SMQT Pharmacy and Medication Services 2 — Questions and Answers
Question 1: During a survey, you observe that a nurse administered a medication two hours after the scheduled time without documentation. What is the primary concern?
- Staff shortage causing delays
- Failure to follow the prescribed medication schedule and lack of documentation (Correct answer)
- The medication was still effective
- The physician was not available to approve the delay
Correct answer: Failure to follow the prescribed medication schedule and lack of documentation
Surveyors cite facilities when medications are not administered per the physician's order and when deviations are not documented in the medical record.
Question 2: A surveyor finds that a facility's drug storage room is kept at 80°F consistently. Which regulation is most likely violated?
- Fire safety standards
- USP storage temperature requirements for room-temperature medications (Correct answer)
- Staff-to-patient ratio requirements
- Controlled substance count procedures
Correct answer: USP storage temperature requirements for room-temperature medications
USP standards require most medications labeled 'store at room temperature' to be kept between 68°F and 77°F (20°C–25°C), so 80°F is out of range.
Question 3: Under the Medicare Conditions of Participation for long-term care, how often must pharmacists conduct drug regimen reviews for residents?
- Weekly
- Every 60 days
- At least monthly (Correct answer)
- Quarterly
Correct answer: At least monthly
42 CFR §483.45(c) requires a licensed pharmacist to review each resident's drug regimen at least once a month.
Question 4: A surveyor observes unlabeled syringes prefilled with insulin sitting on a medication cart. What is the most critical immediate concern?
- Insulin waste without documentation
- Risk of wrong-patient or wrong-dose medication error due to missing identification (Correct answer)
- Improper sharps container placement
- Lack of refrigeration for the syringes
Correct answer: Risk of wrong-patient or wrong-dose medication error due to missing identification
Unlabeled medications or syringes create a serious risk of medication errors, including administration to the wrong patient or at the wrong dose.
Question 5: When surveying medication reconciliation practices at a hospital, which patient transition is most associated with high-risk medication errors?
- Transfer from ICU to a step-down unit
- Admission from home to the hospital (Correct answer)
- Transfer between rooms on the same unit
- Discharge from the hospital to home
Correct answer: Admission from home to the hospital
Admission from home is a high-risk transition because complete and accurate home medication lists are often unavailable, leading to omissions or duplications.
Question 6: A facility's policy allows nursing staff to accept verbal orders for Schedule II controlled substances. How should a surveyor evaluate this practice?
- Acceptable if the physician countersigns within 24 hours
- Permissible only in emergencies per state law
- A deficiency because DEA regulations prohibit verbal orders for Schedule II substances except in emergencies (Correct answer)
- Compliant as long as two nurses witness the order
Correct answer: A deficiency because DEA regulations prohibit verbal orders for Schedule II substances except in emergencies
DEA regulations generally prohibit verbal (phone) orders for Schedule II controlled substances except in genuine emergency situations with immediate follow-up written order.
Question 7: During observation, a surveyor notices a CNA crushing a tablet that is labeled 'do not crush.' What regulation or standard is most directly implicated?
- Resident rights regulations
- Medication administration standards requiring medications to be given in the form prescribed (Correct answer)
- Dietary supplement guidelines
- Hand hygiene protocols
Correct answer: Medication administration standards requiring medications to be given in the form prescribed
Crushing a 'do not crush' medication (e.g., extended-release tablets) alters the dose form and delivery, violating medication administration standards and potentially harming the resident.
SMQT Pharmacy and Medication Services 2
During a survey, you observe that a nurse administered a medication two hours after the scheduled time without documentation.
What is the primary concern?