SMQT - Surveyor Minimum Qualifications Pharmacy and Medication Services Questions and Answers — Questions and Answers
Question 1: A consultant pharmacist, during a monthly drug regimen review, identifies that a resident is prescribed two medications with a known significant drug-to-drug interaction that could cause serious harm. According to 42 CFR §483.45, what is the pharmacist's required action after identifying this irregularity?
- Document the finding for review at the next quarterly Quality Assurance meeting.
- Contact the resident's family to inform them of the potential risk.
- Report the finding to the facility's administrator and medical director.
- Report the irregularity to the attending physician and the director of nursing. (Correct answer)
Correct answer: Report the irregularity to the attending physician and the director of nursing.
According to 42 CFR §483.45(c)(4), the pharmacist must report any identified irregularities to the attending physician and the facility's director of nursing. This ensures that those with the authority to make clinical changes are promptly informed to take necessary action.
Question 2: A surveyor is reviewing a resident's record and notes a new order for an antipsychotic medication to manage agitation. Which of the following findings would most strongly suggest that the facility is not in compliance with regulations regarding unnecessary drugs?
- The medication was initiated after the resident had a documented altercation with another resident.
- The resident's family provided consent for the use of the medication.
- The record lacks documentation of non-pharmacological interventions being tried before the medication was started. (Correct answer)
- The initial dose prescribed is the lowest recommended dose for geriatric patients.
Correct answer: The record lacks documentation of non-pharmacological interventions being tried before the medication was started.
Federal regulations at 42 CFR §483.45(e) require that residents who have not used psychotropic drugs are not given these drugs unless the medication is necessary to treat a specific, diagnosed condition. Furthermore, guidance emphasizes the use of non-pharmacological approaches first. The absence of documented attempts at non-pharmacological interventions indicates the facility may be using a chemical restraint rather than treating a condition appropriately.
Question 3: Which of the following scenarios constitutes a 'significant medication error' according to the Centers for Medicare & Medicaid Services (CMS) definition?
- A resident is administered a medication to which they have a known, severe allergy, requiring emergency intervention. (Correct answer)
- A resident's routine daily multivitamin is administered one hour after its scheduled time.
- A nurse documents the administration of a medication in the wrong time slot in the Medication Administration Record (MAR).
- A resident refuses one dose of a non-critical medication, and the refusal is properly documented.
Correct answer: A resident is administered a medication to which they have a known, severe allergy, requiring emergency intervention.
A significant medication error is defined as one which causes the resident discomfort or jeopardizes their health and safety. Administering a drug to a resident with a known severe allergy clearly jeopardizes their health and safety and has the potential for a life-threatening outcome.
Question 4: During a tour of a facility, a surveyor observes a medication cart in a hallway. The cart is unlocked and unattended while the nurse is in a resident's room with the door closed. This practice is a direct violation of which pharmacy service requirement?
- Drug Regimen Review
- Medication Error Prevention
- Labeling of Drugs and Biologicals
- Storage of Drugs and Biologicals (Correct answer)
Correct answer: Storage of Drugs and Biologicals
Regulation 42 CFR §483.45(h) requires that drugs and biologicals be stored in locked compartments under proper temperature controls and that access is limited to authorized personnel. Leaving a medication cart unlocked and unattended in a common area violates this security requirement.
Question 5: A skilled nursing facility stores its Schedule II controlled substances in a locked tackle box inside a locked medication cart. How does this practice align with federal storage requirements for controlled substances?
- It is non-compliant because Schedule II drugs must be stored in a hospital-grade safe.
- It is compliant because the drugs are double-locked, meeting the storage standard. (Correct answer)
- It is non-compliant unless the cart is kept in a separately locked medication room.
- It is compliant only if the state board of pharmacy has specifically approved this method.
Correct answer: It is compliant because the drugs are double-locked, meeting the storage standard.
Federal regulation 42 CFR §483.45(h)(2) requires that Schedule II drugs be stored in separately locked, permanently affixed compartments. The common and accepted practice that meets this standard is a 'double lock' system, such as a locked box within a locked cart or cabinet. This ensures a higher level of security for substances with a high potential for abuse.
Question 6: A surveyor notes that a resident's prescribed eye drops are being stored in a medication refrigerator alongside staff food items. The eye drops are in their original, labeled container. This practice fails to comply with which aspect of medication services?
- Proper temperature control.
- Procedures for medication disposal.
- Sanitary storage and prevention of contamination. (Correct answer)
- Administration by licensed personnel only.
Correct answer: Sanitary storage and prevention of contamination.
While the medication is refrigerated (addressing temperature), storing it with food items creates a significant risk of contamination for both the food and the medication. Pharmacy standards and survey guidance require that refrigerators used for medication storage be dedicated to that purpose only, ensuring sanitary conditions and preventing cross-contamination.
SMQT - Surveyor Minimum Qualifications Pharmacy and Medication Services Questions and Answers
A consultant pharmacist, during a monthly drug regimen review, identifies that a resident is prescribed two medications with a known significant drug-to-drug interaction that could cause serious harm.
According to 42 CFR §483.45, what is the pharmacist's required action after identifying this irregularity?