NPS Medication Safety Quiz (Assessment Task 1)

Question 1

True or False: Medication errors are most likely to occur when the medication is first prescribed.

Answer 1

False

Question 2

From the following list of medication errors choose those where the source of the mistake can be clearly identified.

(One answer)

• A patient received a dose of medication from a mis-labelled box.
• An administration rate was calculated using drops/hour instead of drops/minute
• A patient receiving a high-risk medication was not adequately monitored for potential adverse events
• A drug dose was charted as 3 mg IM instead of 0.3 mg IM
• None of the above

Answer 2

• None of the above

Question 3

Which professionals are responsible for medication safety?

(One answer)

• Pharmacists
• Prescribing doctor
• All of the above
• Nurses

Answer 3

• All of the above

Question 4

True or False: According to an Australian study, most prescribing errors can be traced back to one major mistake made by a single individual.

Answer 4

False

Question 5

Medication errors are a major problem in Australian hospitals. When they occur, it is important to identify, report and learn from them and avoid placing the blame on one individual.

Why should we avoid blame?

(One answer)

• Making errors is all part of learning on the job
• It increases the risk of legal action
• It increases the chance that the patient will find out about the error
• It is likely that many different factors contributed to the error

Answer 5

• It is likely that many different factors contributed to the error

Question 6

You see that a medication has been prescribed at a dose that may be causing harm to the patient. You act at once to alert the prescriber to ensure that the dose on the chart is changed.

Do you need to report the error?

(One answer)

• Yes, but only if it results in serious harm or death.
• No, errors should be reported by the person responsible for them
• Yes, report all medication errors in accordance with your hospital’s incident reporting system guidelines
• No, it was most likely corrected before serious harm was done

Answer 6

• Yes, report all medication errors in accordance with your hospital’s incident reporting system guidelines

Question 7

When a medication error results in patient harm, the patient and/or their family should…

(One answer)

• None of the above
• Be sent the incident report for further comment
• Be officially notified in writing after the patient is discharged
• Be informed of the incidence during open discussions that allow information to be exchanged

Answer 7

• Be informed of the incidence during open discussions that allow information to be exchanged

Question 8

All health professionals play an important role in making medication use safe for their patients and preventing medication errors.

Which of the actions below help make medication use safer for patients?

(Select all that apply)

• Report and learn from medication errors and near misses
• Be aware of medications with a high risk of adverse events
• Write clearly and legibly
• Keep staff communication to a minimum to avoid distractions
• When prescribing a drug, trust that the pharmacist will identify any potential drug interactions
• Obtain a complete medication history at the point of prescribing
• Check and double-check medications before administration

Answer 8

• Report and learn from medication errors and near misses
• Be aware of medications with a high risk of adverse events
• Write clearly and legibly
• Obtain a complete medication history at the point of prescribing
• Check and double-check medications before administration

Question 9

True or False: Medication errors are most likely to occur when the medication is first prescribed.

Answer 9

False

Question 10

After the drug is administered, monitoring the patient’s response to the medication is the responsibility of

(One answer)

• the patient
• the nurse on duty
• the prescribing doctor
• all health care professionals involved in patient’s care

Answer 10

• all health care professionals involved in patient’s care

Question 11

You hear that a patient on another ward was mistakenly given a dose of fluvoxamine instead of the intended medication, fluoxetine.

Who was most likely to blame?

(One answer)

• The ward pharmacist
• The prescribing doctor
• The nurse who administered the dose
• It’s not clear

Answer 11

• It’s not clear

Question 12

What is the most common type of medication error that occurs during hospital admission?

(One answer)

• Omission of a required medication
• Underdose
• Overdose
• Medication given to the wrong patient
• Medication given by the wrong route

Answer 12

• Omission of a required medication

Rationale: A review of medication safety studies conducted in Australian hospitals has shown that omission of therapy was the most common type of medication error, accounting for 40%–60% of errors. Errors in medication histories recorded at admission were highest in hospitals where medication reconciliation was not undertaken.

Question 13

When do you think medication errors can occur?

(Select all that apply)

• At the time of admission to hospital
• When prescriptions are written
• When medicines are administered
• At the time of discharge
• After discharge from hospital

Answer 13

• At the time of admission to hospital
• When prescriptions are written
• When medicines are administered
• At the time of discharge
• After discharge from hospital

Question 14

When determining an appropriate dose for the patient, there are many factors that need to be taken into consideration. Which of the following should be considered?

