ISMP Safe Medication Principles 2 — Questions and Answers
Question 1: Which ISMP error-reduction strategy involves removing concentrated electrolytes from nursing unit stock?
- Redundancy
- Forcing functions (Correct answer)
- Standardization
- Simplification
Correct answer: Forcing functions
Forcing functions physically prevent an error from occurring, such as removing concentrated KCl from units so it cannot be inadvertently given undiluted.
Question 2: A nurse receives a verbal order during a code. What is the ISMP-recommended first step after the emergency?
- Document the order in the chart immediately after the event
- Have the prescriber co-sign the written order within 24 hours
- Repeat the order back before administering, then get written confirmation (Correct answer)
- Notify pharmacy within 1 hour
Correct answer: Repeat the order back before administering, then get written confirmation
ISMP recommends read-back verification of verbal orders during the event, followed by prompt written confirmation from the prescriber.
Question 3: Which practice does ISMP identify as a primary cause of look-alike/sound-alike (LASA) drug errors?
- Using brand names exclusively
- Storing LASA drugs in alphabetical sequence on shelves (Correct answer)
- Requiring two-nurse verification
- Using tall-man lettering on labels
Correct answer: Storing LASA drugs in alphabetical sequence on shelves
Storing LASA drugs alphabetically places similar-looking names adjacent to each other, increasing the risk of selection errors.
Question 4: What does the ISMP term 'signal-to-noise ratio' refer to in medication safety?
- The ratio of alarm volume to ambient noise in an ICU
- The proportion of meaningful safety alerts versus irrelevant alerts that clinicians receive (Correct answer)
- Barcode scanning accuracy rates
- The percentage of adverse drug events caught before reaching patients
Correct answer: The proportion of meaningful safety alerts versus irrelevant alerts that clinicians receive
A low signal-to-noise ratio means clinicians receive so many irrelevant alerts that they begin ignoring meaningful warnings, a phenomenon called alert fatigue.
Question 5: Per ISMP guidance, which action best prevents wrong-patient medication errors during administration?
- Checking the room number before entering
- Using two independent patient identifiers before administration (Correct answer)
- Relying on the patient to state their own name
- Scanning the medication barcode at the Pyxis station
Correct answer: Using two independent patient identifiers before administration
ISMP and The Joint Commission require two independent identifiers (e.g., name + date of birth) to be confirmed directly at the bedside before administration.
Question 6: A pharmacy receives a prescription written as 'morphine 2.0 mg IV.' What ISMP-recommended practice was violated?
- Using generic names
- Writing a trailing zero after a decimal point (Correct answer)
- Failing to specify the route
- Not including the indication
Correct answer: Writing a trailing zero after a decimal point
ISMP advises against trailing zeros (e.g., 2.0 mg) because if the decimal point is missed the dose reads as 20 mg, a ten-fold overdose.
Question 7: Which ISMP strategy addresses the hazard of incomplete medication reconciliation at care transitions?
- Implementing tall-man lettering
- Obtaining a Best Possible Medication History (BPMH) from every patient (Correct answer)
- Restricting prescribing to attending physicians only
- Requiring pharmacy review only for high-alert medications
Correct answer: Obtaining a Best Possible Medication History (BPMH) from every patient
A BPMH gathered from the patient, caregivers, and community pharmacies provides the most complete picture to reconcile against newly ordered medications.
ISMP Safe Medication Principles 2
Which ISMP error-reduction strategy involves removing concentrated electrolytes from nursing unit stock?