Unit 5: Medication Safety and Error Prevention

• Topic 01

  Medication Error Types — Prescribing, Dispensing, Administration, and Monitoring

  15 questions
• Topic 02

  High-Alert Medications — ISMP List and Safe Handling

  15 questions
• Topic 03

  Look-Alike/Sound-Alike (LASA) Drugs — Tall Man Lettering

  15 questions
• Topic 04

  Tall Man Lettering, Barcode Medication Administration (BCMA)

  15 questions
• Topic 05

  Error Reporting — USP MEDMARX, FDA MedWatch, and Internal Near-Miss Reporting

  15 questions
• Topic 06

  Pharmacist Verification — DUR and Prospective Review

  15 questions

A few questions from this unit, with the answer and a full explanation. The complete bank is available when you start practising.

1. An error reaches the patient but causes no harm and requires no additional monitoring. Which NCC MERP category applies?

   • A
     Category B
   • B
     Category E
   • C
     Category F
   • D
     Category C
     Correct answer
   Explanation

   NCC MERP Category C describes an error that occurred and reached the patient but caused no harm and required no additional monitoring or intervention. Category B describes an error that occurred but did not reach the patient. Category D describes an error that reached the patient, caused no harm, but required monitoring to confirm no harm resulted. Category E describes an error that caused temporary harm requiring intervention. Key takeaway: Category C = error reached patient, no harm, no monitoring required.

2. Why is CISplatin vs. CARBOplatin considered one of the most critical LASA pairs in pharmacy practice?

   • A
     They are both platinum-based chemotherapy agents with similar names, but very different doses, toxicity profiles, and indications — confusion has caused patient deaths.
     Correct answer
   • B
     They are confused primarily because their brand names (Platinol and Paraplatin) sound alike when spoken aloud during telephone orders
   • C
     They have identical mechanisms of action, so any confusion leads directly to therapeutic duplication and toxicity
   • D
     They are both oral chemotherapy agents dispensed in similar tablet packaging, making visual pick errors common in outpatient oncology pharmacies
   Explanation

   CISplatin and CARBOplatin are both platinum-based chemotherapy agents whose names are orthographically similar, but they differ significantly in dose, toxicity (cisplatin has greater nephrotoxicity and emetic potential), and indications. Confusion between them has caused severe patient harm and deaths. ISMP tall-man lettering (CISplatin vs. CARBOplatin) highlights the CIS/CARBO distinction. This is considered one of the highest-priority LASA pairs in oncology pharmacy. Key takeaway: CISplatin vs. CARBOplatin — similar names, very different drugs; confusion has caused deaths in oncology patients.

3. What are the Five Rights of medication administration?

   • A
     Right patient, right drug, right dose, right route, right documentation
   • B
     Right prescriber, right drug, right dose, right route, right patient
   • C
     Right patient, right drug, right strength, right formulation, right time
   • D
     Right patient, right drug, right dose, right route, right time
     Correct answer
   Explanation

   The Five Rights of medication administration are: right patient, right drug, right dose, right route, and right time. These are the foundational checks performed by nurses before administering any medication. The expanded Nine Rights add: right documentation, right reason, right response, and right dosage form. While the Five Rights are essential, they are not sufficient on their own to prevent all medication errors (e.g., they do not address system factors like LASA names or look-alike packaging). Key takeaway: Five Rights = right patient, drug, dose, route, time.