Practices and Processes of Care Flashcards
1
Q
- 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.
A
- Answer: C
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.
2
Q
- 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.
A
- Answer: B
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.
3
Q
- 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.
A
- Answer: B
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.
4
Q
- 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.
A
- Answer: B
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.
5
Q
- 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.
A
- Answer: D
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.
6
Q
- A patient has been referred to the pharmacist for albuterol inhaler and spacer technique education. Which best
describes the pharmacist’s responsibility as part of pharmaceutical care?
A. Inform the patient’s physician that the patient came to their appointment.
B. Call the patient in 1 week to see if the patient still has albuterol at home.
C. Ensure the patient thoroughly understands the inhaler technique before leaving the visit.
D. Document the interaction in a personal file, should the patient return again.
A
- Answer: C
The pharmacist should involve the patient’s physician and
other health care providers when necessary. Alerting the
referring physician of the patient to the appointment does
not alter or assist in a patient’s drug plan, making Answer
A incorrect. Calling the patient in 1 week just to see if they
still have albuterol on hand does not achieve the goals of
pharmaceutical care, which are to optimize the patient’s
health-related quality of life and achieve positive clinical
outcomes, making Answer B incorrect. Moreover, having
documentation that is kept solely for your own personal
use does not promote interprofessional communication
to benefit the patient, making Answer D incorrect. The
pharmacist’s responsibility is to ensure that the patient,
caregiver, or both have all the necessary supplies, information,
and knowledge to carry out the plan with the patient’s
medication, making Answer C correct.
7
Q
- According to the CMS criteria, which best describes a targeted patient for MTM services?
A. A patient with asthma and an upper respiratory tract infection who is taking tiotropium, albuterol, budesonide/
formoterol, monetlukast, and azithromycin; his medications cost $3995 per year.
B. A patient with diabetes, hypertension, and hyperlipidemia who is taking metformin, lisinopril, and rosuvastatin;
his medications cost $3587 per year.
C. A patient with diabetes and occasional headaches who is taking acetaminophen, insulin glargine, and insulin
lispro; his medications cost $4631 per year.
D. A patient with a kidney transplant and diabetes who is taking metformin, tacrolimus, and mycophenolate; his
medications cost $5129 per year.
A
- Answer: D
The CMS criteria for eligibility of MTM services are as
follows: chronic disease states, multiple medications for
chronic conditions, and Part D drugs costing at least $4696
per year; making Answer D correct and Answers A, B, and
C incorrect.
8
Q
- A 67-year-old woman was referred to the pharmacist by her primary care physician for CMM as part of a patientcentered
medical home (PCMH). Which best qualifies this patient for CMM?
A. Recent admission for an upper respiratory tract infection and taking levofloxacin and albuterol.
B. Hospitalized 8 months ago for atrial fibrillation with rapid ventricular response, for which she is taking aspirin
and metoprolol.
C. Hospitalized twice in the past month, once for chest pain and once for symptomatic anemia.
D. Having uncontrolled hypertension without any admissions in the past year.
A
- Answer: D
Patients qualify for CMM if they have medical conditions
associated with high-cost and multiple medications,
have difficulty reaching goals of therapy, are experiencing
adverse drug events, have difficulty understanding and following
a medication regimen, have high-risk medications
that need to be monitored, or have frequent hospital readmissions,
making Answer D correct and Answers A, B,
and C incorrect.
9
Q
- The pharmacist is setting up a CMM appointment for a newly referred patient. The patient asks if she has to come
into the clinic to talk with the pharmacist. Which most appropriately describes how CMM can be delivered?
A. Face-to-face only
B. Face-to-face and telephonic visit
C. Face-to-face, telephonic, or virtual visit
D. Face-to-face, telephonic, virtual, or written communication
A
- Answer: C
To conduct a CMM visit, communication must be bidirectional;
thus, written forms of communication, such
as sending a letter, are inappropriate, making Answer D
incorrect. However, the visit does not have to be face-toface
only; telephonic and virtual communication are also
acceptable, making Answer C correct and Answers A and
B incorrect. Providers of CMM must be comfortable and
well trained in all means of communication that are specific
to their practice sites.
10
Q
- A pharmacist has created a CDTM plan in agreement with a physician group. Which of the following settings is
most likely to produce successful CDTM?
A. A pharmacist working in a community pharmacy who has access to the patient’s electronic medical record
B. A pharmacist working in the physician group’s clinic who just started and came from industry working with
cancer drugs
C. A pharmacist working in the hospital who sees patients whenever she isn’t busy checking prescriptions
D. A pharmacist working for the college of pharmacy and placed in the general medicine clinic to gain pharmacy
notoriety.
A
- Answer: A
CDTM can be practiced anywhere regardless of place of
service. However, the most successful practice will have
access to the patient’s medical records, knowledge, skills
and ability to perform authorized functions, documents in
the medical records, accountability for quality measures,
ability to be reimbursed for drug therapy management,
and committed time and resources. Answer B is incorrect
because the pharmacists currently may not have the knowledge
or potentially the skills because they just came from
a setting that did not require clinic management of patients
and their knowledge surrounded a particular disease state.
Answer C is incorrect because the pharmacist does not
have devoted time. Answer D is incorrect because not
being considered part of the general medicine clinic may
limit the pharmacist’s ability to bill for services. Answer A
is the best answer because they have access to the patient’s
medical records.