(Select all that apply)

• age
• weight
• co-morbidities
• renal and liver function
• current clinical state
• current observations
• indication for the drug
• route of administration

Answer 14

• age
• weight
• co-morbidities
• renal and liver function
• current clinical state
• current observations
• indication for the drug
• route of administration

Rationale: This means that to ensure patient safety every dose prescribed should be individualised. Reference sources should be used to ensure that appropriate dose adjustments are made according to the patient’s unique parameters. Suitable reference sources include MIMS, the Australian Medicines Handbook (AMH), the Therapeutic Guidelines and, when prescribing for children, the Royal Children’s Hospital Melbourne Paediatric Pharmacopoeia.

Pharmacists play an important role in checking that doses are acceptable according to the patient’s parameters and can assist with selection of an appropriate dose in complex cases.

Nurses have a responsibility to double check that an appropriate dose has been prescribed before administering any medication to the patient.

Question 15

Mr Jones is currently prescribed 2.5 mg doses of intravenous morphine for pain relief as required. He is now able to take oral medications and you have been asked to switch his medicine to oral morphine. (This is the only opioid he is receiving). The bioavailability of oral morphine is approximately 30%.

Which of the available doses of oral (tablet) morphine below would provide Mr Jones with approximately the same effect as his IV dose?

(One answer)

• 2.5 mg
• 5 mg
• 7.5 mg
• 75mg

Answer 15

• 7.5 mg

Rationale: The available dose of oral (tablet) morphine required to achieve approximately the same effect is 7.5 mg. The bioavailability of oral morphine is 30%, hence we expect only about a third (1/3) of the oral dose to be absorbed into the bloodstream.

In this setting, the oral dose of morphine needs to be three times the IV dose to have the same effect.

Question 16

What is an intravenous route?

Answer 16

An intravenous route is one route of administration whereby medication is administered into the veins and therefore goes directly into the systemic circulation.

Question 17

What is ‘bioavailability’?

Answer 17

The amount of active drug that ends up in the systemic circulation is known as the ‘bioavailability’.

Question 18

What is the bioavailability percentage rate when medication is administered via the intravenous route and why?

Answer 18

Medications have 100% bioavailability when administered via the intravenous route because they go directly into the systemic circulation.

Question 19

Why doesn’t oral medication have the same bioavailability as medication administered the intravenous route?

Answer 19

Oral medications must first be absorbed from the gastrointestinal tract before it reaches the systemic circulation.

Question 20

What is the bioavailability of oral medication and why?

Answer 20

The bioavailability of every oral medication is different, but most will have a bioavailability of less than 100%. Products with a lower bioavailability require a higher oral dose to achieve the same therapeutic effect.

Question 21

Prednisolone is listed on a patient’s electronic medication display as follows:

‘prednisolone – oral – dose 5.0 mg – once a day in the morning – after food’

The dose area provides an example of _____________? This should be avoided as it increases the risk of a wrong dose error.

• a leading zero
• an overdose
• a trailing zero

Answer 21

• a trailing zero

Rationale: In this case, the use of the trailing zero (a decimal point followed by a zero) increases the risk that the directions could be misread as 50 mg, which is 10-times the intended dose.

The dose should be displayed as follows:

‘prednisolone – oral – dose 5 mg – once a day in the morning – after food’

Question 22

What are the four patient identifiers that must be used to ensure the medication is given to the right patient?

Answer 22

Generally it is the patient’s name, medical record number and date of birth. Allergies/adverse drug reactions (ADRs) must also be confirmed.

Question 23

What steps can you take to prevent errors when using electronic medication management systems?

(Select all that apply)

• Ensuring you have been trained in your hospital’s computer system.
• Practicing using the system.
• Knowing how to access technical support.
• Relying on system alerts to notify you of medication errors.
• Communicating with other staff when there is a need for workarounds so that potential solutions can be identified.

Answer 23

• Ensuring you have been trained in your hospital’s computer system.
• Practicing using the system.
• Knowing how to access technical support.
• Communicating with other staff when there is a need for workarounds so that potential solutions can be identified.

Question 24

Which statement is FALSE regarding medication administration errors?

