Chapter 4 Control Substace Diversion

Question 1

In organization, where controlled substances are used, all staff should be educated about Controlled Substances, Diversion, Prevention program (CSDPP) , including:

Answer 1

Including :
-leadership oversight.
-legal and regulatory requirements.
-Monitoring and surveillance
-Automation and technology.
-Pharmacy controls.

Question 2

It can be defined as any criminal act or deviation that removes a prescription drug from its intended path from manufacturer to the intended patient

Answer 2

Drug diversion

Question 3

Example of common risk ,points, and methods of diversion:

:
-purchase order and packing slip removed from the record.
-Unauthorized individual orders for CS on stolen DEA form 222
-Product container is compromised

Answer 3

1-Procurement

Question 4

2 . Example of common risk points and methods of diversion

— CS replaced by product of similar appearance when packaging
— removing volume from premix infusion.
— multi-dose vial OVERFILL overfilled diverted.
— preparer syringe contents are replaced with saline solution

Answer 4

preparation and dispensing

Question 5

3-examples of common risk points and methods of diversion:

-prescription Pat diverted and forced to obtain CS
-Prescriber self-prescribes CS
-Verbal order for CS credit, but not verified by prescriber
-Written prescriptions altered by patients

Answer 5

3-Prescribing:

Question 6

4-example of common risk points, and method of diversion:

CS is a withdraw from an ADD on discharged or transferred patient
-medication documented as given, but not administered to patient.
-Waste is not adequately witnesses or subsequently diverted.
-Substitute drugs is remote an image search while CS is the diverted

Question 7

5-examples of common risk points and methods of diversion:
— CS waste is removed from unsecure waste containment.
— she is waste in with syringe is replaced with saline
— expired CS are diverted from holding area

Answer 7

5- waste and removal:

Question 8

Opportunity for drug diversion
- 6 ways:

Answer 8

1-failure to waste.
2-wasting entire doses.
3-delayed wasting to facilitate substitution.
4-deliberate removal of a large does the necessarily.
5-Premature replacement up PC eighth and trips.
6-theft from Sharper containers

Question 9

Failure to waste :
3 ways:

Answer 9

1-failure to waste occurs when only a portion of a single use product is necessary to provide. They ordered dose
2-the remainder should be disposed of properly
3-most institutions have procedures in place, such as requiring a “waste buddy” or a second healthcare, professional, that what does this and document in disposal 

Question 10

A coworker or healthcare for Fessional that shows as the second person, and a witness to the destruction or removal of controlled substance wastes

Answer 10

Definition : waste buddy”

Question 11

Opportunity for drug diversion

Answer 11

Theft From sharps containers

Question 12

Which of the following would warrant investigation or civilians related to potential controlled substances diversion ?
A-recognizing the weekend shift is feeling red sharp container beyond recommendation capacity
B-a compounding technician only disposes of hazardous product syringe in yellow sharps container.
C-sharps, container, controlled substance waste, and so we just with tamper-evident tops that have been compromised.
D-none of the above warrant investigation or surveillance 

Answer 12

Answer :
C-sharps, container, controlled substance, waste and syringes with tamper- evident tops that have been compromised

Question 13

5:

1-accessing medication when it is not needed.
2-removing medication for a patient who has already discharge.
3-removing a duplicate dose
4-reusing a fentanyl patch
5-using a colleague’s , locking to access the ADC
1-accessing medication when it is not needed.
2-removing medication for a patient who has already discharge.
3-removing a duplicate dose
4-reusing a fentanyl patch
5-using a colleague’s , locking to access the ADC 1-accessing medication when it is not needed.
2-removing medication for a patient who has already discharge.
3-removing a duplicate dose
4-reusing a fentanyl patch
5-using a colleague’s , locking to access the ADC

Answer 13

Opportunity for job diversion

Question 14

which of the following is an example of drug diversion?
A-were using fentanyl patches because they contain a significant amount of fentanyl after used
B-accessing an automated dispensing cabinet using a coworker passcode.
C-asking a patient’s son if he understands how set a new patches are to be apply and then disposed after 72 hours.
D-both A and B example of drug diversion

