MTM Transitions of Care & Reconciliation 5

Question 1

A pharmacist performing a post-discharge MTM visit identifies that the patient's primary care physician (PCP) was never notified of new medications started during hospitalization. This failure represents a breakdown in:

Accepted Answer

Care team communication and handoff

Answer

Failure to communicate discharge medication changes to the PCP is a critical handoff communication breakdown that endangers continuity of care.

Question 2

A patient on warfarin is transitioning from hospital to home. The safest protocol includes all of the following EXCEPT:

Accepted Answer

Automatically resuming the pre-hospitalization warfarin dose without assessment

Answer

Warfarin dosing post-hospitalization requires reassessment, not automatic resumption, because clinical factors may have changed during the hospital stay.

Question 3

In the context of care transitions, 'medication reconciliation' is BEST defined as:

Accepted Answer

The process of comparing a patient's medication orders to all medications the patient has been taking to avoid errors

Answer

Medication reconciliation is the formal process of comparing ordered medications against the patient's complete medication list to identify and resolve discrepancies.

Question 4

A pharmacist is developing a transitions of care program for patients with heart failure. Which intervention has the STRONGEST evidence for reducing 30-day readmissions?

Accepted Answer

Providing a phone-based follow-up call within 72 hours of discharge combined with a medication review

Answer

Early phone follow-up combined with medication review within 72 hours of discharge has the strongest evidence base for reducing heart failure readmissions.

Question 5

A patient transitioning from ICU to general floor care has their vancomycin dose held by the floor nurse because it was not re-ordered in the new unit's system. This is an example of which type of transition error?

Accepted Answer

Order omission due to inadequate handoff in the medication reconciliation process

Answer

Failure to transfer active medication orders during intra-hospital transitions is an omission error resulting from inadequate medication reconciliation during the handoff.

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

MTM Transitions of Care & Reconciliation 5