Chapter 35 Medication Errors
Medications can sometimes be confused because they have similar: a. Spellings. b. Routes of administration. с. Mechanisms of action. d. Manufacturers.
Spellings.
What did the FDA create in order to avoid label confusion on medications? a. Running-Man Lettering b. Iron-Man Lettering с. Tall-Man Lettering d. Burning-Man Lettering
Tall-Man Lettering
According to the American Hospital Association list of common medication errors, when are labeling errors liable to occur? a. At the factory where the drug is made b. When the drug is received and stored at the pharmacy с. When the prescription is received and processed d. When the drug is prepared and repackaged into smaller units
When the drug is prepared and repackaged into smaller units
Mr. Samuels cannot swallow release tablets and Mr. Samuels washes large pills, so the nurse crushes his two extended- them down with a sip of water. What type of error has occurred? a. Wrong route error b. Wrong dose error с. Wrong dosage form error d. Wrong drug error
Wrong dosage form error
Mrs. Burke cannot swallow pills, so the physician has ordered her medication be given in the form of a suppository. The pharmacy dispenses oral capsules. What type of error has occurred? a. Wrong route error b. Wrong dose error с. Wrong dosage form error d. Wrong drug error
Wrong dosage form error
The Pittsburgh pharmacist who mistook milligrams for micrograms, leaving a patient totally disabled and suffering from complex partial seizures, made what kind of error? a. Wrong dose error b. Wrong drug error с. Wrong time error d. Wrong route error
Wrong dose error
The nurse notices that patient has 200% less medication than was prescribed. What kind of medication error should be reported? a. Wrong route error b. Wrong dose error с. Wrong drug error d. Omission error
Wrong dose error
What kind of error occurs when a patient is given an oral administration of a drug instead of the prescribed topical administration? a. Wrong dose error b. Wrong drug error с. Extra dose error d. Wrong route error
Wrong route error
A dose of medication mistakenly placed in the right eye instead of the left eye would be considered a(n): a. Wrong route error. b. Wrong dose error. с. Wrong drug error. d. Wrong location error.
Wrong route error.
A hospital patient is scheduled to be given a dose of pain relief medication at 7:3 O p.m. The nurses become involved with another patient and the first patient ends up waiting two hours for the pain medication. This is an example of what kind of error? a. Omission erTor b. Attention error с. Wrong time error d. Wrong dose error
Wrong time error
To help avoid medication errors, should not be used. a. complete drug names b. calibrated syringes c. decimal whole numbers d. abbreviations in drug names
abbreviations in drug names
Pharmacy technicians should automated pharmacy technology. a. understand that their role is diminishing because of b. be prepared for a brave new world of с. rely less on pharmacists and more on d. be required to take mandatory continuing education course and training in
be required to take mandatory continuing education course and training in
Drugs should be prepared in a environment. а. clean b. warm с. cold d. dark
clean
The Institute for Safe Medication Practices (ISMP) has identified many that are directly linked to patient harm. a. easily misinterpreted abbreviations b. class I controlled substances с. over-the-counter medications d. pediatric vaccines
easily misinterpreted abbreviations
To prevent medication errors, check with another team member, especially if unusual in dosage or amount to be given. a. medication calculations b. generic equivalents с. route of administration d. the physician's FDA number
medication calculations
Wrong dose errors are not counted for except when the quantity has been specified by the physician. a. intravenous injections b. extended-release tablets с. ointments and topical solutions d. suppositories
ointments and topical solutions
medication but the medication is never given, and no record can be found of an A hospital patient has been prescribed a dose of attempt to administer the medication. This is a(n) error. a. unauthorized drug error b. unordered drug error с. wrong drug error d. omission error
omission error
Incomplete information in such areas as can result in medication errors. a. spouse's medical history b. recently visited foreign countries с. other current medications d. number of years of education beyond high school
other current medications
Calculations for drugs such as digoxin, epinephrine, theophylline, and narcotics should be checked and rechecked, especially for patients. a. handicapped b. pediatric C. elderly d. post-literate
pediatric
As their role evolves, are performing more duties that were once performed by a. pharmacists; physicians b. pharmacy technicians; pharmacists с. pharmacists; pharmacy technicians d. physicians; pharmacists
pharmacy technicians; pharmacists
If a physician makes a mistake in ordering a medication for a patient, that is known as a error. a. medication b. pharmacy с. prescribing d. malicious
prescribing