Answer 14

Answer:
D- both A & B are example of Drug diversion

Question 15

1-falsifying a verbal or electronic order.
2-tampering or substitution

Answer 15

Opportunities for drug diversion

Question 16

which of the following is a correct statement?
A-evidence suggests that Pharmacist I always ethical and never complicit in drug diversion .
B-only pharmacy technicians have been identified in the diversion of control substances.
C-pharmacist have been played guilty to a crime involving drug diversion.
D-none of the above are accurate statement

Answer 16

Answer.
C-Pharmacist have played guilty to crimes in the truck diversion

Question 17

1-the lead technician removed, morphine sulfate in Hydromorphone hydrochloride from a violent intended for using in mix IV bag.
2-he diluted the vials to hide
his theft
3-he prepared the vast majority of CRXI’s IV bags, which helps safeguard his scheme

Answer 17

Signs of product tampering, and or alteration

Question 18

Which of the following is true?
A-I Pharmacy Technician’s are positioned in area of trust such , that if they are draw a syringe and set is beside a vial of a controlled substance, it is assumed the syringe contains the Contant of the vial of that controlled substances
B-I pharmacist rely on and trust technicians such that the pharmacist Rea has reason to question that the actual indicated product and quantity has been injected into the IV bag to be administered.
C-technicians perform the work, and know that process so well that they know what is necessary to convince a pharmacist, if they have devious intention
D-all of the following accurate statement

Answer 18

Answer.
D-all of the following are accurate statement.

Question 19

Healthcare providers, who still prescription, medicines or controlled substances such as opioids for their own use put patient at risk.
Consequences of tampering with injectable:
This can result in several types of patients harms, including :

Answer 19

1-substandard care delivered by an impaired healthcare provider
2-denial of essential pain medication or therapy.
3-risk of infection (example: with hepatitis C virus or bacterial pathogens)

Question 20

Which of the following is a consequence of tapering with injectable?
A-the injection will sting and leave a purple bum.
B-there are none, so long as the content replaced with tapwater.
C-a patient in my experience paining when it is assumed he or she is receiving an order those of medication.
D-patient may become addicted to the tampered injectable

Answer 20

Answer.
C-a patient in my experience paining it is assumed he has he is receiving an order dose of medication

Question 21

What is drug assay sampling?

Answer 21

Tempering was discovered when an employee of the pharmacy detected irregularities in a certain vials of drug.
— after the tempering was discovered, some of the wild, where analyzed by an independent laboratory and found to be substantial below their labor strength

Question 22

Suspicious practices, techniques and suspicious data patterns:

Answer 22

1-technology designed to prevent drug diversion.
2-read reconciling Tatian of invoice to purchase history report
3-record audits.
4-checklist to verify all paperwork is complete

Question 23

BD Health-Sight, supported by Microsoft, utilize machine learning algorithms and dispensing behaviors, such as overrides, canceled transactions, dispensing, delays, and Mr. medication and waste medication children defy, potential diversion… Looking at multiple signals… Looking for anomalies ( some thing that deviate stand out, not normal or expected)

Answer 23

Technology designed to prevent drug diversion

Question 24

BD health looks for anomalies using :
A-algorithms( process or a set rule to follow in calculation of all the problems. solving operation) that include dispensing behaviors.
B-algorithm that access overrides
c-algorithms that access canceled transactions
D-algorithms that asses waste medications.
E. All of the above are true

Answer 24

Answer
E-All of the above are true

Question 25

It Is leverage machine learning and advanced analytics to detect drug theft across hospitals and a hospital and health system

Answer 25

Definition of Invictis

Question 26

1-inviistics supported by a supplementary grant from the national institutes of health, launched in 2018
2-Invictis leverages machine learning in advance analytics to detect drugs, thelf across hospital and health system
3-by reducing and preventing drug diversion… Healthcare systems can improve patient safety, lower the risk of financial loss and better protect, healthcare worker

Answer 26

Technology designed to prevent drug diversion

Question 27

Is supported by a supplementary grant from national Institute of health, launch in 2018.
It’s also leverage machine learning and advanced analytics to detect drug test across hospital and health system. What is the technology call?

