Archive June 2017 XVIII, No. 6

Take Our Medication Safety Quiz

Just like look-alike and sound-alike drugs, things aren't always as they seem.

John Karwoski, RPh, MBA

best practices TEST TIME Are you complying with best practices in medication safety? Take our quiz to find out.

Each of the 17 questions in this medication safety quiz covers a hot topic with surveyors from the Department of Health, state agencies, accreditation agencies, CMS, DEA — in other words, all the citation-writing powers that be. Check your work some may stump you.

1. The earliest and most sensitive indicator of an acute malignant hyperthermia crisis is _________ .

a. an increase in end-tidal carbon dioxide
b. a sudden increase in body temperature
c. crying patient
d. nausea and vomiting

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2. Which drug do you use during an MH crisis?

a. dantrolene
b. Ryanodex
c. Dantrium
d. Revonto
e. all of the above

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3. According to the DEA, what are the 2 acceptable ways to destroy controlled substances?

a. coffee grounds and kitty litter
b. flushing and running down the drain
c. incineration or chemical digestion
d. placing whole pills or liquids into the trash can

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multi-dose vial MULTI-DOSE VIALS If you use multi-dose vials for more than one patient, store and access the vial in a dedicated medication preparation area, away from patient treatment areas.

4. Expired opioids should __________ .

a. be kept secure until they are properly disposed of or destroyed
b. be thrown in the trash the day they expire since the active ingredient may not be potent anymore
c. still be given to patients to avoid spending too much money on replacement medication stock
d. go home with employees in case they ever need emergency pain relief

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5. All of these are appropriate ways to safeguard against the misuse of sound-alike, look-alike drugs (SALAD), except __________ .

a. identifying SALAD on your facility's printed formulary
b. posting the SALAD list provided by the Institute for Safe Medication Practice (ISMP)
c. putting stickers on all SALAD
d. storing SALAD in separate areas

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6. Diverting opioids in the surgical setting can result in __________ .

a. an incapacitated employee unable to deliver reliable care to patients
b. a patient not receiving the intended dose of medication
c. the diverter infecting the patient and themselves
d. all of the above

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7. Vancomycin 1 gram vials need to be reconstituted with 20 ml Sterile Water for Injection. After reconstituting with the SWFI, how many mls are needed for a 750 mg dose?

a. 20 ml
b. 15 ml
c. 10 ml
d. 7.5 ml
e. none of the above

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more than cluttered 4 WRONGS This tray is more than just cluttered.

8. What's wrong with this picture?

a. The syringes are unlabeled.
b. Controlled, highly divertible drugs are unattended.
c. Personal items are on the tray
d. The tray is disorganized with lots of clutter
e. all of the above

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9. Where can you access and use sterile injectable multi-dose medications for multiple patients?

a. in the operating room
b. at the patient bedside
c. in the medication room
d. on the medication cart in the OR hallway

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10. When can you use single-dose vials for multiple patients?

a. the syringe is prepared in a medication prep area in advance of medication administration
b. the syringe has all the proper labeling requirements
c. never
d. there's a national shortage and it's difficult to obtain the drug

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11. Intravenous ondansetron is available 4 mg/2 ml. What is your final drug concentration of the vial? ___ /ml

a. 4 mg
b. 2 mg
c. 8 mg
d. 1 mg

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12. A pediatric patient is ordered 1 mg IV. How many mls will you administer?

a. 1 ml
b. 1.5 ml
c. 0.5 ml
d. 0.2 ml

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13. If done in your facility, who may remove prescription drugs from their original container and repackage them for ease of use?

a. a registered pharmacist
b. 2 RNs working in tandem
c. the doctor who writes an order
d. the lead anesthesia provider

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14. You should keep a medication refrigerator at a temperature range of __________ .

a. 36° to 46°F
b. 36° to 46°C
c. -4° to +14°F
d. -4° to +14°C

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15. You may use multi-dose vials in an OR if ___ .

a. you label the vial with the date opened and 28-day expiration
b. you change the needle between each patient
c. the medication is drawn up in between cases
d. all of the above
e. none of the above

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16. What's not true about an FDA-registered 503B outsourcing facility (compounder)?

a. you must supply patient identifiers to the compounder when placing an order
b. its name, location and inspection information will appear on the FDA website for registered outsourcing facilities
c. it will display an FDA registration emblem on its website
d. warning letters from FDA inspections are available online

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17. Who determines what medications and supplies you stock on a crash cart?

a. your pharmacy consultant
b. ACLS
c. American Heart Association
d. medical board

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