The staffing of pharmacy technicians who have been will promote a work environment designed for reducing medication errors. a. screened with a criminal background check b. to graduate school c. trained and tested for competency d. nurses or nurse-practitioners
trained and tested for competency
When preparing prescriptions for pediatric patients, pharmacy technicians should recheck calculations against dosage ranges. a. height-based b. weight-based с. disease-based d. genetically based
weight-based
What is the average rate of medication errors each year? a. 1.8% b. 5% с. 7.3% d. 19%
1.8%
Some researchers use the more narrow definition of a wrong dose error for doses of injectable medications that are measured by the nurse, in which case only a(n) difference is allowed. a. 10% b. 12% с. 18% d. 30%
10%
If a pharmacy has a 1% prescription error rate, and fills 10,000 prescriptions per year, how many prescriptions will have errors? a. 1 b. 10 c. 100 d. 1,000
100
According to a Harvard study, what percentage of medication pharmacy dispensing mistakes? a. 12% b. 17% с. 38% d. 42%
12%
If a pharmacy makes the average number of medication errors in a year, and fills 20,000 prescriptions, how many mistakes will result? a. 0.36 b. 3.6 с. 36 d. 360
360
Out of 3 billion prescriptions filled annually in the United States, how many contain errors? a. 3 million b. 6 million с. 30 million d. 60 million
60 million
How many deaths are estimated to occur each year as a result of medical errors? a. 7,000 b. 9,800 с. 27,000 d. 98,000
98,000
Which of the following is NOT included in the definition of an extra dose error? a. A dose given in excess of the total number of times ordered by the physician b. A dose given on the basis of an expired order c. A dose given of a brand name drug after a generic version has become available d. A dose given after a drug has been put on hold
A dose given of a brand name drug after a generic version has become available
Which of the following is NOT on the list of top 10 drugs associated with medication errors? a. Insulin b. Morphine с. Acetaminophen d. Warfarin
Acetaminophen
Among the hormones/synthetics/modifiers that are subject to frequent medication errors are all of the following EXCEPT: a. Insulin. b. Anti-diabetic agents. с. Adrenal corticosteroids. d. Beta blockers.
Beta blockers.
Which type of patient is most vulnerable to age-related medication errors? a. Children b. Young men с. Middle-aged women d. Seniors
Children
discontinued, or after a drug has been put on hold? by the physician, on the basis of an expired order, after a drug has been What occurs when a dose is given in excess of the total number of times ordered a. Wrong dose error b. Wrong drug error с. Unauthorized drug error d. Commission error
Commission error
What female hormone was mistakenly dispensed to a Florida man who took it for 11 days before his wife discovered the error? a. Orapred® b. Cycrin® с. Yazmine® d. Estring®
Cycrin
Among the top drugs for medication errors are cardiovascular medications such as: a. Adrenal corticosteroids. b. Opioid analgesics. с. Diuretics. d. Anxiolytics.
Diuretics.
Before filling a prescription, the pharmacy technician should check for current allergies and: a. Generic equivalents. b. Brand name alternatives. c. OTC options. d. Drug compatibilities.
Drug compatibilities.
In order to avoid medication errors what should NOT be stored next to each other? a. Drugs from the same manufacturer b. Drugs for the same patient с. Drugs that look alike d. Drugs of the same class
Drugs that look alike
Which of the following is NOT among commonly confused or misused medication information? а. Drugs with similar MOAS b. Drugs with similar names c. Zeroes and decimal points d. Metric and other dosing units
Drugs with similar MOAS
Which of the following should be an organization's target goal? a. Incorporating technology across the entire medication management spectrum b. Using the multi-factorial nature of most medication errors to avoid litigation с. Maintaining organizational procedures regardless of past errors d. Removing technology where possible to avoid system failures
Incorporating technology across the entire medication management spectrum
The Medication Errors Reporting Program (MERP) is run by which organization? a. United States Pharmacopeia b. Institute for Safe Medication Practices c. Institute of Medicine d. U.S. Food and Drug Administration
Institute for Safe Medication Practices
Which organization maintains a website with list of many easily misinterpreted abbreviations that are directly linked to patient harm? a. United States Pharmacopeia b. Institute for Safe Medication Practices с. Institute of Medicine d. U.S. Food and Drug Administration
Institute for Safe Medication Practices
One of the leading organizations for monitoring and reporting medication errors is the ISMP, which stands for: a. Institutional Safety in Medication and Pharmacy. b. Institute for Safe Methods of Pharmacy. с. Institute for Safe Medication Practices. d. International Society for Medication and Pharmacy.
Institute for Safe Medication Practices.
The top three drug classes for medication errors include the following EXCEPT: a. Central nervous system medications. b. Integumentary system medications. с. Cardiovascular medications. Hormones/synthetics/modifiers.
