Welcome, PharmD students, to this crucial MCQ quiz on the Introduction to Medication Errors. Patient safety is a cornerstone of pharmacy practice, and understanding how medication errors occur, their types, causes, and prevention strategies is paramount. This quiz will test your knowledge on defining medication errors, identifying contributing human and system factors, recognizing high-alert medications, and exploring strategies like the ‘Five Rights,’ error reporting, and creating a culture of safety. Let’s solidify your understanding of how to prevent harm and ensure optimal patient outcomes.
1. A medication error is defined by the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) as:
- a) Any adverse drug reaction experienced by a patient.
- b) Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.
- c) An intentional act by a healthcare professional to cause harm with a medication.
- d) Only those errors that result in severe patient harm or death.
Answer: b) Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.
2. An event that could have resulted in a medication error but did not reach the patient is best described as a(n):
- a) Adverse drug event
- b) Sentinel event
- c) Near miss (or close call)
- d) Latent error
Answer: c) Near miss (or close call)
3. Which of the following represents a prescribing error?
- a) A pharmacist dispenses the wrong strength of a medication.
- b) A nurse administers a medication via the wrong route.
- c) A physician writes a prescription for a drug to which the patient has a known allergy.
- d) A patient takes an extra dose of their medication by mistake.
Answer: c) A physician writes a prescription for a drug to which the patient has a known allergy.
4. Illegible handwriting on a prescription is a common cause of which type of medication error?
- a) Administration error
- b) Monitoring error
- c) Transcribing or Dispensing error
- d) Compliance error
Answer: c) Transcribing or Dispensing error
5. The “Five Rights” of medication administration traditionally include the Right Patient, Right Drug, Right Dose, Right Route, and Right:
- a) Documentation
- b) Time
- c) Reason
- d) Price
Answer: b) Time
6. Medications that bear a heightened risk of causing significant patient harm when used in error are known as:
- a) Orphan drugs
- b) Over-the-counter (OTC) drugs
- c) High-alert medications
- d) Complementary and alternative medicines
Answer: c) High-alert medications
7. A systemic approach to identify the underlying causes of a medication error or adverse event, with the goal of preventing recurrence, is known as:
- a) Failure Mode and Effects Analysis (FMEA)
- b) Root Cause Analysis (RCA)
- c) Therapeutic drug monitoring
- d) Drug Utilization Review (DUR)
Answer: b) Root Cause Analysis (RCA)
8. Look-alike/sound-alike (LASA) drug names are a common source of which type of medication error?
- a) Monitoring error
- b) Dispensing or Prescribing error
- c) Compliance error
- d) Allergic reaction
Answer: b) Dispensing or Prescribing error
9. Confirmation bias in the medication use process can lead to errors because individuals may:
- a) Double-check all information meticulously.
- b) Seek out information that confirms their initial belief, even if it’s incorrect, and ignore disconfirming evidence.
- c) Always follow standardized procedures.
- d) Be overly cautious and slow down the process.
Answer: b) Seek out information that confirms their initial belief, even if it’s incorrect, and ignore disconfirming evidence.
10. Which of the following is a system-based strategy to prevent medication errors?
- a) Relying solely on individual vigilance.
- b) Implementing computerized prescriber order entry (CPOE) with clinical decision support.
- c) Punishing individuals for making errors.
- d) Using verbal orders for all chemotherapy.
Answer: b) Implementing computerized prescriber order entry (CPOE) with clinical decision support.
11. The Institute for Safe Medication Practices (ISMP) primarily focuses on:
- a) Regulating pharmaceutical manufacturers.
- b) Advancing patient safety by identifying medication error risks and promoting safe medication practices.
- c) Setting prices for medications.
- d) Conducting clinical trials for new drugs.
Answer: b) Advancing patient safety by identifying medication error risks and promoting safe medication practices.
12. A “latent error” in the medication use system refers to:
- a) An error that occurs at the point of direct patient care (active error).
- b) A hidden system flaw or weakness that contributes to the likelihood of an active error occurring (e.g., poor staffing, inadequate training).
- c) An error that causes no harm to the patient.
- d) An error made intentionally by a healthcare provider.
Answer: b) A hidden system flaw or weakness that contributes to the likelihood of an active error occurring (e.g., poor staffing, inadequate training).
13. Use of “tall man lettering” (e.g., hydrOXYzine and hydrALAZINE) is a strategy to help reduce errors associated with:
- a) Incorrect dosing calculations.
- b) Look-alike/sound-alike drug names.
- c) Administration via the wrong route.
- d) Illegible handwriting.
