Clinical Decision Support Systems (CDSS) are powerful tools integrated into Electronic Health Records (EHRs) that help guide clinicians, reduce medication errors, and improve patient safety. However, their effectiveness is entirely dependent on the quality of the underlying data—a principle often summarized as “garbage in, garbage out.” As pharmacists, you are on the front lines of interacting with and contributing to this data every day. Your ability to accurately verify information, as taught in courses like the Professional Skills Labs, and understand the role of automated systems, as covered in the Hospital IPPE, is critical. This quiz will test your understanding of how data quality impacts clinical decision support and the pharmacist’s essential role in maintaining it.
1. A Clinical Decision Support System (CDSS) is best described as:
- a. The hospital’s billing software.
- b. A tool that provides clinicians with knowledge and person-specific information to enhance health and health care.
- c. A secure messaging platform for providers.
- d. The physical computer hardware in a pharmacy.
Answer: b. A tool that provides clinicians with knowledge and person-specific information to enhance health and health care.
2. The principle of “Garbage In, Garbage Out” (GIGO) in the context of CDSS means:
- a. If a system is designed poorly, it will never work.
- b. If inaccurate or incomplete data is entered into the system, the system’s output and alerts will be inaccurate or misleading.
- c. All clinicians input garbage data.
- d. The system automatically filters out bad data.
Answer: b. If inaccurate or incomplete data is entered into the system, the system’s output and alerts will be inaccurate or misleading.
3. A pharmacist receives a drug-allergy alert for a patient prescribed amoxicillin. The patient’s allergy list shows an allergy to penicillin, but upon questioning, the patient says they only experienced mild nausea. This is an example of:
- a. A clinically significant, life-threatening allergy.
- b. Poor data quality, as the reaction type was not accurately documented.
- c. A properly functioning CDSS with no issues.
- d. A drug-seeking behavior.
Answer: b. Poor data quality, as the reaction type was not accurately documented.
4. A CDSS alert that fires inappropriately due to inaccurate data contributes to what major problem for clinicians?
- a. Increased job satisfaction.
- b. Alert fatigue, which can lead to ignoring future valid alerts.
- c. Faster workflow.
- d. Reduced number of medication errors.
Answer: b. Alert fatigue, which can lead to ignoring future valid alerts.
5. What is a pharmacist’s most critical role in maintaining high-quality data for a CDSS?
- a. Inputting billing codes.
- b. Performing accurate and thorough medication reconciliation and allergy verification.
- c. Deleting old lab values.
- d. Overriding all alerts to save time.
Answer: b. Performing accurate and thorough medication reconciliation and allergy verification.
6. A CDSS uses a patient’s weight to calculate a dose for an antibiotic. If the weight in the EHR is from a previous admission and the patient has lost 50 pounds, the calculated dose will be:
- a. Correct
- b. Too low
- c. Too high
- d. It is impossible to tell.
Answer: c. Too high
7. “Accurately verify orders in an EHR” is a key objective for student pharmacists, which directly impacts data quality.
- a. True
- b. False
Answer: a. True
8. A patient’s allergy to lisinopril is documented as “cough.” A new order for ramipril is entered. Why might a CDSS appropriately fire a cross-sensitivity alert?
- a. Because both drugs are expensive.
- b. Because both drugs are ACE Inhibitors and the new order presents a therapeutic duplication.
- c. A cough is a class effect of ACE Inhibitors, not a true allergy, but the system may still alert on it based on how it was entered.
- d. Ramipril is known to cause severe allergies.
Answer: c. A cough is a class effect of ACE Inhibitors, not a true allergy, but the system may still alert on it based on how it was entered.
9. What is a “false negative” in the context of CDSS alerts?
- a. An alert that fires when there is no actual problem.
- b. A situation where an alert should have fired for a dangerous situation but did not, due to missing or inaccurate data.
- c. An alert that is overridden by a pharmacist.
- d. An alert that is seen by a nurse but not a physician.
Answer: b. A situation where an alert should have fired for a dangerous situation but did not, due to missing or inaccurate data.
