RCA Medication Management Oversight 3 — Questions and Answers
Question 1: A nurse discovers a controlled substance count discrepancy at the end of a shift. What is the FIRST required action?
- Notify the patient's family
- Report the discrepancy to the charge nurse and initiate a formal investigation (Correct answer)
- Administer a replacement dose from another patient's supply
- Document the discrepancy only in personal notes
Correct answer: Report the discrepancy to the charge nurse and initiate a formal investigation
Controlled substance discrepancies must be immediately reported to supervisory staff and investigated per DEA and facility policy to rule out diversion.
Question 2: Which of the following BEST describes a 'high-alert medication' as defined by the Institute for Safe Medication Practices (ISMP)?
- Drugs that are frequently prescribed and low risk
- Drugs that bear a heightened risk of causing significant patient harm when used in error (Correct answer)
- Any medication requiring refrigeration
- Over-the-counter drugs with a long half-life
Correct answer: Drugs that bear a heightened risk of causing significant patient harm when used in error
ISMP defines high-alert medications as those that carry a disproportionate risk of causing serious harm when involved in a medication error.
Question 3: An order reads 'metoprolol 50 mg PO BID.' The 'PO' refers to which route of administration?
- By injection
- By mouth (oral) (Correct answer)
- Per ostomy
- Peripheral only
Correct answer: By mouth (oral)
PO is Latin for 'per os,' meaning by mouth, indicating the medication should be taken orally.
Question 4: Under The Joint Commission (TJC) standards, which is a required element of a complete medication order?
- Patient's insurance information
- Drug name, dose, route, frequency, and indication (Correct answer)
- Prescriber's home address
- Pharmacy dispensing fee
Correct answer: Drug name, dose, route, frequency, and indication
TJC requires medication orders to include at minimum the drug name, dose, route, frequency, and clinical indication to ensure safe dispensing and administration.
Question 5: Which tool is recommended by ISMP to standardize the expression of medication doses and reduce transcription errors?
- Using abbreviations like 'U' for units freely
- Adopting error-prone abbreviation lists and avoiding prohibited shorthand (Correct answer)
- Writing doses only in Roman numerals
- Expressing all doses as ratios regardless of drug class
Correct answer: Adopting error-prone abbreviation lists and avoiding prohibited shorthand
ISMP's list of error-prone abbreviations identifies shorthand like 'U' (mistaken for '0' or '4') that should be avoided to prevent dosing errors.
Question 6: A healthcare facility wants to reduce medication errors using a closed-loop medication management system. Which technology is central to this approach?
- Paper-based medication administration records (MAR)
- Computerized physician order entry (CPOE) integrated with barcode medication administration (BCMA) (Correct answer)
- Verbal order reliance for speed
- Manual pill-counting trays without electronic tracking
Correct answer: Computerized physician order entry (CPOE) integrated with barcode medication administration (BCMA)
Closed-loop systems link CPOE, pharmacy verification, and BCMA to electronically track a medication from order entry to patient administration, minimizing error opportunities.
Question 7: What is the purpose of a medication use evaluation (MUE) in a hospital setting?
- Billing insurers for drug administration fees
- Assessing the prescribing, dispensing, and administration of a drug to improve outcomes and safety (Correct answer)
- Negotiating drug purchase contracts with manufacturers
- Training pharmacy students on compounding
Correct answer: Assessing the prescribing, dispensing, and administration of a drug to improve outcomes and safety
An MUE is a performance improvement activity that evaluates how well a specific medication is being used relative to established criteria and clinical guidelines.
RCA Medication Management Oversight 3
A nurse discovers a controlled substance count discrepancy at the end of a shift.
What is the FIRST required action?