MCQ Quiz: Practical Applications to Improve Quality

Quality Improvement (QI) moves from theory to action through its practical applications in daily pharmacy practice. The goal is to use systematic tools and strategies to make patient care demonstrably safer and more effective. This quiz covers practical applications of QI principles that pharmacists use to enhance the medication-use system and improve patient outcomes.

1. A pharmacy team notices an increase in dispensing errors. What is the most appropriate first practical step in a QI process?

• a. To immediately blame the technician with the most errors.
• b. To map the current dispensing process to identify potential points of failure.
• c. To implement a new, untested workflow immediately.
• d. To purchase a new computer system.

Answer: b. To map the current dispensing process to identify potential points of failure.

2. A practical application of Barcode Medication Administration (BCMA) is the reduction of which type of medication error?

• a. Prescribing errors
• b. Administration errors at the bedside
• c. Transcribing errors
• d. Compounding errors

Answer: b. Administration errors at the bedside

3. After a serious medication error involving a look-alike/sound-alike drug pair, a Root Cause Analysis is performed. Which of the following is the most practical and effective system-based solution?

• a. Telling the pharmacists to “be more careful.”
• b. Separating the storage of the two medications and using “tall man” lettering in the computer system.
• c. Firing the pharmacist involved in the error.
• d. Creating a new policy that is not enforced.

Answer: b. Separating the storage of the two medications and using “tall man” lettering in the computer system.

4. A pharmacist implements a new MTM service for patients with diabetes. To measure the quality of this new service, which of the following would be the best outcome measure?

• a. The number of patients enrolled in the service.
• b. The change in average A1c for the enrolled patients over 6 months.
• c. The number of counseling sessions performed.
• d. The revenue generated by the service.

Answer: b. The change in average A1c for the enrolled patients over 6 months.

5. A practical application of the Plan-Do-Study-Act (PDSA) cycle is:

• a. Implementing a large, permanent change across the entire hospital at once.
• b. Testing a change on a small scale, analyzing the results, and then refining the change before wider implementation.
• c. A method for analyzing an error that has already happened.
• d. A tool for brainstorming only.

Answer: b. Testing a change on a small scale, analyzing the results, and then refining the change before wider implementation.

6. The curriculum covers the practical application of developing policies and procedures to enhance quality patient care.

• a. True
• b. False

Answer: a. True

7. A practical application of health informatics to improve quality is:

• a. Using a paper-based ordering system.
• b. Implementing Computerized Provider Order Entry (CPOE) to eliminate handwriting errors.
• c. Disabling all clinical decision support alerts.
• d. Storing all patient records in a filing cabinet.

Answer: b. Implementing Computerized Provider Order Entry (CPOE) to eliminate handwriting errors.

8. A pharmacy wants to improve patient adherence. A practical application to achieve this would be to:

• a. Implement a medication synchronization program.
• b. Only tell patients to take their medications.
• c. Call patients only when they are more than 30 days late for a refill.
• d. Charge patients more for their prescriptions.

Answer: a. Implement a medication synchronization program.

9. The use of a “smart pump” with a standardized drug library is a practical application designed to prevent:

• a. The wrong drug being selected from the pharmacy.
• b. Errors related to IV infusion rates and concentrations.
• c. The patient from getting a rash.
• d. A patient from falling.

Answer: b. Errors related to IV infusion rates and concentrations.

10. A pharmacist is participating in a “tracer” activity for The Joint Commission. This is a practical application of:

• a. Quality assurance and regulatory compliance.
• b. Dispensing a medication.
• c. Compounding a product.
• d. Patient counseling.

Answer: a. Quality assurance and regulatory compliance.

11. The Root Cause Analysis is a practical tool covered in the Patient Care 3 curriculum.

• a. True
• b. False

Answer: a. True

12. To improve the quality of patient education, a pharmacist decides to use the teach-back method for all new prescriptions. This is a practical application of:

• a. A dispensing technique.
• b. An inventory management technique.
• c. A health literacy and communication strategy.
• d. A billing technique.

Answer: c. A health literacy and communication strategy.

13. A practical way to measure the impact of a new workflow designed to reduce wait times is to:

• a. Ask patients if they think they are waiting less.
• b. Collect data on average prescription wait times before and after the change.
• c. Assume the new workflow is better.
• d. Measure the number of prescriptions filled.

Answer: b. Collect data on average prescription wait times before and after the change.

14. A “forcing function” is a practical QI application that:

• a. Reminds a user to do something.
• b. Makes it physically impossible to do a task incorrectly, such as using a special connector for an oral syringe that won’t fit an IV line.
• c. Requires a second person to double-check the work.
• d. Involves educating staff.

