QMAP Administering Controlled Substances 2 — Questions and Answers
Question 1: What is the primary purpose of the controlled substance count at shift change?
- To determine if more medication needs to be ordered
- To verify the physical count matches documentation and detect diversion (Correct answer)
- To check expiration dates
- To update the prescriber on remaining supply
Correct answer: To verify the physical count matches documentation and detect diversion
The count verifies that physical inventory matches documentation, helping detect missing medications that could indicate diversion.
Two staff members independently count all controlled substances and compare the physical count to the documented count. Any discrepancy must be investigated and reported immediately. Both staff members must sign the log confirming agreement.
Question 2: A resident has a PRN Schedule II pain medication. They request it 2 hours after the last dose, but the order says every 4 hours. What should the QMAP do?
- Give a half dose
- Administer since the resident is in pain
- Explain the timing requirement and notify the supervising nurse (Correct answer)
- Document that the resident refused to wait
Correct answer: Explain the timing requirement and notify the supervising nurse
Follow the prescribed interval. Explain to the resident and notify the nurse about uncontrolled pain.
QMAPs must strictly adhere to prescribed intervals. Administering early risks overdose and respiratory depression. The QMAP should acknowledge the pain, explain the interval, notify the nurse who can contact the prescriber for additional pain management.
Question 3: Which of the following is an example of controlled substance diversion?
- Administering at the prescribed time
- A staff member taking a resident's pain medication for personal use (Correct answer)
- Documenting administration on the MAR
- Counting substances at shift change
Correct answer: A staff member taking a resident's pain medication for personal use
Diversion is the unauthorized redirection of prescription medications from their intended recipient.
Common forms include staff pocketing medications, substituting placebos, documenting administration that did not occur, and wasting without a witness. Diversion is a serious criminal offense that endangers residents.
Question 4: When wasting an unused portion of a controlled substance, what is required?
- The QMAP can waste it alone
- A witness must observe and co-sign the documentation (Correct answer)
- The unused portion should be saved
- It should be returned to the pharmacy
Correct answer: A witness must observe and co-sign the documentation
All controlled substance wasting must be witnessed and co-signed by another authorized staff member.
The witness must physically observe the disposal and co-sign the controlled substance record documenting the amounts administered and wasted. This prevents diversion by ensuring unused portions are actually destroyed.
Question 5: What information must be recorded each time a controlled substance is administered?
- Only date and resident name
- Date, time, resident name, medication, dose, and administering staff signature (Correct answer)
- Only medication name and dose
- Just initials on the MAR
Correct answer: Date, time, resident name, medication, dose, and administering staff signature
Complete documentation includes date, time, resident ID, medication, dose, route, running balance, and full signature.
Every controlled substance administration must include date, exact time, resident full name, medication name and strength, dose, route, running balance, and full signature of the administering staff member. This creates an audit trail for regulatory inspections.
Question 6: Under which DEA schedule are medications with the highest abuse potential and no accepted medical use?
- Schedule I (Correct answer)
- Schedule II
- Schedule III
- Schedule V
Correct answer: Schedule I
Schedule I substances have high abuse potential and no accepted medical use, such as heroin and LSD.
Schedule I: high abuse, no medical use (heroin, LSD). Schedule II: high abuse with medical use (oxycodone, fentanyl). Schedule III: moderate abuse (ketamine). Schedule IV: low abuse (benzodiazepines). Schedule V: lowest abuse (some codeine preparations).
QMAP Administering Controlled Substances 2
What is the primary purpose of the controlled substance count at shift change?