fipp 6

5 steps of EBP

1) ask a clinical question 2) collect the most relevant and best evidence 3) critically appraise the evidence 4) integrate the evidence with clinical expertise and patient value in making practice decision or change 5) evaluate the practice decision or change

HFMEA Process

1. choose high risk process/topic 2.assemble team 3. graphically design the process 4. conduct hazard analysis for each failure mode 5. develop actions and outcome measures

USP 797 guidelines indicate that personnel involved in compounding of sterile products should be evaluated initially and every ____ months thereafter.

12

Calculate BEE for a 70 year old male patient with weight of 220 pounds and height of 6 feet. Select the closest approximation from the options below.

1870 kcal

What is the CrCl for a 62-year-old male patient who is 5'8" and has a SCr of 2.5? Round to the nearest whole number

30 mg/dL

Lipids generally comprise about what percentage of total kcal in a 3-in-1 TPN ?

30%

How many kcal are in each gram of protein?

4 kcal

Calculate the absolute risk reduction for a therapy if the event rate in the control group is 15% and the event rate in the treatment group is 10%.

5%

USP _____ is an enforceable document that sets rules and guidelines for sterile compounding

797

Which of the following is likely to be the strongest driver of the culture of a hospital?

A pharmacy tech staying after her shift to help the techs on the next shift get the IV prep hood cleaned

cohort study

A type of epidemiologic study where a group of exposed individuals (individuals who have been exposed to the potential risk factor) and a group of non-exposed individuals are followed over time to determine the incidence of disease

Case-control study

A type of epidemiologic study where a group of individuals with the diseases, referred to as cases, are compared to individuals without the disease, referred to as controls

According to Dr. Nau, specialty pharmaceuticals account for what proportion of overall pharmaceutical expenditures in the U.S.

About half (50%)

Which of the following ideas may be helpful to managing the distractions and interruptions that often occur in a busy practice site?

All of the above may be useful

This type of single dose container, is a hermetically sealed glass container. When drawing solution out, a filter needle or straw must be used.

Ampule

Medication errors

Any preventable adverse drug events involving inappropriate medication use by a patient or health care professional; they may or may not cause the patient harm.

The technicians in your hospital pharmacy are responsible for making sure that the laminar airflow hood (for preparing IVs) is thoroughly sanitized at least once each shift. Over the past week, the surge in IV orders and short staffing has led them to start drifting away from getting the hood sanitized each shift. This drift away from the standard procedures is best viewed as...

At-risk behavior

You see the following differential for a patient: Segs 20 Bands 2 Lymph 60 Eos 5 Mono 10 Baso 3 What is most likely going on with this patient?

COVID-19

Which of the following companies is the largest PBM based on total prescriptions managed?

CVS Health

cost benefit

Captures all outcomes in terms of dollars; can be used to compare different outcomes

Review the chart below and select the one best answer to this question: How can you appropriately determine if vancomycin with pipercillin/tazobactam can be administered through the same IV line?

Click on the Y-site link in the chart Conduct a literature search of IV compatibility of these 2 products Review the package inserts of the 2 products

For the situation described in the preceding question (where the techs were drifting away from making sure that the laminar airflow hood was sterilized each shift), the type of response to this situation by a manager within a Just Culture would be....

Coach the team to remind them of the importance of sterilizing the hood every shift and to discuss ways to make sure that the task is getting done each shift?

129,942 patients older than 65 years who were prescribed an oral or topical carbonic anhydrase inhibitor in Ontario, Canada, between January 1, 1995, and January 1, 2020, were identified. Time zero was defined as the date of the first identified prescription for the medication, and the primary analysis focused on the first 120 days of follow-up. The primary end point was a severe complicated adverse event of either Stevens-Johnson syndrome, toxic epidermal necrolysis, or aplastic anemia.

Cohort

Pharmacy Benefit Managers (PBMs)

Companies that administer drug benefit programs for employers and health insurance carriers

A hospital pharmacist designs a study in which two pharmacologic products will be investigated in terms of their costs, as dollars ($), and their outcomes, as clinical cure rate. Which pharmacoeconomic study type is this?

