SMQT Pharmacy and Medication Services 3 — Questions and Answers
Question 1: A surveyor reviews a facility's controlled substance records and finds a discrepancy between the count on record and the actual count in the cabinet. What is the FIRST required action by the facility?
- Discharge the responsible nurse
- Report the discrepancy per the facility's policy and notify the pharmacist and appropriate authorities (Correct answer)
- Lock the medication cabinet and continue the survey
- Order a full pharmacy audit before taking action
Correct answer: Report the discrepancy per the facility's policy and notify the pharmacist and appropriate authorities
Facilities must have policies requiring immediate reporting of controlled substance discrepancies to the pharmacist, administrator, and law enforcement or DEA as appropriate.
Question 2: Which of the following findings would constitute a deficiency related to the Beers Criteria during an SMQT survey of a long-term care facility?
- Administering acetaminophen for pain in an elderly resident
- Prescribing a benzodiazepine as a first-line hypnotic for a 78-year-old without documented clinical rationale (Correct answer)
- Using a beta-blocker for an elderly resident with heart failure
- Ordering a multivitamin daily for a resident with poor appetite
Correct answer: Prescribing a benzodiazepine as a first-line hypnotic for a 78-year-old without documented clinical rationale
The Beers Criteria identifies benzodiazepines as potentially inappropriate for older adults; use without clinical justification or attempted alternatives is a common survey deficiency.
Question 3: A pharmacist's monthly drug regimen review identifies that a resident is on two drugs with a clinically significant interaction but the physician has not been notified. What should the surveyor cite?
- The pharmacist for failing to document the review
- The facility for not ensuring the pharmacist's recommendation prompted a physician response (Correct answer)
- The prescribing physician for an unauthorized order
- The charge nurse for administering both drugs
Correct answer: The facility for not ensuring the pharmacist's recommendation prompted a physician response
Under 42 CFR §483.45(c)(4), the facility must ensure that the physician and director of nursing are informed of pharmacist recommendations and that there is a timely response.
Question 4: What does PRN (pro re nata) medication monitoring require in a long-term care survey context?
- PRN medications may be given freely without documentation
- PRN orders must have a documented indication, and use must be monitored for effectiveness and appropriateness (Correct answer)
- PRN orders expire after 30 days automatically
- PRN medications cannot be psychotropic drugs
Correct answer: PRN orders must have a documented indication, and use must be monitored for effectiveness and appropriateness
Surveyors verify that PRN medications have a clear indication in the order, are documented each time given, and are reviewed for efficacy and ongoing appropriateness.
Question 5: A hospital surveyor observes that expired medications are stored alongside current stock in a medication room. What type of deficiency is this?
- Dietary services deficiency
- Infection control deficiency
- Pharmaceutical services deficiency related to proper storage and removal of outdated drugs (Correct answer)
- Housekeeping deficiency
Correct answer: Pharmaceutical services deficiency related to proper storage and removal of outdated drugs
Facilities must segregate and promptly remove expired medications from active stock to prevent accidental administration.
Question 6: During a survey, a resident reports feeling sedated all day after a new medication was started last week. There is no reassessment note in the chart. What regulatory requirement is most relevant?
- The facility must conduct a comprehensive resident assessment and monitor for adverse drug reactions, documenting findings (Correct answer)
- The pharmacy must be contacted immediately to change the medication
- The family must be informed before any assessment is done
- The medication cannot be given until a new physician order is written
Correct answer: The facility must conduct a comprehensive resident assessment and monitor for adverse drug reactions, documenting findings
Facilities are required to monitor residents for adverse medication effects and document clinical reassessments, particularly when new symptoms emerge after a medication change.
Question 7: Which scenario best illustrates unnecessary drug use as defined under F758 (unnecessary medications) in long-term care surveys?
- Administering a statin to a resident with documented hyperlipidemia
- Continuing an antipsychotic for six months without a diagnosis-based indication or gradual dose reduction attempts (Correct answer)
- Giving acetaminophen PRN for arthritis pain
- Prescribing a diuretic for a resident with congestive heart failure
Correct answer: Continuing an antipsychotic for six months without a diagnosis-based indication or gradual dose reduction attempts
F758 targets antipsychotics and other medications used without a valid indication, without dose reduction attempts, or for excessive duration beyond clinical need.
SMQT Pharmacy and Medication Services 3
A surveyor reviews a facility's controlled substance records and finds a discrepancy between the count on record and the actual count in the cabinet.
What is the FIRST required action by the facility?