Practice and Processes Flashcards
A 77-year-old man is referred to the pharmacy for medication therapy management (MTM) under Medicare Part D. Which best describes why the patient is eligible for MTM under Medicare Part D?
A. He pays at least $4376 per year for his Part D covered medications, has at least one chronic disease
state, and takes one medication.
B. He pays at least $3996 per year for his Part D covered medications, has at least four chronic disease
states, and takes two medications.
C. He pays at least $4696 per year for his Part D covered medications, has at least two chronic disease
states, and takes three medications.
D. He pays at least $4044 per year for his Part D
covered medications, has at least three chronic
disease states, and takes four medications.
According to CMS’s definition for 2022, the criteria for
eligibility of MTM services encompass multiple chronic
disease states, multiple Part D–covered medications, and
Part D drug costs of at least $4696 per year and/or are
at-risk beneficiaries under the plan’s drug management
program, making Answer C correct and Answers A, B,
and D incorrect.
Correct Answer: C
A 64-year-old man is referred to the pharmacist by
his provider for management of uncontrolled diabetes as dictated by the established collaborative drug
therapy management (CDTM) agreement. Which best
describes the pharmacist’s general scope of practice
under a CDTM agreement?
A. Diagnose the patient with peripheral neuropathy,
and initiate gabapentin.
B. Discontinue the patient’s glyburide, and initiate
glargine.
C. Order and obtain the patient’s chemistries and A1C.
D. Order continuous positive airway pressure
(CPAP) machine for the patient’s obstructive
sleep apnea.
The pharmacist’s responsibilities under the CDTM agreement can include initiating, modifying, and discontinuing medications; ordering and interpreting laboratory values; and assessing and providing patient education, depending on the individual practice act covering the state of practice. Furthermore, a pharmacist can place a referral as necessary to improve patient care. The physician is responsible
for determining the illness diagnosis; therefore, Answer A is incorrect. Answer C is incorrect; whereas the CDTM agreement allows for ordering labs, it does not have a provision for drawing the actual lab. Answer D is incorrect because sleep apnea is outside the scope of the CDTM agreement. Discontinuing and initiating a medication for diabetes management is in the scope of the CDTM, making Answer B correct.
Correct Answer: B
A 57-year-old woman has an anticipated hospital
discharge for tomorrow. She was admitted because
of a mild asthma exacerbation requiring steroids and
nebulizer treatments. Which best describes how a pharmacist could improve the patient’s transition of care?
A. Scheduling the patient for a comprehensive
medication review (CMR) in 3 months with the
pharmacist.
B. Completing medication reconciliation for the
patient on hospital admission and discharge.
C. Providing recommendations to the inpatient team
on outpatient pharmacies that will deliver the
patient’s medications to her home.
D. Conducting an Asthma Control Test with the
patient at a follow-up visit in the clinic.
To ensure a safe and effective transition for the patient,
it is important to facilitate a detailed, timely, and thorough handoff from the inpatient to the outpatient setting. Therefore, scheduling the CMR 3 months later may not be as beneficial as scheduling it within 14 days of discharge, making Answer A incorrect. To ensure a smooth transition for the patient, a thorough medication reconciliation must be completed at each transition, whether from the outpatient to inpatient setting or vice versa, and a discharge plan should be communicated to the outpatient provider verbally
or in writing, making Answer B correct. Providing recommendations to the inpatient team on pharmacies located in the area may not be beneficial to patients, depending on where they live, and the pharmacy should be tailored to the patient’s preference, making Answer C incorrect. Conducting an Asthma Control Test at a follow-up visit will not assist in transitioning the patient to the outpatient setting, making Answer D incorrect.
Correct Answer: B
Which method of medication safety analysis is best for
prospectively identifying the risk of error in a process and for estimating the likelihood of a process failure?
A. Root cause analysis.
B. Failure modes and effects analysis.
C. Safety culture assessment.
D. Analysis of medication error trends
Failure modes and effects analysis is useful for identifying potential failures to a new system or process before it is implemented, allowing safety measures to be put in place to prevent those failures or minimize their risks, making Answer B correct. Root-cause analysis is a structured retrospective method used to analyze serious adverse events, and system and process improvements are typically identified, making Answer A incorrect. Safety culture assessment facilitates the identification of problems within
the culture of an organization that may not foster a safety culture, but it is not used to analyze processes, making Answer C incorrect. Analysis of medication error trends is not a prospective method, making Answer D incorrect.
Correct Answer: B
A pharmacist who is a member of the organization’s
pharmacy and therapeutics (P&T) committee needs
to determine whether a new drug that came to market
should be placed on the drug formulary. Which best
depicts what the pharmacist should consider before
recommending that the drug be placed on formulary?
A. Ease of preparation, cost-effectiveness, time on
the market.
B. Adherence, manufacturer, variety of dosage forms.
C. Storage requirements, somnolence potential,
convenience.
D. Safety, physician demand, efficacy.
There are several aspects that a P&T committee may evaluate, typically both the clinical and financial impacts that could provide value. These could include dosage forms of the medication, volume of use, convenience, dosing schedule, adherence, abuse potential, provider demand, and storage requirements. Making Answer D correct and Answers A, B and C incorrect.
Correct Answer: D
A private primary care practice wants to improve healthcare effectiveness data and information set (hedis) measures for vaccination rates and patients who are 65 and older. How should a pharmacist in this practice identify patients that may require a pneumococcal vaccination?
A. Run a report of all patients in the practice with Medicare coverage
B. Running reportable patients in the practices electronic database who are 65 years of age and older
C. Screen each new geriatric patient for vaccination history by patient self-report during appointment check-in
D. Obtain Health claims data from the third party administrator regarding pneumococcal vaccination claims for the practice
B. Run a report of all patients in the practices electronic database for 65 years of age and older