11
Q
- Which would be the best quality measure for evaluating a transition of care service from the inpatient to the
outpatient setting?
A. The number of patients adherent to their medications 1 year after discharge.
B. The number of patients who had medication reconciliation within 30 days after discharge.
C. The number of patients who are knowledgeable about their medications 6 months after discharge.
D. The number of patients who have a medication error during hospitalization
A
- Answer: B
Quality measures reinforce the need for pharmacist participation
during transitions of care. Assessing medication
adherence and knowledge does not directly reflect the outcomes
from the transitions of care service, making Answers
A and C incorrect. The number of patients who had medication
reconciliation within 30 days post-discharge is a
process indicator that a pharmacist can facilitate and a
direct indicator listed by the AHRQ to ensure appropriate
transitions in care, making Answer B correct. Measuring
the number of patients with a medication error during hospitalization
is not beneficial in assessing the quality of the
transitional care service, making Answer D incorrect.
12
Q
- G.H. is an older adult with chronic medical conditions who takes 14 prescription medications. She has had several
hospital and ED admissions this year, and she receives care from a family physician, cardiologist, nephrologist,
and endocrinologist. The medication regimen for treatment of heart failure and diabetes is regularly adjusted by
several providers in many settings. Which strategy is most likely to maintain the accuracy of the medication list
for this patient?
A. Provide pharmacist-led medication reconciliation in the primary care clinic after each hospital discharge.
B. Evaluate the patient’s electronic medical record for all medication changes the providers wanted to take
place.
C. Contact all pharmacies that have filled prescriptions for the patient each time she is seen in the primary care
clinic.
D. Educate her on how to keep an up-to-date medication list and to share it with all health care providers.
A
- Answer: D
Medication reconciliation provided in the primary care
clinic after hospital discharge, regardless of the provider
of the service, has not shown benefit, making Answer A
incorrect. Even if all of the patient’s electronic medical
record and prescription claims data were accessible, she
would still need to explain how the medications are actually
being taken, making Answers B and C incorrect. If
the patient keeps an up-to-date list of medications at all
times, this will probably be the most accurate medication
list available, making Answer D correct.
13
Q
- Your pharmacy is contracted to dispense 340B medications. You have a patient who presents a prescription from
a physician who you know works for the covered entity your pharmacy is contracted with; however, the prescription
is written on a prescription pad from a different facility. Which best describes how the prescription should
be processed?
A. Using 340B medications because the physician works for the covered entity.
B. Using non-340B medications because the physician did not write the prescription while working at the covered
entity.
C. Using 340B medications because the patient receives some of her care at the covered entity.
D. Using non-340B medications because the patient’s insurance is a Medicare Part D plan.
A
ACCP/ASHP 2022 Ambulatory Care Pharmacy Preparatory Review and Recertification Course
613
8. Answer B
To use a 340B medication, the covered entity should be
responsible for the patient’s health care, and care should be
provided and maintained by a health care provider while
working in a 340B-eligible outpatient clinic. Moreover, the
prescription should have originated from a provider while
working in a 340B-eligible outpatient clinic, or it should
be a discharge prescription from a covered entity hospital.
In addition, the patient should not have a Medicaid
or Medicaid managed care plan. Because this prescription
was not written while the physician was working at a
340B-eligible clinic and was thus written on a different prescription
pad, non-340B medications must be used, making
Answer B correct and Answers A, C, and D incorrect.
14
Q
- A community pharmacist overrode a serious drug-drug interaction computer alert involving warfarin; subsequently,
the patient developed a stroke with permanent functional impairment because of the drug interaction. To
support process improvements in the pharmacy, which would be the most appropriate reporting system to use?
A. FDA MedWatch
B. The pharmacy’s internal voluntary reporting system
C. ISMP reporting program
D. FDA Vaccine Adverse Event Reporting System
A
- Answer: B
Answer B is correct because an internal report can be
used by the pharmacy to track and trend errors, facilitating
improvements in processes and systems. Answers A,
C, and D are all external reports, so the pharmacy may
be unaware of the error, limiting internal improvements.
Answer A is also incorrect because the adverse event was
the result of an error rather than an unexpected adverse
effect. Answer D is also incorrect because the incident was
not a non preventable adverse reaction to a vaccine product.
15
Q
- You are a clinical pharmacist in the community setting. Which resource would best prevent adverse drug events
from occurring in your patient population?
A. Monitor the FDA safety communications to identify safety concerns, and collaborate with community physicians
to ensure appropriate prescribing.
B. Submit error reports through the ISMP website.
C. Sign up to receive recall notices from the FDA, and establish a standardized response to class III recalls.
D. Use a standard taxonomy of medication errors based on the level of harm within your pharmacy’s confidential
reporting system.
A
- Answer: A
Answer A is correct because the FDA safety communications
will allow the pharmacist to design a specific plan to
reduce adverse events for specific patients who meet certain
criteria described in the communication. Submitting error
reports to a national organization might raise awareness to
a wider audience, but this would not necessarily facilitate
a direct change within the local practice, making Answer
B incorrect. Establishing a standardized response to class
III recalls would not reduce adverse effects because class
III recalls are unlikely to cause harm, making Answer C
incorrect. Answer D is incorrect because using a standard
taxonomy for medication errors might make it easier
to analyze errors, but it would not reduce adverse effects
without further action.