Answer: b. Makes it physically impossible to do a task incorrectly, such as using a special connector for an oral syringe that won’t fit an IV line.

15. A pharmacist reporting a “near miss” to their hospital’s safety system is a practical application of:

• a. A culture of safety.
• b. Proactive quality improvement.
• c. Both a and b.
• d. Neither a nor b.

Answer: c. Both a and b.

16. The curriculum covers medication safety principles that are the basis for QI.

• a. True
• b. False

Answer: a. True

17. A practical application for improving the safety of high-alert medications is:

• a. Storing them next to all other medications.
• b. Requiring an independent double-check before dispensing or administration.
• c. Allowing any staff member to access them.
• d. Using verbal orders for them whenever possible.

Answer: b. Requiring an independent double-check before dispensing or administration.

18. A hospital pharmacy team decides to create a standardized, pre-printed order set for managing DKA. This is a practical application of QI aimed at:

• a. Making the process more complicated.
• b. Reducing variability and improving adherence to evidence-based practice.
• c. Increasing the cost of care.
• d. Increasing the number of medication errors.

Answer: b. Reducing variability and improving adherence to evidence-based practice.

19. Which of the following is a practical application of quality improvement in a community pharmacy?

• a. Implementing a new system to flag patients due for vaccinations.
• b. Creating a new workflow to separate the filling and verification processes.
• c. Starting a pharmacist-led adherence program.
• d. All of the above.

Answer: d. All of the above.

20. The curriculum covers automated systems that are practical tools for QI.

• a. True
• b. False

Answer: a. True

21. A “huddle” at the start of a shift where the team discusses potential safety issues for the day is a practical application of:

• a. Proactive communication to improve quality.
• b. A formal root cause analysis.
• c. A disciplinary meeting.
• d. A waste of time.

Answer: a. Proactive communication to improve quality.

22. A practical application of the “Study” phase of a PDSA cycle would be:

• a. Deciding to implement a new workflow.
• b. Implementing the new workflow for one hour on a Tuesday.
• c. Analyzing the error rates and wait times from that one-hour test.
• d. Rolling out the new workflow to the entire pharmacy.

Answer: c. Analyzing the error rates and wait times from that one-hour test.

23. The principles of evidence-based practice are crucial for designing QI initiatives.

• a. True
• b. False

Answer: a. True

24. A pharmacy team uses a run chart to track the percentage of patients receiving medication counseling each day. This is a practical application of:

• a. Using data to monitor a process over time.
• b. Guessing about performance.
• c. A research study.
• d. A financial analysis.

Answer: a. Using data to monitor a process over time.

25. A pharmacist’s most important role in quality improvement is:

• a. To only identify problems without suggesting solutions.
• b. To actively participate in designing, implementing, and evaluating safer medication-use systems.
• c. To focus only on the speed of dispensing.
• d. To manage the pharmacy’s budget.

Answer: b. To actively participate in designing, implementing, and evaluating safer medication-use systems.

26. A practical application of QI to reduce transcription errors is:

• a. Using CPOE.
• b. Requiring all verbal orders to be read back.
• c. Both a and b.
• d. Neither a nor b.

Answer: c. Both a and b.

27. A key to the practical application of QI is to focus on:

• a. Blaming individuals
• b. The process
• c. The outcome
• d. Both b and c

Answer: d. Both b and c

28. A practical challenge to implementing QI in a busy pharmacy is:

• a. Finding the time and resources.
• b. Getting buy-in from staff.
• c. Resistance to change.
• d. All of the above.

Answer: d. All of the above.

29. The use of “tall man” lettering (e.g., hydrALAZINE vs. hydrOXYzine) is a practical application of QI aimed at:

• a. Reducing look-alike, sound-alike drug errors.
• b. Improving the aesthetic of the label.
• c. Saving ink.
• d. Fulfilling a legal requirement.

Answer: a. Reducing look-alike, sound-alike drug errors.

30. The medication safety modules in the curriculum provide the basis for understanding practical QI applications.

• a. True
• b. False

Answer: a. True

31. What is a practical way to apply QI principles to patient counseling?

• a. To provide the same pamphlet to every patient.
• b. To use the teach-back method to ensure understanding.
• c. To rush through the counseling to save time.
• d. To avoid counseling altogether.

Answer: b. To use the teach-back method to ensure understanding.

32. A pharmacist-led anticoagulation service that monitors INRs and adjusts warfarin doses according to a protocol is a practical application of QI that improves:

• a. Patient safety.
• b. Therapeutic outcomes.
• c. Both a and b.
• d. Neither a nor b.