Cost-effectiveness analysis (CEA)

A pharmacist at a PBM is reviewing 2 new medications, with similar clinical outcomes, for formulary inclusion, but only one can be included. Which type of pharmacoeconomic analysis assumes equal outcomes of two treatments, summing all associated costs in terms of dollars ($) in order to compare two treatments?

Cost-minimization analysis (CMA)

cost of illness

Determines burden of disease on society, compares cost of one disease to another, compare costs of treating illness in 1 geographic region to another

costs

Direct medical costs - costs associated with detection, prevention, or treatment of disease (e.g., drugs, office visits, hospitalizations) Direct nonmedical costs - costs for non-medical services associated with disease or treatment (e.g., travel to treatment, babysitter, food and lodging for family) Indirect costs - costs from the loss of productivity due to illness or death (e.g., missed days of work or school) Intangible costs - non-financial costs incurred (e.g., pain, suffering, anxiety, fatigue)

consequences ECHO

Economic outcomes - includes the cost of care. Many times this is operationalized as avoided cost. Clinical outcomes - include medical events from the disease, treatment or service. Examples include mortality, mmHg, A1C, number of seizures, symptom free days. Humanistic outcomes - have to do with the patient experience. Humanistic outcomes include health-related quality of life, functional status, and satisfaction with treatment/ services.

Which of the following are appropriate recommendations for when establishing reorder points for a particular drug product in a community pharmacy with stable prescription volume?

Ensure "Max Single Fill" is met

Safety Culture

Establishacompelling vision of safety Value trust, respect and inclusion Board Engagement Prioritize safety in the selection and development of leaders Lead and reward a Just Culture Establish behavioral expectations

All smartphone apps that provide health information must receive approval from the FDA.

False

Current literature suggests that lawsuits from medication errors can be prevented by avoiding disclosure of the error or admitting fault to patients and their caregivers/family.

False

Ohio state law prohibits PBMs from owning a pharmacy

False

True or False? ASHP and CDC recommend that every pharmacy maintain a stockpile of critical medications to be prepared for natural disasters or other emergencies.

False

The number one source of contamination is _______

Human touch

A study is evaluating the cost associated with missing work due to an illness. What type of cost would 'missing work' represent?

Indirect

which of the following medications may cause hyperkalemia?

Lisinopril

The segment of telehealth that grew the most during 2020 and 2021 was..

Live video visits

What organ can be assessed by alk phos, ALT and AST?

Liver

Which of the following terms from a pharmacoeconomic article has to do with uncertainty in the parameters estimates? Select the SINGLE best answer.

Monte Carlo simulation

Which of the following is an advantage of a PICC line?

PICC lines can be used for long-term IV access

What is the term for when a healthcare provider uses the sense of touch to evaluate a patient?

Palpation

A pharmacy resident helped a QI team conduct a survey of pharmacy staff. In that survey, the staff are asked to choose the most important root cause from a list of 8 potential causes of IV preparation errors. The resident tallies the number of respondents who chose each of the 8 options and wants to create a simple way of displaying the results to help the team focus their efforts on the most important root causes. Which of the following tools may be the best way to display the results of the survey?

Pareto Diagram

PDSA cycle

Plan, Do, Study, Act

All of the following regarding population health is true, EXCEPT:

Population health is about focusing on the sickest to the exclusion of the healthy

Types of Medication Errors

Prescribing Error Omission error Wrong time error Unauthorized drug error Improper Dose Error Wrong dosage form error Wrong drug preparation error Wrong administration Deteriorated drug error Monitoring error Compliance error

Sterile multiple dose containers always contain a ______________.

Preservative

Which of the following policies/tactics are commonly used by PBMs for Formulary management? choose the best answer

Prior Authorization Step Therapy

___________ bias occurs when the applied treatment for a disease or outcome appears to cause the outcome. For example, patients may take non-steroidal anti-inflammatory drugs (NSAIDs) to relieve the symptoms of heart failure prior to the date of diagnosis of the condition. Such a situation may cause biased results, which could be misinterpreted as the drug causing the disease.