10. Which of the following is an example of incomplete data leading to a potential error?
- a. The patient’s full home medication list is documented.
- b. The patient’s allergy to peanuts is documented.
- c. The patient’s home use of a potent CYP3A4-inhibiting supplement is not documented.
- d. The patient’s blood pressure is recorded accurately.
Answer: c. The patient’s home use of a potent CYP3A4-inhibiting supplement is not documented.
11. Identifying how automated systems assist in decreasing medication errors is a key objective for pharmacy students.
- a. True
- b. False
Answer: a. True
12. To improve data quality, patient allergies should be documented with:
- a. Only the name of the drug.
- b. The name of the drug and the specific reaction that occurred.
- c. The date the allergy was first reported.
- d. Both b and c.
Answer: d. Both b and c.
13. A CDSS provides a renal dosing recommendation based on a serum creatinine value from three weeks ago. This recommendation may be inaccurate if:
- a. The patient’s renal function has changed since the lab was drawn.
- b. The patient’s weight has not changed.
- c. The drug is not cleared by the kidneys.
- d. The patient is over 65.
Answer: a. The patient’s renal function has changed since the lab was drawn.
14. Utilizing an EHR to collect relevant information is a core skill taught in the Professional Skills Labs.
- a. True
- b. False
Answer: a. True
15. Data that is entered into discrete, coded fields (e.g., selecting from a dropdown menu) is more useful for a CDSS than data entered as:
- a. A number.
- b. A date.
- c. Free text in a progress note.
- d. A specific lab value.
Answer: c. Free text in a progress note.
16. A pharmacist notes that a patient is prescribed warfarin and amiodarone, but no drug-drug interaction alert fired. What is a possible data-related cause?
- a. The amiodarone order was entered as a “PRN” medication.
- b. The warfarin was entered using a different, unrecognized name.
- c. One of the medications was not on the patient’s active medication list at the time of verification.
- d. All of the above are possible data-related causes.
Answer: d. All of the above are possible data-related causes.
17. The ultimate responsibility for the correctness of a medication order lies with:
- a. The CDSS software.
- b. The hospital’s IT department.
- c. The pharmacist and the prescriber, who use the CDSS as a tool.
- d. The patient.
Answer: c. The pharmacist and the prescriber, who use the CDSS as a tool.
18. What is the best way to ensure a patient’s weight is accurate for dosing?
- a. Use the weight from their driver’s license.
- b. Ask the patient to estimate their weight.
- c. Use a current, measured weight from the current admission.
- d. Use the weight from their admission a year ago.
Answer: c. Use a current, measured weight from the current admission.
19. How does accurate problem-list documentation impact CDSS?
- a. It has no impact.
- b. It allows the CDSS to fire drug-disease interaction alerts (e.g., an alert for a beta-blocker in a patient with an active diagnosis of asthma).
- c. It only helps with billing.
- d. It slows down the system.
Answer: b. It allows the CDSS to fire drug-disease interaction alerts (e.g., an alert for a beta-blocker in a patient with an active diagnosis of asthma).
20. A pharmacist’s meticulous verification of a medication order is a form of:
- a. Bypassing the system.
- b. Data quality control.
- c. Creating more work.
- d. Inefficient workflow.
Answer: b. Data quality control.
21. A major challenge in maintaining data quality for medication lists is:
- a. The use of electronic prescribing.
- b. A lack of available medications.
- c. Discrepancies between what the patient actually takes at home and what is listed in the EHR.
- d. Patients having only one pharmacy.
Answer: c. Discrepancies between what the patient actually takes at home and what is listed in the EHR.
22. An alert for therapeutic duplication (e.g., two ACE inhibitors on the profile) will fail to fire if:
- a. The drugs are prescribed by the same doctor.
- b. One of the ACE inhibitors is not on the active medication list.
- c. The patient has hypertension.
- d. Both drugs are generic.
Answer: b. One of the ACE inhibitors is not on the active medication list.
23. The quality of a CDSS is solely dependent on the sophistication of its rules and algorithms.
- a. True
- b. False
Answer: b. False
24. Which of the following is an example of structured data?
- a. A progress note describing a patient’s rash.