(One answer)

• Administration errors include errors in timing, dosage, and route of administration.
• Electronic prescribing prevents administration errors.
• Interruptions or distractions to nurses can lead to administration errors.
• Certain abbreviations can lead to administration errors.
• Failing to check the patient’s identification against the medication can lead to administration errors.

Answer 24

• Electronic prescribing prevents administration errors.

Question 25

You should never make assumptions when interpreting what a patient has said when it comes to identifying the medications they take. Any uncertainties should always be clarified.

What sources could you use to clarify a patient’s medication history?

(Select all that apply)

• The patient’s GP
• The patient’s community pharmacist
• The patient’s own medications
• The patient’s carer or family members
• Information from previous admissions
• The patient’s medication list

Answer 25

• The patient’s GP
• The patient’s community pharmacist
• The patient’s own medications
• The patient’s carer or family members
• Information from previous admissions
• The patient’s medication list

Question 26

Which of the following are possible causes of wrong drug errors?

(Select all that apply)

• Drug name confusion
• Look-alike drug names
• Sound-alike drug names
• Product selection errors

Answer 26

• Drug name confusion
• Look-alike drug names
• Sound-alike drug names
• Product selection errors

Question 27

What steps can you take to prevent look-alike drug errors from occurring?

(Select all that apply)

• Ensure the order is legible
• Clarify the order with the prescriber
• Prescribe by brand name
• Include the indication for using the drug

Answer 27

• Ensure the order is legible
• Clarify the order with the prescriber
• Include the indication for using the drug

Question 28

Which of the following is TRUE regarding Tall Man lettering?

(One answer)

• It helps make look-alike drug names more distinguishable
• Its use is likely to decrease as electronic systems become more common
• It is designed for use in handwritten prescriptions
• It capitalises the the first 5 letters of look-alike drug names to make them more distinguishable

Answer 28

• It helps make look-alike drug names more distinguishable

Rationale: True. Tall Man lettering uses a combination of lower- and upper-case letters to highlight the differences between look-alike drug names, helping to make them more easily distinguishable.

Question 29

Which of the following are TRUE regarding sound-alike errors?

(Select all that apply)

• Medications that sound-alike also always look-alike when written down
• Sound-alike errors may be caused by confirmation bias (ie, hearing what we are familiar with rather than what is actually being said)
• Asking the patient is the best way to clarify which medication to prescribe
• The patient’s carer or family can be consulted to clarify their medication history

Answer 29

• Sound-alike errors may be caused by confirmation bias (ie, hearing what we are familiar with rather than what is actually being said)
• The patient’s carer or family can be consulted to clarify their medication history

Question 30

Which of the following is FALSE regarding ways to prevent product selection errors from occurring?

(One answer)

• Store similar looking products near each other on shelves and in storage areas
• Use individual bedside medication lockers
• Use barcode scanning technology
• Recheck prepared products after they have been selected and prepared

Answer 30

• Store similar looking products near each other on shelves and in storage areas

Question 31

From the list choose the routes by which fentanyl may be given.

(Select all that apply)

• Transmucosal
• Intravenous
• Transdermal
• Intramuscular
• Epidural
• Rectal
• Intradermal

Answer 31

• Transmucosal
• Intravenous
• Transdermal
• Intramuscular
• Epidural

Question 32

Any product administered into a patient’s veins must be:

(Select all that apply)

• colourless
• particle free
• sterile

Answer 32

• particle free
• sterile

Rationale: Some solutions for intravenous use are coloured though, the colour of a liquid cannot be used to determine the route of administration.

Question 33

We have identified that it is unsafe to give an oral formulation intravenously, but can you safely give an intravenous formulation via the oral route?

• Yes
• No

Answer 33

• Yes

Rationale: Occasionally an intravenous preparation may be used to provide an oral/enteral dose of medication. This is only necessary if there is no commercially available oral product that meets the needs of the particular situation. For example if:

• no oral liquid is available
• the tablet form cannot be crushed
• the dose required cannot be obtained from a whole tablet or portion of a tablet.

Note: where possible the dose should be changed to accommodate use of an oral formulation.

Question 34

True or False: To avoid inadvertent intrathecal administration, in adults, vincristine must always be administered in a minibag not a syringe.

