MTM Transitions of Care & Reconciliation 3 — Questions and Answers
Question 1: The 'MARQUIS' collaborative study focused primarily on improving which aspect of hospital care?
- Reducing surgical site infections
- Improving inpatient medication reconciliation (Correct answer)
- Decreasing length of stay in the ICU
- Optimizing antimicrobial stewardship
Correct answer: Improving inpatient medication reconciliation
MARQUIS (Multi-site Medication Reconciliation Quality Improvement Study) is a landmark initiative targeting inpatient medication reconciliation improvement.
Question 2: A patient with heart failure is readmitted 10 days post-discharge. The pharmacist finds the patient stopped taking furosemide because the discharge instructions said 'water pill' but the prescription label said 'furosemide.' What type of barrier does this represent?
- Financial barrier to medication access
- Health literacy and communication gap (Correct answer)
- Formulary restriction
- Provider prescribing error
Correct answer: Health literacy and communication gap
Discrepancies between lay language and drug names cause confusion and non-adherence, highlighting health literacy communication gaps.
Question 3: Which metric is MOST commonly used to evaluate the effectiveness of care transition programs?
- Patient satisfaction scores only
- 30-day hospital readmission rates (Correct answer)
- Average length of hospital stay
- Number of prescriptions filled post-discharge
Correct answer: 30-day hospital readmission rates
30-day readmission rates are the primary outcome measure for care transition interventions and are tied to CMS reimbursement penalties.
Question 4: A pharmacist reviewing a patient's discharge medications identifies that lisinopril was inappropriately discontinued during hospitalization and not restarted. What is the MOST appropriate term for this type of discrepancy?
- Commission error
- Omission error (Correct answer)
- Transcription error
- Therapeutic substitution
Correct answer: Omission error
An omission error occurs when a necessary medication is not included in the medication list or orders.
Question 5: Under the CMS Conditions of Participation, hospitals are required to provide patients with a written discharge plan that includes:
- Only new medications started during hospitalization
- A complete medication list including dose, frequency, and purpose (Correct answer)
- Medications the patient should avoid in the future
- Only controlled substance prescriptions
Correct answer: A complete medication list including dose, frequency, and purpose
CMS requires hospitals to provide patients a complete, reconciled medication list at discharge to support safe transitions.
Question 6: A patient newly started on clopidogrel at hospital discharge does not understand why they need it. Which element of the Coleman Care Transitions Intervention addresses this gap?
- Follow-up appointment scheduling
- Personal health record and medication self-management (Correct answer)
- Community resource referral
- Social work assessment
Correct answer: Personal health record and medication self-management
The Coleman CTI uses a personal health record to help patients understand and self-manage their medications during transitions.
Question 7: During a transition of care, a pharmacist discovers the patient was on home metformin 1000 mg BID but was discharged on metformin 500 mg BID without documentation of why the dose changed. The BEST next step is to:
- Assume the dose reduction was intentional and dispense 500 mg
- Contact the discharging physician for clarification before dispensing (Correct answer)
- Automatically reinstate the higher dose per patient's report
- Hold all diabetes medications until the patient sees their primary care physician
Correct answer: Contact the discharging physician for clarification before dispensing
Undocumented dose changes require prescriber clarification to determine intent and ensure patient safety.
MTM Transitions of Care & Reconciliation 3
The 'MARQUIS' collaborative study focused primarily on improving which aspect of hospital care?