Answer: b) Look-alike/sound-alike drug names.
14. Medication reconciliation is a process designed to:
- a) Determine the cost-effectiveness of a drug.
- b) Prevent adverse drug reactions by avoiding all high-alert medications.
- c) Create the most accurate list possible of all medications a patient is taking — including drug name, dosage, frequency, and route — and use this list to guide therapy.
- d) Only document medications administered in the hospital.
Answer: c) Create the most accurate list possible of all medications a patient is taking — including drug name, dosage, frequency, and route — and use this list to guide therapy.
15. Which of the following is an example of a dispensing error?
- a) A physician prescribes a subtherapeutic dose.
- b) A pharmacist fills a prescription with the wrong drug.
- c) A nurse administers a medication at the wrong time.
- d) A patient does not adhere to their medication regimen.
Answer: b) A pharmacist fills a prescription with the wrong drug.
16. The most common point in the medication use process where errors occur is often cited as:
- a) Monitoring
- b) Dispensing
- c) Prescribing
- d) Transcribing
Answer: c) Prescribing
17. A non-punitive culture of safety in a healthcare setting encourages medication error reporting by:
- a) Focusing on blaming the individual who made the error.
- b) Emphasizing learning from errors to improve systems, rather than punishing individuals for unintentional mistakes.
- c) Only allowing anonymous reporting.
- d) Disciplining staff for all reported near misses.
Answer: b) Emphasizing learning from errors to improve systems, rather than punishing individuals for unintentional mistakes.
18. Which organization is primarily responsible for collecting reports of adverse drug events and medication errors through its MedWatch program in the USA?
- a) The Joint Commission
- b) The Food and Drug Administration (FDA)
- c) The Institute for Safe Medication Practices (ISMP)
- d) The Centers for Disease Control and Prevention (CDC)
Answer: b) The Food and Drug Administration (FDA)
19. Barcode medication administration (BCMA) systems help prevent errors by:
- a) Automatically calculating drug doses.
- b) Verifying the “Five Rights” (e.g., right patient, right drug, right dose) at the point of administration using barcodes.
- c) Storing medications securely.
- d) Improving prescriber handwriting.
Answer: b) Verifying the “Five Rights” (e.g., right patient, right drug, right dose) at the point of administration using barcodes.
20. Using trailing zeros (e.g., 5.0 mg) or not using leading zeros (e.g., .5 mg) in prescriptions are examples of practices that can:
- a) Improve clarity and reduce errors.
- b) Increase the risk of dosing errors due to misinterpretation.
- c) Are required by all state pharmacy boards.
- d) Only apply to pediatric prescriptions.
Answer: b) Increase the risk of dosing errors due to misinterpretation. (ISMP recommends avoiding trailing zeros and always using leading zeros).
21. An independent double check is a process where:
- a) One person checks their own work twice.
- b) Two individuals independently perform the same calculation or check a critical task, then compare their results.
- c) A computer system performs the check automatically.
- d) The patient verifies the medication.
Answer: b) Two individuals independently perform the same calculation or check a critical task, then compare their results.
22. Failure Mode and Effects Analysis (FMEA) is a proactive risk assessment tool used to:
- a) Investigate errors that have already occurred.
- b) Identify potential failures within a system or process and their likely effects before they occur, allowing for preventative action.
- c) Document patient allergies.
- d) Calculate drug dosages.
Answer: b) Identify potential failures within a system or process and their likely effects before they occur, allowing for preventative action.
23. Distractions and interruptions in a busy pharmacy environment are recognized as significant contributors to:
- a) Improved workflow efficiency.
- b) Increased risk of medication errors.
- c) Better communication between staff.
- d) Enhanced pharmacist vigilance.
Answer: b) Increased risk of medication errors.
24. Which of the following is an example of an administration error?
- a) A prescription written for the wrong patient.
- b) A drug product that is mislabeled by the manufacturer.
- c) A nurse giving a medication intravenously when it was ordered intramuscularly.
- d) A pharmacist failing to counsel on a new prescription.
Answer: c) A nurse giving a medication intravenously when it was ordered intramuscularly.
25. The NCC MERP Index for Categorizing Medication Errors classifies errors based on:
- a) The cost of the medication involved.
- b) The type of healthcare professional who made the error.
- c) The actual or potential outcome for the patient, ranging from Category A (capacity to cause error) to Category I (error contributed to death).
- d) The time of day the error occurred.
Answer: c) The actual or potential outcome for the patient, ranging from Category A (capacity to cause error) to Category I (error contributed to death).
