Transitions of Care & Care Coordination 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 & Care Coordination flashcards as text
Which intervention is MOST critical for a pharmacist conducting MTM during a patient's transition from hospital to home?
Answer: Reconciling the discharge medication list against pre-admission medications
Medication reconciliation at discharge is the highest-priority MTM activity because discrepancies between discharge and pre-admission medications are a leading cause of post-discharge adverse events.
A patient is discharged from the hospital on warfarin. Within the first 30 days post-discharge, which MTM activity best reduces readmission risk?
Answer: Conducting a targeted medication review with INR monitoring follow-up
A targeted medication review focused on warfarin therapy, combined with INR monitoring coordination, addresses the high risk of bleeding or thrombosis in the vulnerable post-discharge window.
According to CMS guidelines, how soon after hospital discharge should an MTM follow-up contact ideally occur to reduce readmissions?
Answer: Within 7 days
CMS and quality improvement initiatives recommend MTM follow-up within 7 days of discharge to catch medication errors, adverse effects, and adherence issues before they lead to readmission.
Which tool is MOST commonly used by pharmacists to document medication discrepancies identified during care transitions?
Answer: Best Possible Medication History (BPMH)
The Best Possible Medication History (BPMH) is the standard tool used to capture a complete, accurate medication list from multiple sources, serving as the baseline for reconciliation during care transitions.
A patient newly prescribed a beta-blocker for heart failure is being transitioned from a hospitalist to a primary care provider. The MTM pharmacist's MOST important coordination action is to:
Answer: Communicate the indication, dose titration schedule, and monitoring parameters to the receiving provider
Communicating indication, titration plan, and monitoring parameters ensures continuity and prevents the receiving provider from inadvertently discontinuing or mismanaging a newly initiated guideline-directed therapy.
Which patient characteristic most significantly increases the risk of medication-related problems during care transitions?
Answer: Polypharmacy (5 or more chronic medications) in a patient with multiple comorbidities
Polypharmacy combined with multiple comorbidities greatly increases the probability of drug interactions, duplications, omissions, and dosing errors during the transition process.
During a post-discharge MTM call, a patient reports not filling two of five new prescriptions due to cost. The pharmacist's BEST initial action is to:
Answer: Assess the clinical priority of each unfilled medication and explore financial assistance options
Assessing clinical priority ensures life-sustaining medications are obtained first, while exploring patient assistance programs, generics, or therapeutic alternatives addresses the cost barrier without compromising safety.