Answer 34

• True

Rationale: Use of a minibag aims to ‘design out the error’ by preventing connection to a spinal needle.

Question 35

True or False: Intravenous medications should be packaged, transported and stored separately from medicines to be administered intrathecally.

Answer 35

• True

Question 36

What is one way to distinguish between ‘Eye’ and ‘Ear’ medication?

Answer 36

By identifying the medical terms for both medication:

• Optic = Eyes
• Otic = Ears

Question 37

A 30-year-old man has been admitted to the hospital. His current medications include Medication A, which can be administered via oral, intramuscular, and intradermal routes, and Medication B, which can be administered via oral, intravenous, intranasal, and subcutaneous routes. Which medication has a higher potential for error?

• Medication A
• Medication B
• Both Medication A and B have similar potential for error
• It is impossible to say with the information provided.

Answer 37

• Medication B

Rationale: Medication B has a higher probability for error as it lists four different routes of administration compared to three different routes noted for medication A. Medications with more administration options have a higher chance for error.

Question 38

Which of the following statements are TRUE regarding the ACSQHC guidelines for the labelling of lines?

(Select all that apply)

• All lines other than those whose primary purpose is not for medicine administration must be identifiable.
• The route of administration must be identified on all administration lines.
• The label should be placed near the container on the patient side.
• The date and time that the line was commenced should be documented on the label.

Answer 38

• The route of administration must be identified on all administration lines.
• The date and time that the line was commenced should be documented on the label.

Question 39

Which of the following statements reflect steps you can take to prevent wrong route errors from occurring in your workplace?

(Select all that apply)

• Regular medications should always be prescribed in the regular section of the chart.
• To avoid medications being given by the wrong route, the intended route should be clearly stated using common abbreviations, such as SC, IT and IVI.
• Medications should never be administered from an incomplete prescription.
• When prescribing liquid medications, the dose should always be specified in millilitres, not milligrams or micrograms.

Answer 39

• Regular medications should always be prescribed in the regular section of the chart.
• Medications should never be administered from an incomplete prescription.

Question 40

Which of the following is FALSE regarding reasons that oral medications are not suitable for intravenous use?

(One answer)

• Oral formulations may have extremes of pH and are not isotonic.
• Oral medications may have large undissolved particles of drug and excipients (inactive ingredients) which can cause emboli to form in the patient.
• Oral medications are often smaller doses than those required for intravenous administration.
• Oral medications are not sterile and can therefore cause sepsis if given intravenously.

Answer 40

• Oral medications are often smaller doses than those required for intravenous administration.

Rationale: When a medication is given orally only part of the dose may reach the bloodstream. When given intravenously the whole dose enters into the bloodstream. For this reason oral doses are often larger than intravenous doses.

Question 41

Which of the following statements reflect steps that may be taken to ensure the safe administration of intrathecal medications.

(Select all that apply)

• Intrathecal medications should only ever be administered in highly specialised areas under sterile conditions.
• Intrathecal medication should only be administered by highly trained, competent professionals.
• All intrathecal medications should be checked using formal checking procedures before administration to the patient.
• A single staff member should check the patient identifiers, drug, dose, volume, route and rate and verify these against the medication order immediately prior to administration.

Answer 41

• Intrathecal medications should only ever be administered in highly specialised areas under sterile conditions.
• Intrathecal medication should only be administered by highly trained, competent professionals.
• All intrathecal medications should be checked using formal checking procedures before administration to the patient.

Question 42

Your patient requires a dose of digoxin 375 micrograms immediately for atrial tachycardia.

The ampoules available to you contain digoxin 500 microg/2 mL.

Volume (mL) = Dose / strength per mL

Calculate how much drug is contained in 1 mL (this gives the strength of the ampoules in microg/mL).

Answer 42

250 microg/mL

Rationale: 500 microg ÷ 2ml = 250 microg/mL.

The ampoules contain 250 microg digoxin in 1 mL of solution.

Question 43

Your patient requires a dose of digoxin 375 micrograms immediately for atrial tachycardia.

The ampoules available to you contain digoxin 500 microg/2 mL.

You have worked out that the ampoules contain 250 microg digoxin in 1 mL of solution.

Volume (mL) = Dose / strength per mL

Now calculate the volume required to give the 375 microgram dose.

