Transitions of Care & Reconciliation Flashcards
7 cards from real MTM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Transitions of Care & Reconciliation flashcards as text
A patient is discharged from the hospital on warfarin 5 mg daily, but their outpatient record shows warfarin 2.5 mg daily. What is the pharmacist's FIRST action?
Answer: Contact the discharging physician to clarify the intended dose
Dose discrepancies require immediate clarification with the prescriber before dispensing to prevent patient harm.
During a post-discharge MTM visit, which tool is MOST useful for identifying medications the patient is actually taking versus what was prescribed?
Answer: Brown bag medication review
A brown bag review allows the pharmacist to physically inspect all medications the patient has at home, capturing the most accurate picture of actual use.
Which patient population is at HIGHEST risk for medication errors during care transitions?
Answer: Elderly patients with multiple chronic conditions on polypharmacy
Elderly patients with polypharmacy are most vulnerable due to complex regimens, cognitive changes, and multiple prescribers.
A pharmacist conducting medication reconciliation at hospital admission finds a patient takes an herbal supplement not listed on any prior record. What should the pharmacist do?
Answer: Document it and assess for drug-herb interactions
All supplements must be documented and evaluated for potential interactions with prescribed medications.
Which of the following BEST describes the purpose of the 'teach-back' method during care transition counseling?
Answer: Confirming patient understanding by asking them to explain information back
Teach-back confirms comprehension by having the patient restate information in their own words, identifying gaps in understanding.
A patient transitioning from inpatient to skilled nursing facility (SNF) care has insulin orders that differ between settings. Who bears PRIMARY responsibility for reconciling these orders?
Answer: The healthcare team at both the sending and receiving facilities working together
Safe medication reconciliation during handoffs requires collaboration between both the sending and receiving care teams.
After a patient is discharged from the ED with a new beta-blocker prescription, the MTM pharmacist discovers the patient already takes a beta-blocker at home. What is this an example of?
Answer: Therapeutic duplication identified during medication reconciliation
Prescribing the same drug class twice creates therapeutic duplication, a common error caught during medication reconciliation.