Integumentary system medications.
During the preparation of a medication, the pharmacy technician should make every effort to avoid: a. Excessive quiet. b. Interruptions. c. The patient. d. The pharmacist.
Interruptions.
What greatly increases the risk of errors in OTC medications? a. Lack of pediatric dosing indications and guidelines b. Pediatric dosages only being available with a prescription c. Mislabeling of topical medications as oral medications d. Generic products from unknown suppliers
Lack of pediatric dosing indications and guidelines
Which of the following is NOT a reason for medication error identified by the 18 48 Code of Ethics of the Philadelphia College of Pharmacy and still an issue today? a. Poor handwriting of prescribing physicians b. Improper or mistaken use of medical and pharmaceutical abbreviations с. Lack of proper training and certification for pharmacy technicians d. Poor environmental conditions causing distractions to those dispensing and selecting medications
Lack of proper training and certification for pharmacy technicians
Which of the following can cause a miscommunication of drug orders? a. Lack of up-to-date clinical warnings b. Labeling error when drug is repackaged into smaller units с. Misuse of zeroes and decimal points d. Broken air conditioner in customer waiting area
Lack of up-to-date clinical warnings
Which of the following is NOT a cause of miscommunication of drug orders? а. Poor handwriting b. Lack of up-to-date clinical warnings с. Misuse of zeroes and decimal points D) Inappropriate abbreviations
Lack of up-to-date clinical warnings
Which federal legislation authorizes incentive programs for electronic prescribing? a. Social Security Act Amendments (1965) b. Patient Protection and Affordable Care Act (PPACA) с. Health Insurance Portability and Accountability Act of 1996 (HIPAA) d. Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)
Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)
Which of the following is NOT a way that medication errors are reported to the FDA? а. Manufacturer's reports b. Medication package inserts с. Direct contact reports d. USP or ISMP reports
Medication package inserts
Which of the following is a proper dispensing utensil? a. Measuring cup b. Household teaspoon с. Medicine cup d. Coffee cup
Medicine cup
Which Birmingham, Alabama, pharmacy dispensed total parental nutrition bags that were infected with S. marcescens to 19 patients? а. Birmingham TPN Pharmacy b. CVS IV TPN Pharmacy с. Rite-Aid Pharmacy d. Meds IV Pharmacy
Meds IV Pharmacy
Pediatric patients vary in weight, organ maturity, and physiological difference that affect their: a. Ability to comply with a drug regimen. b. Tolerance of medical intervention. с. Routes of administration. d. Metabolism and excretion
Metabolism and excretion
Shorthand directions are often: a. Incomplete and derivative. b. For the wrong drug by the wrong route. c. Mistyped and misread. d. Better than writing the prescription out in longhand.
Mistyped and misread.
The "triple-check" process includes all of the following EXCEPT: a. Read what you type as you type it and again when you produce the label. b. Compare the original prescription with the printed label. с. Read the label again before giving it to the pharmacist to check. d. Ask the patient to read the label aloud to you before leaving the pharmacy
Ask the patient to read the label aloud to you before leaving the pharmacy
Which of the following would NOT make it easier to lose concentration while dispensing medication? a. Angry and impatient customer b. Personal telephone calls с. Air conditioning set at comfortable level d. Flickering overhead fluorescent lights
Air conditioning set at comfortable level
Which of the following drugs is number 2 on the list of top 10 drugs associated with medication errors? a. Albuterol b. Potassium chloride с. Levofloxacin d. Furosemide
Albuterol
If the CPHT has a question about a drug that is being prescribed, the pharmacy technician should: a. Tell the pharmacist that the CPHT has a question. b. Attempt to answer the question themself. с. Ask the pharmacist. d. Fill the prescription to the best of their understanding.
Ask the pharmacist.
The research-based definition of a medication administration error is: a. Any preventable event that could cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer. b. Any deviation from the prescriber's written order, or as entered into a computer system by the prescriber. c. Any error related to professional practice, healthcare products, procedures, and systems, including prescribing, order communication, product labeling, packaging and nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use. d. Any dose given that contains the wrong number of preformed dosage units such as tablets) or was, in the judgment of the observer, more than 17% greater or less than the correct dosage.
Any deviation from the prescriber's written order, or as entered into a computer system by the prescriber.