26. A “Swiss Cheese Model” of accident causation suggests that errors occur when:
- a) Individuals are intentionally negligent.
- b) A single, catastrophic failure occurs in an otherwise perfect system.
- c) Multiple system defenses or barriers (layers of cheese) are breached by aligning “holes” (weaknesses or latent errors).
- d) There are too many safety protocols in place.
Answer: c) Multiple system defenses or barriers (layers of cheese) are breached by aligning “holes” (weaknesses or latent errors).
27. Abbreviations such as “U” for unit or “Q.D.” for once daily are on ISMP’s list of error-prone abbreviations because they:
- a) Are too long to write.
- b) Can be easily misinterpreted, leading to medication errors.
- c) Are not understood by patients.
- d) Are only used in veterinary medicine.
Answer: b) Can be easily misinterpreted, leading to medication errors.
28. The pharmacist’s role in preventing medication errors includes all of the following EXCEPT:
- a) Verifying the appropriateness of a prescription.
- b) Counseling patients on proper medication use.
- c) Solely relying on physicians to catch all potential errors.
- d) Participating in medication safety initiatives and reporting errors.
Answer: c) Solely relying on physicians to catch all potential errors.
29. A “slip” is a type of human error that occurs when:
- a) An individual lacks the necessary knowledge to perform a task correctly.
- b) An action is performed incorrectly due to an unintended lapse in attention or execution, even though the person knows the correct procedure.
- c) A rule is intentionally violated.
- d) A system is poorly designed.
Answer: b) An action is performed incorrectly due to an unintended lapse in attention or execution, even though the person knows the correct procedure.
30. Automated dispensing cabinets (ADCs) can help reduce medication errors by:
- a) Eliminating the need for pharmacists.
- b) Improving medication security, providing accurate dispensing, and tracking inventory.
- c) Allowing any staff member to access all medications.
- d) Only storing over-the-counter medications.
Answer: b) Improving medication security, providing accurate dispensing, and tracking inventory.
31. Tall Man lettering is most effective when applied to drug names that are:
- a) Chemically similar but therapeutically different.
- b) Similar in spelling and pronunciation, leading to potential confusion.
- c) Generic and brand names for the same drug.
- d) Controlled substances only.
Answer: b) Similar in spelling and pronunciation, leading to potential confusion.
32. Disclosing a medication error to a patient should involve:
- a) Blaming another healthcare professional.
- b) Withholding information to avoid alarming the patient.
- c) A truthful and timely explanation of what happened, the potential consequences, and steps taken to mitigate harm and prevent recurrence.
- d) Only informing the patient if they directly ask about an error.
Answer: c) A truthful and timely explanation of what happened, the potential consequences, and steps taken to mitigate harm and prevent recurrence.
33. Which of the following is a human factor that can contribute to medication errors?
- a) Poor lighting in the pharmacy.
- b) Use of standardized order sets.
- c) Fatigue, stress, or heavy workload.
- d) Barcode scanning technology.
Answer: c) Fatigue, stress, or heavy workload.
34. Read-back and verify for verbal or telephone orders is a safety practice designed to:
- a) Speed up the ordering process.
- b) Confirm the accuracy of the communicated order and prevent misunderstandings.
- c) Document who gave the order.
- d) Eliminate the need for written orders.
Answer: b) Confirm the accuracy of the communicated order and prevent misunderstandings.
35. A medication error that reaches the patient and causes harm is also considered a(n):
- a) Near miss
- b) Preventable adverse drug event (ADE)
- c) Latent condition
- d) Standard operating procedure
Answer: b) Preventable adverse drug event (ADE)
36. The “just culture” model in healthcare safety aims to balance:
- a) Blame and punishment.
- b) Learning from errors with accountability for actions, distinguishing between human error, at-risk behavior, and reckless behavior.
- c) Speed and efficiency over safety.
- d) Individual performance and system design, ignoring the latter.
Answer: b) Learning from errors with accountability for actions, distinguishing between human error, at-risk behavior, and reckless behavior.
37. What is a primary reason for reporting “near misses” or “close calls”?
- a) To identify individuals who need disciplinary action.
- b) They provide valuable opportunities to identify system vulnerabilities and implement preventative measures before patient harm occurs.
- c) They are not important as no harm occurred.
- d) To increase paperwork for the pharmacy.
Answer: b) They provide valuable opportunities to identify system vulnerabilities and implement preventative measures before patient harm occurs.
38. Patient counseling by pharmacists is a critical step in medication safety because it:
- a) Ensures the pharmacy gets paid.