Answer 43

1.5 mL

Rationale: Dose / strength per mL = Volume (mL)

375 microg ÷ 250 microg/mL = 1.5 mL

Question 44

True or False: Usually only part of an oral dose reaches the general circulation.

Answer 44

• True

Rationale: With oral dosing usually only part of the dose reaches the bloodstream and has an effect. Some of the drug may be destroyed by enzymes in the gastro-intestinal tract, some will not pass through the gut wall into the blood and some may be metabolised in the liver before it reaches the general circulation (known as “first pass metabolism”). However, with IV dosing the entire dose is immediately available in the bloodstream so the entire dose has an effect. The amount of drug reaching the general circulation is known as the bioavailability. Drugs with a low oral bioavailability include beta-blockers and some opioids. The IV doses of these drugs are much more potent than oral doses of the same drug.

Question 45

True or False: If a drug has a low bioavailability the oral dose needed to achieve the desired effect will be lower than the IV dose.

Answer 45

• False

Rationale: When a drug has a low bioavailability not all of the dose reaches the bloodstream when the drug is given orally. Therefore a higher dose is needed compared with the dose for IV use.

For example:

The bioavailability of oral ranitidine is approximately 60%.

The usual IV dose for adults is 50 mg TDS (total daily dose 150 mg).

The equivalent oral dose is 150 mg BD (total daily dose 300 mg).

Question 46

True or False: If a dose intended for oral use is administered intravenously the patient may receive an overdose.

Answer 46

• True

Rationale: The oral dose may be higher than the dose needed IV, to compensate for the proportion of drug that does not reach the circulation. If the higher oral dose is inadvertently given IV, the higher dose may cause adverse effects.

For example, if a patient were given 150 mg ranitidine IV, this would be 3 times the normal IV dose. The patient is likely to suffer from adverse effects, such as confusion, agitation and hallucinations.

Question 47

True or False: The duration of action of a drug may be different for different routes of administration.

Answer 47

• True

Rationale: With IV administration the drug enters the circulation immediately but also starts to be excreted from the body almost straight away. With oral dosing the drug takes more time to enter the circulation with a corresponding delay in elimination. This means that sometimes the frequency of dosing is also different for IV and oral dosing.

This explains why ranitidine is given TWICE DAILY for oral dosing, but THREE TIMES A DAY for IV dosing.

Question 48

What is an example of a ‘trailing zero’?

Answer 48

5.0 mg misread as 50 mg.

Question 49

What is an example of ‘omission of a leading zero’?

Answer 49

.5 mg read as 5 mg instead of 0.5 mg.

Question 50

What is an example of ‘use of error-prone abbreviations’?

Answer 50

“u” for units read as a zero resulting in 10 times overdose; µg read as mg or nanograms.

Question 51

What is an example of ‘misheard numbers for verbal orders’?

Answer 51

15 mg heard as 50 mg.

Question 52

What is an example of ‘incomplete or unclear orders’?

Answer 52

“1 ampoule” when ampoules may be available in different strengths.

Question 53

Which problems do you think occur as a result of a chemical reaction?

(Select all that apply)

• Precipitation of solid particles which can block lines and cause emboli in the patient
• Reduced potency of the drug (s) involved
• Formation of new substances which may be toxic to the patient

Answer 53

• Precipitation of solid particles which can block lines and cause emboli in the patient
• Reduced potency of the drug (s) involved
• Formation of new substances which may be toxic to the patient

Question 54

A dose of 200 mg IV ampicillin is required for a child. The product available in the hospital is Ampicyn 1 gram. The ampicillin powder in the vial has a displacement value of 0.7 mL.

If 10 mL water for injection is added to the vial, what would the resultant volume be?

Answer 54

10.7mL

Rationale: If 10 mL of water was added the resultant volume would be 10.7 mL (10 mL water + 0.7 mL powder). This would make it very difficult to accurately calculate the volume required to give a 200 mg dose.

Question 55

A dose of 200 mg IV ampicillin is required for a child. The product available in the hospital is Ampicyn 1 gram. The ampicillin powder in the vial has a displacement value of 0.7 mL.

What volume of water should be added to the vial make a total volume of 10 mL?

Answer 55

9.3mL

Rationale: By adding 9.3 mL the resulting volume is 10 mL (9.3 mL water + 0.7 mL powder).