- b. Selecting “Hives” from a pre-defined list of allergic reactions.
- c. A scanned-in document from an outside hospital.
- d. A voice message from a physician.
Answer: b. Selecting “Hives” from a pre-defined list of allergic reactions.
25. A pharmacist’s intervention to clarify an ambiguous order (e.g., “resume home meds”) improves data quality by:
- a. Creating a more specific and accurate active medication list.
- b. Adding more free text to the chart.
- c. Delaying therapy.
- d. It does not improve data quality.
Answer: a. Creating a more specific and accurate active medication list.
26. Who is responsible for maintaining the quality of data in a patient’s EHR?
- a. Only the IT department.
- b. Only the physicians.
- c. Only the pharmacists.
- d. All clinicians who interact with the patient’s record.
Answer: d. All clinicians who interact with the patient’s record.
27. A CDSS that provides dosing guidance for vancomycin is useless if what data is missing or outdated?
- a. The patient’s allergy list.
- b. The patient’s recent serum creatinine and actual body weight.
- c. The patient’s home address.
- d. The patient’s insurance information.
Answer: b. The patient’s recent serum creatinine and actual body weight.
28. How can a pharmacist help combat alert fatigue?
- a. By advocating for the removal of all alerts from the system.
- b. By helping to refine and customize alerts to make them more specific and clinically meaningful.
- c. By overriding every alert without reading it.
- d. By complaining about the alerts to colleagues.
Answer: b. By helping to refine and customize alerts to make them more specific and clinically meaningful.
29. The information used to build a CDSS rule for a drug-drug interaction comes from:
- a. Social media trends.
- b. Clinician opinions.
- c. Evidence-based drug information literature and databases.
- d. The number of prescriptions written for a drug.
Answer: c. Evidence-based drug information literature and databases.
30. Data integrity means that the data in the EHR is:
- a. Accessible to everyone.
- b. Stored in the cloud.
- c. Accurate, complete, and has not been improperly altered.
- d. Backed up every hour.
Answer: c. Accurate, complete, and has not been improperly altered.
31. The failure to discontinue a home medication that was held upon admission is a common data quality issue that can lead to:
- a. Improved patient outcomes.
- b. An inaccurate discharge medication list and potential patient harm.
- c. A shorter hospital stay.
- d. A more efficient workflow.
Answer: b. An inaccurate discharge medication list and potential patient harm.
32. What is the best way to document an allergy to codeine that caused hives and shortness of breath?
- a. Allergy: “Opiates”
- b. Allergy: “Codeine – Hives, SOB”
- c. Allergy: “Codeine”
- d. Allergy: “Pain medications”
Answer: b. Allergy: “Codeine – Hives, SOB”
33. An EHR system with good interoperability can improve data quality by:
- a. Preventing pharmacists from seeing patient data.
- b. Automatically pulling in accurate data from other healthcare systems, reducing transcription errors.
- c. Making the system more complex and harder to use.
- d. Increasing the number of alerts.
Answer: b. Automatically pulling in accurate data from other healthcare systems, reducing transcription errors.
34. A pharmacist calls a lab to question a potassium value of 8.0 mEq/L that seems inconsistent with the patient’s clinical picture. This action primarily serves to:
- a. Delay patient care.
- b. Challenge the lab’s authority.
- c. Verify data quality before a clinical decision or CDSS alert is acted upon.
- d. Annoy the lab technician.
Answer: c. Verify data quality before a clinical decision or CDSS alert is acted upon.
35. An automated system’s ability to decrease medication errors is directly proportional to the quality of the data it uses.
- a. True
- b. False
Answer: a. True
36. A CDSS may use “if-then” rules. An example is: “IF patient is on an ACE inhibitor AND serum potassium is >5.5, THEN alert the user.” This rule will fail if:
- a. The patient has hypertension.
- b. The most recent potassium value has not been entered into the EHR.
- c. The patient is over 65.
- d. The ACE inhibitor is generic.
Answer: b. The most recent potassium value has not been entered into the EHR.
