
Question 3: An order reads 'insulin regular 10 units sub-Q AC breakfast.' The nurse prepares the dose 45 minutes before the meal tray arrives. What error is most likely to occur?
- Hyperglycemia because insulin was given too late
- Hypoglycemia if the meal is further delayed or the patient refuses to eat (Correct answer)
- A site infection because subcutaneous injection requires a sterile field
- No error, as 45 minutes is always the standard administration window for regular insulin
Correct answer: Hypoglycemia if the meal is further delayed or the patient refuses to eat
Regular insulin given before a meal that is then delayed puts the patient at risk for hypoglycemia, a serious and preventable adverse event.
Question 4: Which best describes the ISMP concept of a 'near miss' in medication safety?
- An error that reached the patient and caused harm
- An error that was caught before it reached the patient, providing a learning opportunity (Correct answer)
- A medication complaint filed by a patient with no clinical outcome
- A prescribing error identified only during a post-discharge chart review
Correct answer: An error that was caught before it reached the patient, providing a learning opportunity
A near miss is an event that could have caused harm but was intercepted before reaching the patient; ISMP encourages reporting these for system improvement.
Question 5: When a smart infusion pump's drug library is bypassed by a clinician using 'free-flow' programming, what key safety feature is defeated?
- The pump's battery backup is disabled
- The hard and soft dose limits that prevent dangerous infusion rates are no longer enforced (Correct answer)
- The electronic medication administration record cannot be updated automatically
- The pump alarm volume is reduced, making it harder to hear alerts
Correct answer: The hard and soft dose limits that prevent dangerous infusion rates are no longer enforced
Bypassing the drug library eliminates the dose-error reduction software (DERS), removing the guardrails that catch lethal programming mistakes.
Question 6: A nurse is asked to administer a chemotherapy agent but has not completed oncology medication competency. Per ISMP, what is the correct action?
- Administer with a pharmacist present to supervise
- Decline to administer and notify the charge nurse to assign a competency-verified nurse (Correct answer)
- Administer because refusing care could constitute patient abandonment
- Request a verbal order from the oncologist and proceed
Correct answer: Decline to administer and notify the charge nurse to assign a competency-verified nurse
ISMP requires that only competency-verified staff administer high-alert drugs such as chemotherapy; a nurse without that competency should not proceed.
Question 7: What is the ISMP-recommended approach when a patient questions whether a newly administered medication is correct?
- Reassure the patient that the nurse has verified the order and proceed
- Stop the administration process, listen to the patient's concern, and re-verify the five rights before continuing (Correct answer)
- Explain that patients are not qualified to evaluate their own medications
- Ask the patient to call the prescriber directly to resolve the confusion
Correct answer: Stop the administration process, listen to the patient's concern, and re-verify the five rights before continuing
ISMP encourages treating patient questions as a safety opportunity; stopping to re-verify has prevented wrong-drug and wrong-dose errors.
ISMP Safe Medication I 4
Which labeling practice does ISMP recommend to differentiate look-alike IV bags at the bedside?