This gives a final concentration of 1 gram in 10 mL or 100 mg/mL. For a dose of 200 mg the required volume is exactly 2 mL.

Question 56

What should you do to ensure even mixing when adding any drug to an infusion bag?

(One answer)

• give the bag a vigorous shake
• gently turn the bag upside down several times
• throw the bag in the air a few times
• leave the bag lying on the bench for 10 minutes

Answer 56

• gently turn the bag upside down several times.

Rationale: To ensure even mixing when adding any drug to an infusion bag or bottle, ensure the container is turned upside down several times before use. Infusion bags should not be shaken or thrown in the air to mix as this can result in bubbles in the solution which can potentially cause air emboli.

Question 57

Which of the following reflects a reason that errors occur when medications are administered intravenously?

(One answer)

• IV therapy is a complex process and requires a high degree of practitioner expertise and skill.
• There are several opportunities for error when prescribing and administering IV drugs including the calculation of dose, volume, concentration, and infusion rate.
• Administration can involve complex technologies such as infusion pumps and syringe drivers.
• Patients requiring IV medications are often acutely unwell and have challenging clinical needs.
• Many high-risk drugs are given by the IV route, for example, opiates, heparin, and chemotherapy agents.
• All of the above.

Answer 57

• All of the above.

Question 58

Which of the following statements are TRUE regarding potential risks associated with IV dosing?

(One answer)

• Since most IV products are available in multiple strengths, calculation of the required volume can be complex.
• IV doses should be tailored to a patient based on body weight alone.
• Inaccurate calculation of the volume for administration contributes to many dosing errors.

Answer 58

• Inaccurate calculation of the volume for administration contributes to many dosing errors.

Question 59

Which one of the following statements regarding IV dosing is true?

(One answer)

• Only part of an IV dose typically reaches the general circulation and has an effect.
• If a dose intended for oral use is administered intravenously the patient may receive an underdose.
• The duration of action of a drug may be different for different routes of administration.
• If a drug has a low bioavailability the oral dose needed to achieve the desired effect will be lower than the IV dose.

Answer 59

• The duration of action of a drug may be different for different routes of administration.

Rationale: This statement is true. With IV administration the drug enters the circulation immediately but also starts to be excreted from the body almost straight away. With oral dosing the drug takes more time to enter the circulation with a corresponding delay in elimination. This means that sometimes the frequency of dosing is also different for IV and oral dosing.

Question 60

Which of the following is FALSE regarding the ACQSHC Labelling Recommendations for User-applied Labelling of Injectable Medicines, Fluids and Lines?

(One answer)

• All medicines and fluids removed from the manufacturers’ or hospital pharmacy’s original packaging must be identifiable.
• All containers (e.g. bags, syringes), containing medicines leaving the hands of the person preparing the medicine, must be labelled.
• For patients receiving multiple medications, the preparation and labelling of medications should occur in tandem to avoid written errors from occurring.
• Any medicine or fluid that cannot be identified (e.g. in an unlabelled syringe or other container) should be considered unsafe and discarded.

Answer 60

• For patients receiving multiple medications, the preparation and labelling of medications should occur in tandem to avoid written errors from occurring.

Question 61

Which of the following reflect steps you can take to reduce the risk of error associated with intravenous therapy?

(Select all that apply)

• The IV route should only be used when other, less invasive, less risky routes are not considered suitable.
• All lines must be identified with a label to indicate the route of that line.
• The use of a burette, rather than an infusion pump, is recommended for administration of large volumes.
• Any unused portions of reconstituted vials should be stored for administration to the same patient only.
• Lines should be flushed with a compatible fluid before and after giving intravenous medications.

Answer 61

• The IV route should only be used when other, less invasive, less risky routes are not considered suitable.
• All lines must be identified with a label to indicate the route of that line.
• Lines should be flushed with a compatible fluid before and after giving intravenous medications.

Question 62

Complete the sentences below:

For short-acting products _______ doses are given _________.

For controlled-release formulations _______ doses are given __________.

• large
• small
• less often.
• more often.

Answer 62

For short-acting products small doses are given more often.

For controlled-release formulations large doses are given less often.

Question 63

What are some abbreviations that are used to indicate if a product is a controlled-release formulation?