Medication errors occur at which point in the medication distribution process? a. Any point b. When the prescription is written с. When the prescription is transcribed d. When the prescription is dispensed
Any point
When do pharmacy technicians need to be sure they are paying especially good attention to avoid mesication errors? a. When preparing medication for a cranky customer b. At peak hours when the pharmacy is busiest c. At the end of the shift d. At the beginning of the shift
At peak hours when the pharmacy is the busiest
What is NOT an error defined as administration of a dose of medication that woe never ordered for that patient? a. Unauthorized drug error b. Unordered drug error с. Wrong drug error d. Authorization error
Authorization error
patients or caregivers about medication before dispensing to avoid medication errors. a. Educate b. Confirm roles of с. Diagnose d. Counsel
Educate
Who was the two-year-old child who died after being cured of cancer because the final chemotherapy treatment had more than 23 times the amount of sodium chloride it was supposed to contain? a. Emily Jerry b. Mary Ellen Kise с. Tim Rogers d. William Coke
Emily Jerry
In addition to taking classes, pharmacy technicians can keep up with their education by keeping up with any of the following EXCEPT: a. Experimenting with new medications. b. News reports. с. Safety advisories. d. Continuing education programs.
Experimenting with new medications.
What happened to the Florida man who took a female hormone for 11 days instead of the anticoagulant Coumadin® that was prescribed? a. He is now totally disabled and suffers from complex partial seizures. b. He contracted serratia marcescens bacteremia. с. He suffered a stroke, then a heart attack, then went into a coma. d. He suffered permanent brain damage.
He suffered a stroke, then a heart attack, then went into a coma.
Which of the following is NOT one of the areas in which the FDA receives medication error reports? a. Prescription drugs b. Hospital check-in procedures с. Generic drugs d. Non-vaccine biological products
Hospital check-in procedures
What has the Institute of Medicine (IOM) identified as a common source of medication errors? a. Insufficient physician training b. Insufficient pharmacy technician training с. Illegible handwriting d. E-prescribring
Illegible handwriting
Which of the following frequent-error medications affects the central nervous system? a. Adrenal corticosteroids b. Opioid analgesics с. Diuretics d. Calcium-channel blockers
Opioid analgesics
Which of the following is NOT on the American Hospital Association list of common medication errors? a. Unavailable drug information b. Overreliance on technology с. Lack of appropriate labeling d. Incomplete patient information
Overreliance on technology
Which of the following is useful for educating patients about their medications? a. Mandatory continuing education b. Suggested continuing education с. Pamphlets and reliable Internet sources d. Pharmacy college
Pamphlets and reliable Internet sources
Reconfirm confusing orders with the pharmacist or the: a. Formulary. b. Patient. с. Physician. d. Data base.
Physician.
Which of the following was identified in the 1848 Code of Ethics of the Philadelphia College of Pharmacy as a cause of medication errors and is still a problem today? a. Use of pharmacists instead of physicians to dispense medication b. Lack of continuing education for certified pharmacy technicians с. Poor understanding of technology and e-prescription methods d. Poor training of pharmacy staff and lack of follow-through by the pharmacist in the dispensing process
Poor training of pharmacy staff and lack of follow-through by the pharmacist in the dispensing process
Within a hospital setting, which step will help prevent medication errors? a. Encourage informal reporting systems. b. Reduce number of patients in each unit. с. Accept only non-Medicaid patients. d. Provide adequate staffing. dispensing systems.
Provide adequate staffing.
What does a pharmacy need to do in addition to obtaining the latest technology? a. Lay off now-extraneous staff members to keep costs down. b. Provide sufficient planning and training for pharmacy staff. с. Prepare for widespread system failures. d. Nothing; technology has made medication errors a thing of the past.
Provide sufficient planning and training for pharmacy staff.
education and disseminating information among the pharmacy staff can help Which of the following is NOT an example of how best practices for ongoing prevent medication errors? involved on a regular basis to review. a. Implement a tracking system for errors and communicate with all staff b. Educate patients or identity and pertinent information before dispensing. caregivers about medication before dispensing. с. Confirm patient d. Refer all questions from caregivers to the automated drug information station.
Refer all questions from caregivers to the automated drug information station.
Which of the following is NOT one of the steps that can help prevent medication errors in a hospital setting? a. Encourage a team environment. b. Replace pharmacy technicians with automated dispensing systems. с. Track medication errors through formal systems and report errors to families. d. Establish a formulary system with therapeutic uses and evaluations for pediatric uses of certain drugs.