Answer 27

It is INVISTICS

Question 28

By reducing and preventing drug diversion, healthcare system can:

Answer 28

A-improve patient safety.
B-lower the risk of financial loss
C- better protect healthcare workers.
D-all of the above at true

Question 29

Reconciliation of invoices to purchase history reports:

Answer 29

1-separating of duties exists between the ordering and receipt of CS
2-two authorized individuals count and check in CS received and confirm that the orders, invoice, and product-received documentation match
3-at least one of the receivers is licensed. The process is overseen by a licensed pharmacist.

Question 30

What is the call :
“ that is a process to investigate and remedy discrepancy with CSRU seat in the pharmacy from the wholesaler or distributor”

Answer 30

Reconciliation of invoices to purchase history reports

Question 31

What is call when “there is a process to track, reconcile , and audit CS products”?
“ all CS procurement paperwork is reviewed for completion and file according to applicable laws and regulations

Answer 31

Records audits
-checklist to verify all paperwork is complete,

Question 32

Which of the following’s is (are) recommended best practices improvement in records, audit of control services?
A-the duties and responsibilities for ordering and receiving of control substances should be separate.

B-the receiving process should be overseen by a licensed pharmacist.

C-a process should be in place to investigate and resolved any discrepancy identified upon receipt of controlled substances.

D-processes should be in please to talk, reconcile an audit controlled substances products.

E-all of the above I recommended best practices

Answer 32

Answer is E- all of the above and recommended best practices

Question 33

Whenever report indicates suspicious data patterns, a through investigation, utilization technology, such as software program, created to interpret the products and identify potential explanation.
-Record audit should be performed routinely, utilizing software developed to identify suspicious patterns, irregularities and anomalous data.

Answer 33

Suspicious data patterns

Question 34

1-type of fraudulent prescriptions.
2-criteria suggesting prescription not issues for legitimate medical purpose.
3-characteristic of fraudulent prescriptions
4-prevention techniques

Diversion control divisions is from US department of justice and DEA
drug enforcement administration

Answer 34

Signs of an methods to detect fraudulent prescriptions

Question 35

-legitimate prescription pat as stolen from physician office and prescription a written for fictitious patient.
-Some patience, in an effort to obtain additional amount of legitimately prescribed drugs,
alter the physician prescriptions

Answer 35

Types of fraudulent prescriptions

Question 36

— patient appears present in prescriptions written in the name of the other people.
— a number of people appear simultaneously, or within a short time, or a very similar prescription from the same physician.
— numbers, “strangers”, people who are not, regular patrons, or resident of all community, so only show up with a prescription, but I sent position

Answer 36

— criteria suggestion prescription that issue for a legitimate medical purpose

Question 37

-prescription looks too good; the prescriber’s handwriting is too legible.
-Quantity, direction or dosage difference from usual medical usage. -Prescription does not comply with the acceptable standard abbreviation or appear to be textbook presentations.
-Prescription appears to be photocopied
-Direction written in full with no abbreviations
-Prescription written in different color of ink, or written in different handwriting

-

Answer 37

-
Characteristics of fraudulent prescriptions

Question 38

-know the prescriber and his or her signature.
-know the prescriber’s DEA registration number;
-know the patient, and
-check the date on the prescription order
—— has it been present it to you in a reasonable’s length of time since the prescriber wrote it?

Answer 38

Prevention techniques

Question 39

Which of the following exemplifies control such a diversion in waste removal?
A-the controlled substance waste in a syringe is replaced by normal saline.
B-the remaining controlled substance content of a single use vial are removed and replaced with sterile water.
C-expired control substances with moved from the holding area.
D-all of a those are example of CS divertion in waste removal

Answer 39

Answer: D-all of those example of CSD diversion in waste or removal.