(Select all that apply)

• MR
• ED
• DS
• LA
• XL
• CR
• EC
• XR
• CD
• ER

Answer 63

• MR = Modified Release (used for gliclazide eg, Diamicron MR).
• LA = Long Acting (used for methylphenidate eg, Ritalin LA).
• XL = Extended Release (used for nifedipine eg, Adefin XL, metoprolol succinate eg, Toprol XL).
• CR = Controlled-Release (used for carbamazepine eg, Tegretol CR).
• XR = Extended Release (used for nifedipine eg, Addos XR, metformin eg, Diaformin XR and Diabex XR, venlafaxine eg, Efexor XR, quetiapine eg, Seroquel XR).
• CD = Controlled Delivery (used for diltiazem eg, Cardizem CD and Vasocardol CD).
• ER = Extended Release (used for felodipine eg, Plendil ER and Felodur ER).

Question 64

Which are some tablets or capsules should not be crushed or chewed?

(Select all that apply)

• Controlled-release formulations
• Enteric-coated (EC) tablets
• Cytotoxics or teratogens
• Sublingual or buccal tablets

Answer 64

• Controlled-release formulations
• Enteric-coated (EC) tablets
• Cytotoxics or teratogens
• Sublingual or buccal tablets

Question 65

In the initial instance, the incorrect administration of a short-acting formulation, instead of a controlled-release formulation, will most likely result in:

(One answer)

• Reduced therapeutic effect
• Toxicity
• Deterioration of the patient’s symptoms
• No significant therapeutic or adverse effect

Answer 65

• Toxicity

Rationale: This statement is true. In the initial instance, administration of the short acting formulation will result in toxicity as a large dose will rapidly enter the bloodstream, resulting in a high concentration of drug in the blood.

Question 66

Which of the following statements are TRUE?

(Select all that apply)

• Similar packaging and names are often used for immediate- and controlled-release formulations.
• Terminology and abbreviations used for controlled-release preparations are inconsistent.
• There are multiple abbreviations used for controlled-release medications, including ED, DS and EC.
• Hospital pharmacies usually only stock a limited range of combination products.
• There are several formulation types that should not be crushed or chewed.

Answer 66

• Similar packaging and names are often used for immediate- and controlled-release formulations.
• Terminology and abbreviations used for controlled-release preparations are inconsistent.
• Hospital pharmacies usually only stock a limited range of combination products.
• There are several formulation types that should not be crushed or chewed.

Question 67

You can be sure that a medicine is safe to crush or chew if:

(One answer)

• It is an immediate-release formulation.
• It is a sub-lingual or buccal tablet.
• It has an enteric coating.
• You have checked the product information carefully in a reliable source such as MIMS or medicines.org.au.

Answer 67

• You have checked the product information carefully in a reliable source such as MIMS or medicines.org.au.

Question 68

Which of the following statements is TRUE regarding the safe prescribing of oral liquid medications?

(One answer)

• Liquid medications should be prescribed by volume.
• The volume should be calculated by the prescriber.
• To calculate the volume of drug to administer, it is useful to first work out the amount of drug in one (1) mL.
• Product concentration is always expressed as weight per 10 mL.

Answer 68

• To calculate the volume of drug to administer, it is useful to first work out the amount of drug in one (1) mL.

Question 69

Which of the following statements about transdermal patches are true?

(Select all that apply)

• If the patch is a combination product that is not available, the individual components should be written as separate prescriptions.
• In general, if the patch is a combination product, it should be prescribed using the brand name to ensure the patient receives a consistent dose strength.
• Application of a heat source such as a heat pack or a hot bath, is recommended to improve the efficacy of a transdermal patch.
• Safe disposal of used transdermal patches is essential because a significant amount of the drug remains in the patch after the intended application period has expired.

Answer 69

• If the patch is a combination product that is not available, the individual components should be written as separate prescriptions.
• Safe disposal of used transdermal patches is essential because a significant amount of the drug remains in the patch after the intended application period has expired.

Question 70

Which of the following steps can you take to improve notes or prescriptions?

(Select all that apply)

• Use joined up or running writing
• Take your time
• Use pencil instead of ink, so that it is easier to erase mistakes
• If you make a mistake in a handwritten note or prescription, cross through it and start again
• Make use of the electronic options available, wherever possible

Answer 70

• Take your time
• If you make a mistake in a handwritten note or prescription, cross through it and start again
• Make use of the electronic options available, wherever possible

Question 71

Which of the following statements is true regarding safe prescribing?