- b) Helps verify patient understanding, improves adherence, and allows for identification of potential issues or misunderstandings.
- c) Replaces the need for written information.
- d) Is only required for new prescriptions.
Answer: b) Helps verify patient understanding, improves adherence, and allows for identification of potential issues or misunderstandings.
39. High-alert medications often require specific safeguards, such as:
- a) Storing them alphabetically with all other drugs.
- b) Limiting access, using standardized concentrations, and employing independent double-checks.
- c) Only allowing physicians to handle them.
- d) Dispensing them without any labeling.
Answer: b) Limiting access, using standardized concentrations, and employing independent double-checks.
40. Which of the following is a common example of a high-alert medication?
- a) Saline nasal spray
- b) Insulin
- c) Multivitamins
- d) Acetaminophen 500 mg tablets
Answer: b) Insulin
41. A “forcing function” is a system design feature that:
- a) Allows for easy workarounds of safety checks.
- b) Makes it impossible to proceed with a task in an incorrect manner.
- c) Relies on human memory to prevent errors.
- d) Increases the complexity of a task.
Answer: b) Makes it impossible to proceed with a task in an incorrect manner. (e.g., a connector that only fits the correct IV line).
42. The use of leading zeros (e.g., 0.5 mg instead of .5 mg) is important because omitting the leading zero can lead to:
- a) The dose being interpreted as 10 times lower.
- b) The dose being misinterpreted as 10 times higher (e.g., .5 mg seen as 5 mg).
- c) No change in interpretation.
- d) The drug being seen as inactive.
Answer: b) The dose being misinterpreted as 10 times higher (e.g., .5 mg seen as 5 mg).
43. Which part of the medication-use process involves the patient?
- a) Only prescribing
- b) Only dispensing
- c) Administration (especially self-administration) and monitoring for effects/side effects.
- d) Only transcribing
Answer: c) Administration (especially self-administration) and monitoring for effects/side effects. (Patient involvement is key throughout for safety).
44. The Joint Commission’s National Patient Safety Goals often include specific recommendations related to:
- a) Pharmacy staffing ratios.
- b) Medication safety, such as labeling medications, reducing harm from anticoagulants, and medication reconciliation.
- c) The cost of medications.
- d) Pharmaceutical marketing practices.
Answer: b) Medication safety, such as labeling medications, reducing harm from anticoagulants, and medication reconciliation.
45. One of the main goals of analyzing medication error data is to:
- a) Identify the single person responsible for all errors.
- b) Identify trends, patterns, and system vulnerabilities to develop targeted improvement strategies.
- c) Publicly shame individuals involved.
- d) Prove that medication errors are unavoidable.
Answer: b) Identify trends, patterns, and system vulnerabilities to develop targeted improvement strategies.
46. In the context of medication errors, “monitoring” refers to evaluating:
- a) The pharmacy’s inventory levels.
- b) The patient’s response to the medication, including therapeutic effects and adverse effects.
- c) The cost of the medication.
- d) The time it takes to dispense a prescription.
Answer: b) The patient’s response to the medication, including therapeutic effects and adverse effects.
47. A pharmacist receives a verbal order for “insulin 10U”. To prevent error, the pharmacist should:
- a) Immediately prepare the dose.
- b) Write down the order, then read it back to the prescriber for confirmation, including spelling out “units”.
- c) Ask a technician to prepare the dose.
- d) Assume it means 10 milliliters.
Answer: b) Write down the order, then read it back to the prescriber for confirmation, including spelling out “units”.
48. What is a primary challenge associated with using abbreviations in prescriptions?
- a) They save too much time.
- b) They can be ambiguous and misinterpreted, leading to errors.
- c) Patients understand them better than full words.
- d) They are always standardized across all institutions.
Answer: b) They can be ambiguous and misinterpreted, leading to errors.
49. An “adverse drug event” (ADE) is defined as:
- a) Any error in the medication process.
- b) Harm experienced by a patient resulting from exposure to a medication.
- c) A near miss that did not reach the patient.
- d) A failure to administer a medication.
Answer: b) Harm experienced by a patient resulting from exposure to a medication. (A medication error may or may not lead to an ADE).
50. The ultimate aim of understanding and addressing medication errors is to:
- a) Create a blame-free environment where no one is accountable.
- b) Improve patient safety and the quality of care by learning from mistakes and redesigning systems.
- c) Eliminate the need for pharmacists in the medication-use process.
- d) Increase the number of regulations in healthcare.
Answer: b) Improve patient safety and the quality of care by learning from mistakes and redesigning systems. Sources
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