MTM Transitions of Care & Reconciliation 4 — Questions and Answers
Question 1: In the Naylor Transitional Care Model, which professional serves as the primary coordinator for high-risk older adults during care transitions?
- Primary care physician
- Social worker
- Advanced practice nurse (Correct answer)
- Pharmacist
Correct answer: Advanced practice nurse
The Naylor Transitional Care Model uses advanced practice nurses as dedicated transition coaches for high-risk elderly patients.
Question 2: 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:
- An intentional therapeutic change
- A potential unintentional discrepancy (Correct answer)
- A formulary substitution
- A duplicate therapy issue
Correct answer: A potential unintentional discrepancy
Undocumented dose changes between BPMH and discharge medications are considered potential unintentional discrepancies until confirmed by the prescriber.
Question 3: Which organization developed the medication reconciliation standards that accredited hospitals must follow?
- American Pharmacists Association (APhA)
- The Joint Commission (TJC) (Correct answer)
- Centers for Medicare and Medicaid Services (CMS)
- American Society of Health-System Pharmacists (ASHP)
Correct 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.
Question 4: 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:
- Advise the patient to skip doses until they can afford the medications
- Connect the patient with patient assistance programs or generic alternatives (Correct answer)
- Document the call and wait for their next physician appointment
- Tell the patient to go to the emergency department for medications
Correct 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.
Question 5: 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?
- Medication reconciliation
- Device training and administration education (Correct answer)
- Adverse effect monitoring
- Drug interaction screening
Correct 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.
Question 6: 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:
- Automatically prescribe the opioid as continuation of home therapy
- Contact the discharging team to determine if discontinuation was intentional (Correct answer)
- Advise the patient to purchase over-the-counter pain medications
- Refer the patient to a pain management clinic without addressing the gap
Correct 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.
Question 7: Which of the following is an example of a HIGH-RISK medication that warrants EXTRA scrutiny during medication reconciliation at care transitions?
- Docusate sodium
- Insulin glargine (Correct answer)
- Multivitamin
- Calcium carbonate
Correct 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.
MTM Transitions of Care & Reconciliation 4
In the Naylor Transitional Care Model, which professional serves as the primary coordinator for high-risk older adults during care transitions?