37. Which of these can lead to poor data quality?
- a. Copy-pasting old notes without updating them.
- b. Using non-standard abbreviations.
- c. Typos and data entry errors.
- d. All of the above.
Answer: d. All of the above.
38. The process of medication reconciliation is a critical step for ensuring:
- a. The patient gets discharged quickly.
- b. The accuracy and completeness of the patient’s medication list data.
- c. The pharmacy is properly reimbursed.
- d. The patient receives brand name drugs only.
Answer: b. The accuracy and completeness of the patient’s medication list data.
39. A well-designed CDSS can help improve data quality by:
- a. Forcing users to enter data in a structured format.
- b. Prompting for missing information.
- c. Providing clear options in dropdown menus.
- d. All of the above.
Answer: d. All of the above.
40. A pharmacist should trust the output of a CDSS without question.
- a. True
- b. False
Answer: b. False
41. The most important patient identifier to ensure data quality is:
- a. The patient’s room number.
- b. The patient’s name only.
- c. Using at least two unique identifiers, like name and date of birth.
- d. The patient’s physician.
Answer: c. Using at least two unique identifiers, like name and date of birth.
42. A CDSS alert for a maximum dose of a medication will be inaccurate if:
- a. The patient’s diagnosis is incorrect.
- b. The patient’s weight used for the mg/kg calculation is incorrect.
- c. The patient is allergic to the medication.
- d. The medication is on formulary.
Answer: b. The patient’s weight used for the mg/kg calculation is incorrect.
43. A key skill for a pharmacist is to be able to synthesize information from various parts of the EHR to:
- a. Create a more complete and accurate clinical picture than any single data point provides.
- b. Find errors in other clinicians’ notes.
- c. Generate a bill.
- d. Bypass the CDSS entirely.
Answer: a. Create a more complete and accurate clinical picture than any single data point provides.
44. If a CDSS consistently provides irrelevant alerts, clinicians are more likely to:
- a. Pay closer attention to every alert.
- b. Develop a habit of overriding all alerts, including important ones.
- c. Report the issue to the IT department.
- d. Ask for more alerts to be added.
Answer: b. Develop a habit of overriding all alerts, including important ones.
45. What is the main data quality risk of using “Resume All Home Meds” as an admission order?
- a. It is efficient and has no risks.
- b. It may re-order medications that should have been held, and it relies on an unverified home medication list.
- c. It ensures the patient receives all their necessary medications.
- d. It is the preferred method for medication reconciliation.
Answer: b. It may re-order medications that should have been held, and it relies on an unverified home medication list.
46. The data in a patient’s EHR is static and does not change.
- a. True
- b. False
Answer: b. False
47. A pharmacist’s role in data quality is best described as being a:
- a. Passive user of the system.
- b. Final gatekeeper who verifies data before it is acted upon.
- c. Data entry clerk only.
- d. Software developer.
Answer: b. Final gatekeeper who verifies data before it is acted upon.
48. An alert that suggests a renal dose adjustment for a patient with AKI is an example of:
- a. An error, because equations are unreliable in AKI.
- b. A helpful prompt that requires the pharmacist to use their clinical judgment to verify the appropriateness of the suggestion.
- c. A directive that must be followed without question.
- d. A therapeutic duplication alert.
Answer: b. A helpful prompt that requires the pharmacist to use their clinical judgment to verify the appropriateness of the suggestion.
49. An organization’s “culture of safety” promotes:
- a. Hiding errors to protect colleagues.
- b. Openly reporting data errors and system issues to allow for improvement.
- c. Punishing clinicians for every alert they override.
- d. Minimizing the use of the EHR.
Answer: b. Openly reporting data errors and system issues to allow for improvement.
50. The ultimate reason to focus on data quality in a CDSS is to:
- a. Make the IT department’s job easier.
- b. Ensure the system functions correctly to support clinical decisions and improve patient safety.
- c. Reduce the number of clicks for clinicians.
- d. Generate more detailed billing reports.
Answer: b. Ensure the system functions correctly to support clinical decisions and improve patient safety.