Protopathic bias

Which of the following statements are true of a Just Culture? Select the best response

Realizes that competent professionals make errors Recognizes that individuals should not be held accountable for systems failures that were beyond the control of the individual

The 5 rights for patients are:

Right patient, right drug, right dose, right time, right route

types of bias

Selection bias: Factors that influence which subjects are enrolled into the study Information bias: Bias in the collection of data » Example: Recall bias Survivor bias: The most severe or fatal cases may be excluded Follow-up bias: Do patients lost to follow-up differ from those who stayed in the study? Temporal bias: Inability to ensure that exposure preceded disease Confounding: Factors associated with exposure and disease and affects the observed association under study

_____________ is the ability of a test to single out people who have disease.

Sensitivity

Sensitivity

The ability of a test to identify correctly those who have the disease.

Specificity

The ability of the test to identify correctly those who do not have the disease.

Population Health Management

The concept that the health of all individuals is improved when the health of the entire population is improved

Which of the following are correct statements about a community pharmacy with annual inventory turns = 5 Select all that apply

The pharmacy is likely to encounter cash flow problems The BOH for the pharmacy is likely to be higher than necessary to serve customers

Clinical decision support software provides pharmacists with information about drug-drug interactions, drug-disease interactions, duplicate medications, and so on. Which of the following is true regarding these clinical decision alerts for pharmacists? (Select the single best answer)

Too many can fatigue a pharmacist, desensitizing them to potentially useful information as they force past the system soft and hard "stops."

Cost effectiveness

When desired comparison takes into consideration cost of same health outcome achieved

cost utility

When quality adjusted life year gained is

A pharmacoeconomic study demonstrates that a new medication has an incremental cost of $1,000, and produces an incremental benefit of 0.1 QALYs. If the willingness-to-pay threshold is $50,000/QALY, should this medication be paid for?

Yes, this medication is below the WTP threshold

The most appropriate definition of a "Sentinel Indicator" is...

a screen for a significant quality-related event that requires further investigation

Nested case-control study

a type of case control-study in which cases and controls are drawn from the population in a cohort study

case-crossover study

compares the exposure status of a case immediately before its occurrence with that of the same case at a prior time

Dr. Nau described the Shingo model that contains 10 guiding principles for creating a high-quality organization. Based on this model, Dr. Nau emphasized that the _____ of an organization is the foundation for CQI.

culture

Which of the following statements are true of specialty pharmacies and specialty pharmaceuticals?

he products are often biologics The products are often very expensive (> $600 per month) Community pharmacies may obtain accreditation as a specialty pharmacy provider

PICO model

patient population, intervention of interest, comparison of interest, and outcome of interest used to formulate EBP

Dr. Nau (with help from ISMP slides) noted that the causes of medication errors generally fall in 2 categories. The 2 categories of causes of medication errors are...

people and systems

Evidence-based practice

process of combining the best available research evidence with your knowledge and skill to make collaborative, patient or population- centered decisions within the context of a given healthcare situation

range of sources from strongest to weakest

random, cohort, control, cross, case report

Perhaps the most important part of preventing future medication errors is _________________. (select the single best answer)

reporting all errors when they occur

just culture

seeks to find a balance between the need to learn from mistakes and the need for disciplinary action against employees

According to Dr. Nau, _____ thinkers recognize that the most proximal cause of an event may have root causes that remain if we only address the most proximal cause

systems

Which of the following abbreviations is error-prone and should be avoided?

u for units

Role of PBM

▪Design prescription plans▪Formulary management▪Monitor drug utilization▪Educate / Remind prescribers about appropriate drug use ▪Contract with pharmacies to fill prescriptions ▪Process pharmacy claims▪Eligibility and co-payment verification▪Contract with manufacturers for rebates or other incentives