MTM Medication Safety & Error Prevention 4 — Questions and Answers
Question 1: Which action BEST exemplifies applying a 'forcing function' to prevent a medication safety error?
- Posting a reminder sign near the medication room
- Requiring a pharmacist to double-check high-alert drugs
- Removing concentrated potassium from floor stock entirely (Correct answer)
- Training nurses on the risks of electrolyte errors
Correct answer: Removing concentrated potassium from floor stock entirely
A forcing function physically prevents the error from occurring; removing concentrated potassium chloride from floor stock makes it impossible for nurses to administer it undiluted.
Question 2: A patient on lithium develops confusion and tremors after being prescribed ibuprofen for knee pain. The MTM pharmacist should recognize this as an example of:
- Lithium toxicity from NSAID-induced renal clearance reduction (Correct answer)
- Serotonin syndrome from combined CNS agents
- Additive nephrotoxicity without effect on lithium levels
- Aspirin-sensitive respiratory disease
Correct answer: Lithium toxicity from NSAID-induced renal clearance reduction
NSAIDs reduce renal prostaglandin synthesis, decreasing lithium clearance and raising serum lithium to toxic levels.
Question 3: Which metric is MOST appropriate for measuring the rate of adverse drug events in an MTM population?
- Number of medication reconciliation forms completed
- ADEs per 1,000 patient-days or per 100 admissions (Correct answer)
- Percentage of patients with ≥5 chronic medications
- Proportion of patients who received a CMR
Correct answer: ADEs per 1,000 patient-days or per 100 admissions
ADE rates expressed per patient-days or admissions normalize for population size and exposure time, making them a valid safety outcome measure.
Question 4: The Beers Criteria is PRIMARILY intended to help MTM pharmacists identify medications that are:
- Contraindicated in pregnancy
- Potentially inappropriate in adults aged 65 and older (Correct answer)
- Requiring renal dose adjustment in all patients
- Associated with QT interval prolongation
Correct answer: Potentially inappropriate in adults aged 65 and older
The AGS Beers Criteria lists medications that are potentially inappropriate in older adults due to unfavorable risk-benefit profiles in this population.
Question 5: A prescriber writes 'QD' for once-daily dosing. Why is this abbreviation considered unsafe?
- It can be mistaken for 'QID' (four times daily), causing a fourfold dosing error (Correct answer)
- It is not recognized by most pharmacy software systems
- It is an unapproved Latin abbreviation under JCAHO rules
- It does not specify the time of day for administration
Correct answer: It can be mistaken for 'QID' (four times daily), causing a fourfold dosing error
ISMP identifies 'QD' as error-prone because it can be misread as 'QID,' leading to four-times-daily dosing instead of once daily.
Question 6: During an MTM visit, a patient says they stopped taking their blood pressure medication because 'it makes me dizzy.' The pharmacist documents this as which type of medication-related problem?
- Unnecessary drug therapy
- Adverse drug reaction causing non-adherence (Correct answer)
- Subtherapeutic dosage
- Need for additional drug therapy
Correct answer: Adverse drug reaction causing non-adherence
Dizziness is a known adverse effect of antihypertensives (especially at initiation) that can cause patients to discontinue therapy; it is classified as an adverse drug reaction.
Question 7: A pharmacist identifies that a patient has been using two different pharmacies and has duplicate prescriptions for oxycodone from two providers. The FIRST action the MTM pharmacist should take is:
- Report the patient to the state pharmacy board
- Notify law enforcement immediately
- Review the prescription drug monitoring program (PDMP) and consult with prescribers (Correct answer)
- Refuse to conduct the MTM session
Correct answer: Review the prescription drug monitoring program (PDMP) and consult with prescribers
The appropriate first step is to review the PDMP to confirm the duplication and then communicate with the prescribers to resolve the situation and ensure patient safety.
MTM Medication Safety & Error Prevention 4
Which action BEST exemplifies applying a 'forcing function' to prevent a medication safety error?