(One answer)

• Prescriptions written by senior consultants should always be administered as written
• Abbreviations should be used to save time and increase efficiency
• Use a trailing zero to make the dose easier to read eg, 5.0 mg
• An unclear order may increase the chance of further errors being made

Answer 71

• An unclear order may increase the chance of further errors being made.

Question 72

Which of the following reflect steps you can take to ensure verbal orders are used as safely as possible?

(Selecta all that apply)

• Verbal medication orders should be prioritised over written communication, as verbal communication provides greater clarity to the receiver.
• The patient’s name and other identifiers, drug name, route, dose and frequency and/or timing should all be stated clearly.
• The whole number should be pronounced first, followed by each numerical digit separately.
• Repetition of the order is not needed if the receiver is confident they have initially heard the order correctly.
• As an extra check, either the prescriber or listener should spell unfamiliar drug names.

Answer 72

• The patient’s name and other identifiers, drug name, route, dose and frequency and/or timing should all be stated clearly.
• The whole number should be pronounced first, followed by each numerical digit separately.
• As an extra check, either the prescriber or listener should spell unfamiliar drug names.

Question 73

Listener engagement is key to communicating for safety. Which of the following are ways that you can engage your listener and deliver your message more effectively?

(Select all that apply)

• Eye contact
• Open body language
• Speaking clearly and confidently
• Listening to the other person’s opinion
• Asking questions

Answer 73

• Eye contact
• Open body language
• Speaking clearly and confidently
• Listening to the other person’s opinion
• Asking questions

Question 74

Which of the following reflect steps you can take to improve your communication skills?

(Select all that apply)

• Speak with a colleague or supervisor for advice in unresolved situations
• Keep a diary or log of difficult situations and how you dealt with them
• Use methods such as the Graded Assertiveness Technique, which focuses on WHO was wrong rather than WHAT was wrong
• Use structured communication tools such as the SBAR, ISBAR and ISOBAR

Answer 74

• Speak with a colleague or supervisor for advice in unresolved situations
• Keep a diary or log of difficult situations and how you dealt with them
• Use structured communication tools such as the SBAR, ISBAR and ISOBAR

Question 75

You notice that the two antibiotic errors have reached the patient.

What action should you take?

(Select all that apply)

• Notify the treating medical team of the issues
• Document the issues and any discussion with the treating medical team in the medical record
• Ensure that the medication chart is corrected in a timely manner
• Notify the nurse in charge
• Complete an incident report

Answer 75

• Notify the treating medical team of the issues
• Document the issues and any discussion with the treating medical team in the medical record
• Ensure that the medication chart is corrected in a timely manner
• Notify the nurse in charge
• Complete an incident report

Question 76

Yes or No: Can paracetamol be given intravenously?

Answer 76

• Yes

Rationale: Paracetamol can be given intravenously. It is generally used for post-operative analgesia in patients who are nil-by-mouth. Most hospitals have strict protocols for its use.

Question 77

Yes or No: Should the patient and his family be made aware of the error that occurred?

Answer 77

• Yes

Rationale: When any clinical incident has an adverse outcome, the patient and their family must be informed.

Question 78

The process of discussing a clinical incident with a patient is called:

(One answer)

• One-way dialogue
• Closed discussion
• Open disclosure
• Clinical debate

Answer 78

• Open disclosure

Rationale: It is called ‘open disclosure’ because when things go wrong, the patient and their family should be provided with information about what happened in an open and honest manner. They should also be informed of the potential consequences and the steps being taken to manage the event and prevent recurrence.

Question 79

Who should discuss the incident with the patient?

(One answer)

• The person who made the error
• The person who discovered the error
• A senior member of staff involved in the patient’s care

Answer 79

• A senior member of staff involved in the patient’s care

Rationale: A senior staff member, trained in the process of open disclosure, should discuss the incident with the patient.

The person identifying the error should immediately discuss the issue with senior staff members involved in the patient’s care.

The person who made the error should be informed of the error (if not already aware). They may be able to identify factors that contributed to the error. This information could be used to help prevent similar errors from occurring again. The open disclosure process also involves providing support and advice to the staff members involved in the incident without apportioning blame.