QMAP The Seven Rights 2 — Questions and Answers
Question 1: A QMAP picks up a medication that looks different from what the resident usually receives. What should they do according to the "Right Medication" principle?
- Give it since the label matches
- Stop and verify - compare to the MAR, check if the pharmacy changed manufacturers, and contact pharmacy if unsure (Correct answer)
- Throw it away and skip the dose
- Ask the resident if it looks right
Correct answer: Stop and verify - compare to the MAR, check if the pharmacy changed manufacturers, and contact pharmacy if unsure
Any discrepancy in appearance warrants investigation even if the label appears correct.
Possible reasons: pharmacy changed manufacturers (common with generics), dispensing error (wrong medication), or medication degradation. Read the full label, check the indication, verify the dose, and contact the pharmacy if any doubt remains.
Question 2: The prescribed dose is 10 mg but only 5 mg tablets are available. What should the QMAP do?
- Give one 5 mg tablet as a partial dose
- Give two 5 mg tablets to equal 10 mg (Correct answer)
- Contact pharmacy for 10 mg tablets
- Skip the dose
Correct answer: Give two 5 mg tablets to equal 10 mg
Two 5 mg tablets equal the prescribed 10 mg dose. This is standard dosage calculation.
10 mg / 5 mg = 2 tablets. Always perform the calculation yourself and double-check. If the result requires an unusual number of tablets (more than 3-4), verify the order as it may be an error.
Question 3: The route is listed as "SL" but the resident wants to swallow it with water. What should the QMAP do?
- Allow the resident to take it however they prefer
- Explain it must be placed under the tongue as ordered since swallowing changes how it works (Correct answer)
- Let them swallow since it still enters the body
- Give extra water to help dissolve under the tongue
Correct answer: Explain it must be placed under the tongue as ordered since swallowing changes how it works
Sublingual medications must be absorbed under the tongue. Swallowing changes absorption and may render them ineffective.
Sublingual medications provide rapid absorption by bypassing the digestive system. Nitroglycerin for angina works within minutes sublingually but would be dramatically less effective if swallowed. Do not drink water until fully dissolved.
Question 4: What does the "Right Time" principle mean in practice?
- Medications can be given any time as long as all daily doses are given
- Administer within the facility-defined window, typically 30-60 minutes around the scheduled time (Correct answer)
- Must be given at the exact minute
- Time only matters for controlled substances
Correct answer: Administer within the facility-defined window, typically 30-60 minutes around the scheduled time
Most facilities define a 30-60 minute window around the scheduled time.
Time-critical medications (insulin, antibiotics, Parkinson's medications) may have narrower windows. PRN medications have minimum intervals. Consistently late administration should be evaluated for workflow improvements.
Question 5: The "Right Documentation" principle requires documentation at what point?
- Beginning of each shift
- Immediately after each medication is administered (Correct answer)
- End of the shift
- Only when an error occurs
Correct answer: Immediately after each medication is administered
Document immediately after administration to ensure accuracy and prevent double-dosing.
Documenting before is dangerous if the process is interrupted. Delaying risks forgetting details and creates windows for duplicate doses. Include medication name, dose, route, actual time, and QMAP initials or signature.
Question 6: The "Right Reason" is sometimes included as an additional right. What does this mean for a QMAP?
- Understand why each medication is prescribed to verify the order makes sense (Correct answer)
- Diagnose the condition before giving medication
- Only applies to PRN medications
- Only the prescriber's concern
Correct answer: Understand why each medication is prescribed to verify the order makes sense
Understanding why each medication is prescribed helps verify appropriateness and catch potential errors.
Understanding the purpose helps: verify appropriateness, recognize contraindications, assess effectiveness, educate residents, and identify potential errors. QMAPs do not diagnose but understanding therapeutic purpose makes them more effective.
QMAP The Seven Rights 2
A QMAP picks up a medication that looks different from what the resident usually receives.
What should they do according to the "Right Medication" principle?