MTM Collaborative Practice Agreements 4 — Questions and Answers
Question 1: Which of the following best describes a 'statewide' or 'statewide protocol' CPA model?
- Each pharmacist-physician pair drafts a unique agreement
- A state-issued protocol allows all licensed pharmacists to provide specific services without an individual physician agreement (Correct answer)
- Only hospital pharmacists may participate
- The state requires all pharmacists to enter CPAs regardless of practice setting
Correct answer: A state-issued protocol allows all licensed pharmacists to provide specific services without an individual physician agreement
Statewide protocol models authorize all qualifying pharmacists to provide defined services without requiring individual physician agreements.
Question 2: In the context of CPAs, what does 'non-delegable duty' mean?
- A task the pharmacist must perform without supervision
- A clinical responsibility that cannot be legally transferred from the physician to the pharmacist (Correct answer)
- A billing code reserved for pharmacist services
- A required CPA disclosure to the patient
Correct answer: A clinical responsibility that cannot be legally transferred from the physician to the pharmacist
Non-delegable duties are legal obligations a physician cannot delegate, such as diagnosing a new disease, even under a CPA.
Question 3: A pharmacist-run anticoagulation clinic operates under a CPA. A patient's INR is supratherapeutic at 5.2 with no bleeding. Per protocol, the pharmacist should:
- Discharge the patient from the clinic
- Hold warfarin doses per the protocol algorithm and schedule follow-up (Correct answer)
- Immediately send the patient to the ER in all cases
- Increase the dose to correct the INR quickly
Correct answer: Hold warfarin doses per the protocol algorithm and schedule follow-up
Supratherapeutic INR without bleeding is managed per protocol by withholding doses and scheduling close follow-up.
Question 4: What differentiates a CPA from a 'prescriptive authority' grant given directly to pharmacists in some states?
- A CPA requires a physician as a collaborator, while direct prescriptive authority does not (Correct answer)
- Prescriptive authority is only for hospital pharmacists
- CPAs allow pharmacists to diagnose conditions
- There is no legal difference between the two
Correct answer: A CPA requires a physician as a collaborator, while direct prescriptive authority does not
Direct prescriptive authority allows pharmacists to prescribe independently, whereas a CPA always requires a collaborating physician partner.
Question 5: Which scenario illustrates an ethical conflict a pharmacist may face under a CPA?
- Titrating a patient's statin per protocol
- Being asked by the collaborating physician to document interventions they did not actually perform (Correct answer)
- Ordering a lipid panel for monitoring purposes
- Contacting a patient about a missed refill
Correct answer: Being asked by the collaborating physician to document interventions they did not actually perform
Documenting interventions that did not occur constitutes fraud and is an ethical violation regardless of physician request.
Question 6: A pharmacist under a CPA initiates ACE inhibitor therapy for a hypertensive patient. Three days later the patient develops angioedema. The pharmacist's FIRST action should be:
- Reduce the ACE inhibitor dose and observe
- Discontinue the ACE inhibitor, ensure patient safety, and immediately notify the physician (Correct answer)
- Switch to an ARB per the CPA protocol without notifying the physician
- Document the reaction and wait for the next scheduled visit
Correct answer: Discontinue the ACE inhibitor, ensure patient safety, and immediately notify the physician
Angioedema is a life-threatening reaction requiring immediate discontinuation, safety intervention, and urgent physician notification.
Question 7: What is the primary purpose of the 'communication plan' section within a CPA?
- To outline how the pharmacy advertises its services
- To define how and when the pharmacist will update the physician about patient status and interventions (Correct answer)
- To describe the pharmacist's social media policy
- To establish billing rates between the pharmacist and physician
Correct answer: To define how and when the pharmacist will update the physician about patient status and interventions
The communication plan specifies the frequency, method, and content of updates the pharmacist provides to the collaborating physician.
MTM Collaborative Practice Agreements 4
Which of the following best describes a 'statewide' or 'statewide protocol' CPA model?