Answer: c. Both a and b.

33. The goal of a “timeout” before a complex sterile compounding procedure is a practical application of QI to:

• a. Take a break.
• b. Verify the ingredients and calculations to prevent an error.
• c. Speed up the process.
• d. Clean the hood.

Answer: b. Verify the ingredients and calculations to prevent an error.

34. The “5 Whys” technique is a practical tool used during an RCA to:

• a. Assign blame to five different people.
• b. Determine the root cause of a problem.
• c. Create a timeline.
• d. Document the event.

Answer: b. Determine the root cause of a problem.

35. A practical application of QI in inventory management is:

• a. Ordering as much medication as possible.
• b. Using data to identify and remove expired or slow-moving stock.
• c. Storing all medications alphabetically.
• d. Letting technicians order whatever they want.

Answer: b. Using data to identify and remove expired or slow-moving stock.

36. A hospital pharmacist who reviews protocols for IV medication administration is engaging in a practical QI activity.

• a. True
• b. False

Answer: a. True

37. The “Plan” in a PDSA cycle is the most important step.

• a. True, because a good plan is essential for a meaningful test.
• b. False, all steps are equally important for the iterative cycle.
• c. False, the “Do” step is most important.
• d. False, the “Act” step is most important.

Answer: b. False, all steps are equally important for the iterative cycle.

38. The RCA module is part of the Patient Care 3 curriculum.

• a. True
• b. False

Answer: a. True

39. A practical way to improve the quality of medication reconciliation is to:

• a. Have the patient list their medications from memory only.
• b. Use multiple sources, such as the patient interview, pharmacy fill history, and previous records.
• c. Copy the medication list from the previous admission without verifying it.
• d. Have the physician do it alone.

Answer: b. Use multiple sources, such as the patient interview, pharmacy fill history, and previous records.

40. A pharmacist’s professional duty includes contributing to the continuous improvement of the healthcare system.

• a. True
• b. False

Answer: a. True

41. Which of the following is a barrier to the practical application of QI?

• a. A culture that supports learning from mistakes.
• b. A culture that punishes individuals for system errors.
• c. Leadership that provides resources for QI projects.
• d. An engaged team.

Answer: b. A culture that punishes individuals for system errors.

42. A practical application of QI in a community setting is offering MTM services to:

• a. Improve patient outcomes and reduce healthcare costs.
• b. Meet Medicare Part D requirements.
• c. Both a and b.
• d. Neither a nor b.

Answer: c. Both a and b.

43. A Pareto chart is a practical QI tool that helps a team to:

• a. Focus their efforts on the “vital few” problems that are causing the majority of the issues.
• b. Track a measure over time.
• c. Brainstorm all possible causes of a problem.
• d. Show the steps in a process.

Answer: a. Focus their efforts on the “vital few” problems that are responsible for the majority of the issues.

44. A practical first step for a pharmacist wanting to start a QI project is to:

• a. Implement a massive, system-wide change.
• b. Collect some baseline data on a process they believe can be improved.
• c. Form a committee of at least 20 people.
• d. Apply for a large research grant.

Answer: b. Collect some baseline data on a process they believe can be improved.

45. Quality improvement can be applied to what aspect of pharmacy practice?

• a. The dispensing process
• b. Clinical services
• c. Patient counseling
• d. All of the above

Answer: d. All of the above

46. A “balancing measure” for a project to decrease antibiotic use for viral infections might be:

• a. The number of antibiotic prescriptions written.
• b. The rate of secondary bacterial infections or hospitalizations for pneumonia.
• c. The cost of antibiotics.
• d. The number of patients diagnosed with a viral infection.

Answer: b. The rate of secondary bacterial infections or hospitalizations for pneumonia.

47. A practical way to improve safety is to standardize processes whenever possible.

• a. True
• b. False

Answer: a. True

48. Collaborating with teams to enhance quality patient care is an objective in the HIPPE course.

• a. True
• b. False

Answer: a. True

49. The ultimate goal of all practical applications to improve quality is to:

• a. Make the pharmacy look good for inspectors.
• b. Improve patient safety, health outcomes, and the efficiency of care.
• c. Reduce the number of staff needed.
• d. Create more policies and procedures.

Answer: b. Improve patient safety, health outcomes, and the efficiency of care.

50. A pharmacist’s mindset should be one of:

• a. Resisting all change.
• b. Believing the current system is perfect.
• c. Continuously seeking opportunities for improvement.
• d. Focusing only on their individual tasks.

Answer: c. Continuously seeking opportunities for improvement.