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
In the Naylor Transitional Care Model, which professional serves as the primary coordinator for high-risk older adults during care transitions?
Answer: Advanced practice nurse
The Naylor Transitional Care Model uses advanced practice nurses as dedicated transition coaches for high-risk elderly patients.
A patient's BPMH (Best Possible Medication History) reveals they take aspirin 325 mg daily for cardiovascular protection. The hospital discharged them on aspirin 81 mg daily. Without documentation, this change should be classified as:
Answer: A potential unintentional discrepancy
Undocumented dose changes between BPMH and discharge medications are considered potential unintentional discrepancies until confirmed by the prescriber.
Which organization developed the medication reconciliation standards that accredited hospitals must follow?
Answer: The Joint Commission (TJC)
The Joint Commission's National Patient Safety Goals (NPSG.03.06.01) require accredited hospitals to maintain and communicate accurate medication lists.
A pharmacist calls a patient 48 hours post-discharge per a transitions of care protocol. The patient reports they have not filled their new prescriptions because they cannot afford them. The MOST appropriate immediate action is to:
Answer: Connect the patient with patient assistance programs or generic alternatives
Addressing financial barriers proactively through assistance programs and generic alternatives prevents medication non-adherence and potential readmission.
A patient with COPD is being discharged on tiotropium inhaler, but the pharmacist notes no one has taught the patient the proper inhalation technique. This represents a gap in which component of discharge counseling?
Answer: Device training and administration education
Proper inhaler technique education is essential for COPD patients, and failure to provide it is a gap in device training during discharge counseling.
During medication reconciliation, a pharmacist finds that a patient's home medication list includes oxycodone 10 mg Q6H PRN, but this was not addressed or continued at discharge. The pharmacist should FIRST:
Answer: Contact the discharging team to determine if discontinuation was intentional
Unaddressed chronic opioid therapy at discharge requires clarification with the care team to determine if discontinuation was intentional or an oversight.
Which of the following is an example of a HIGH-RISK medication that warrants EXTRA scrutiny during medication reconciliation at care transitions?
Answer: Insulin glargine
Insulin is on ISMP's High-Alert Medication list and requires extra verification during reconciliation due to high potential for serious patient harm from dosing errors.