Replace pharmacy technicians with automated dispensing systems
rights" of medication administration? Which of the following is a new "right" recently added to the five traditional " a. Right route b. Right dose с. Right documentation d. Right time
Right documentation
In the Emily Jerry case, which of the Five Rights did both the pharmacy technician and the pharmacist overlook? a. Right route b. Right drug с. Right dose d. Right patient
Right dose
Mrs. Green has a notation in her patient information that she has had a bad reaction to Cipro. Following abdominal surgery, which of the Five Rights may be an issue for this patient? a. Right route b. Right drug с. Right dose d. Right patient
Right drug
The Cable family has just welcomed twins into the family. One of the babies has an ear infection and the other is allergic to amoxicillin. To which of the Five Rights should the pharmacy technician pay special attention in this case? a. Right route b. Right drug с. Right dose d. Right patient
Right patient
What is the first of the Five Rights of medication administration? a. Right patient b. Right drug с. Right route d. Right dose
Right patient
In the case of the Birmingham pharmacy that exposed 19 patients to S. marcescens, which of the patients' Rights was violated? a. Right does b. Right technique с. Right documentation d. Right route
Right technique
Pharmacy technicians know that IV products must be prepared in a sterile environment. Which "Right" does this represent? a. Right technique b. Right drug с. Right dose d. Right route
Right technique
Which of the following "rights" of medication administration is new and therefore not included in the five traditional "rights"? a. Right patient b. Right technique c. Right route d. Right dose
Right technique
Which of the following is NOT one of the original Five Rights? a. Right route b. Right dose с. Right time d. Right technique
Right technique
Which of the following is NOT an area related to professional practice where a medication error can occur? a. Prescribing b. Self-administration с. Dispensing d. Monitoring
Self-administration
Who was held responsible for the death of Emily Jerry? a. The pharmacist who released the toxic solution the pharmacy technician had prepared b. The pharmacy technician who had prepared a toxic solution that was administered to the child с. The pharmacy technician who had infected the IV bag with a dangerous bacterium d. The pharmacist who mistakenly transcribed milligrams instead of micrograms
The pharmacist who released the toxic solution the pharmacy technician had prepared
Generic drugs can be mistaken for each other because: a. The manufacturer uses a standard size and shape of tablet. b. The manufacturer uses a standard label design. с. All generic drugs come in the same dosage form. d. All generic drugs are less expensive than brand name drugs.
The manufacturer uses a standard label design.
When writing numbers, what should be placed before a decimal if there is no whole number in the amount? a. Nothing; leave the space blank. b. The letter X с. The numeral zero d. The dosage form
The numeral zero
Which of the following was NOT on the chapter's list of drug names that look or sound alike? a. Zyrtec b. Volmax с. Prednisolone d. Viagra
Viagra
Before dispensing a medication, the pharmacy technician should be sure to obtain: a. A clear photocopy of the order. b. A print-out of the order as typed into the computer. с. The original written order. d. A copy of the printed label.
The original written order.
In which case has no wrong time error occurred? a. Nurses are talking at the central station and don't hear the patient ring the buzzer. b. A new patient is brought to the unit, taking staff attention from other patients. с. The patient is in the bathroom when the nurse brings the medication, so she leaves to attend to other patients. d. The patient is on a different floor of the facility for an MRI when the medication dose is due.
The patient is on a different floor of the facility for an MRI when the medication dose is due.
When a pharmacy technician prepared a chemotherapy treatment that killed a toddler, what happened to the pharmacy technician? a. Lost her certification from the Ohio State Board of Pharmacy. b. Sentenced to 20 years in the Ohio State Penitentiary. с. Sentenced to 2 years in the Ohio State Penitentiary and prompted legislation in Ohio to require pharmacy technician certification and training. d. Took a position as a technician supervisor/trainer at a large chain retail pharmacy, prompting legislation in Ohio to require pharmacy technician certification and training.
Took a position as a technician supervisor/trainer at a large chain retail pharmacy, prompting legislation in Ohio to require pharmacy technician certification and training.
What should be implemented to avoid medication errors and follow up on any errors that might be made? a. Database b. Tracking system с. Proper dispensing utensils d. Patient education pamphlets
Tracking system
What type of medication error is made at the same rate as pharmacy dispensing mistakes? a. Nurse administration b. Transcription C. Physician ordering d. Patient compliance
Transcription
In the case of a South Carolina pharmacist who dispensed Glynase instead of Ritalin, leaving a 7-year-old girl with permanent brain damage, what type of error took place? a. Extra dose error b. Omission error с. Wrong route error d. Unauthorized drug error
Unauthorized drug error
Which is preferable to avoid a medication error? a. Use a liquid medications when available. b. Use unit-dose medication forms when possible. medications by hand. с. Compound all tablet d. Compound all sodium-based IVV solutions by hand.
Use unit-dose medication forms when possible.
