- A common and potentially fatal error associated with this high-alert medication involves misinterpreting the frequency, resulting in an incorrect:
Answer: Dose
Methotrexate is often dosed weekly for conditions like rheumatoid arthritis. A frequent error is for the instructions to be entered or read as "daily" instead of "weekly." This leads to a massive overdose and severe toxicity. This is a critical incorrect dose error related to frequency.
- The technician should recognize this as a red flag for a potential:
Answer: Incorrect drug error
Januvia (sitagliptin) is a medication used to treat Type 2 diabetes, not a sinus infection. The mismatch between the drug's actual indication and the patient's understanding of its purpose is a major red flag for an incorrect drug error and requires clarification with the prescriber.
- According to ISMP, the abbreviation "U" for units is on the "Do Not Use" list because it is frequently misread, leading to what type of error?
Answer: Incorrect dose
The abbreviation 'U' for units is easily mistaken for a zero ('0') or the number four ('4'), leading to a 10-fold overdose or a significant underdose, respectively. For safety, the word "units" must always be written out in full. Using 'U' is an error-prone practice that can cause a serious incorrect dose error.
- If the technician incorrectly interprets "AU" and labels the medication for use in the eyes, what type of error has occurred?
Answer: Incorrect route
The abbreviation "AU" stands for auris uterque, which means "both ears." Labeling an otic (ear) medication for ophthalmic (eye) use is a critical incorrect route of administration error that could cause significant harm to the patient.
- According to best practices from the Institute for Safe Medication Practices (ISMP), what type of error is present in the way this dose is written?
Answer: Use of a trailing zero
The use of a trailing zero (e.g., 5.0 mg) is an error-prone practice and should be avoided. The decimal point can be missed, leading to the dose being misread as 50 mg, a 10-fold overdose. The correct way to write this dose is "5 mg". A leading zero (e.g., 0.5 mg) is a safety practice used to prevent a dose from being misread.
- What type of error is present on this prescription?
Answer: Incorrect quantity
The instructions (Sig) call for 1 tablet twice a day (BID). For a 30-day supply, the patient would need 1 2 30 = 60 tablets. The quantity of 30 would only last for 15 days. This is an incorrect quantity because it does not match the days' supply indicated by the directions.
- This prescription contains what type of error?
Answer: A mismatched brand and generic name
This is an incorrect drug error. Zoloft is the brand name for sertraline, an antidepressant. Levothyroxine (brand name Synthroid, among others) is a thyroid hormone. The brand and generic names on the prescription do not match, requiring immediate clarification with the prescriber.
- Based on the patient's diagnosis, the technician should suspect an incorrect drug error. Which medication was most likely intended?
Answer: Lamisil
This is a potential look-alike/sound-alike (LASA) error. Lamictal (lamotrigine) is an anticonvulsant, whereas Lamisil (terbinafine) is an antifungal used to treat nail fungus. Given the patient's diagnosis, Lamisil is the intended medication. Lasix is a diuretic, Lantus is insulin, and Lipitor is a statin.
- Alerting the pharmacist to this potential issue would help prevent what type of medication error?
Answer: Incorrect drug
Keflex (cephalexin) and ceftriaxone are both cephalosporin antibiotics. Patients with an allergy to one cephalosporin may have a cross-sensitivity to others. Dispensing Keflex would be an 'incorrect drug' error for this specific patient due to the potential for an allergic reaction.
- To best prevent an incorrect patient error, what is the next piece of information the technician should ask the patient to verify?
Answer: Her home address
Using at least two patient identifiers is a critical safety check. After confirming the name and date of birth, verifying a third identifier like the home address or phone number is the best practice to ensure the correct patient record is being used, especially if there are multiple patients with similar names.
- This prescription most likely contains what kind of error?
Answer: Incorrect dose
Digoxin has a very narrow therapeutic index, and doses are typically in micrograms (mcg), not milligrams (mg). Common strengths are 125 mcg (0.125 mg) or 250 mcg (0.25 mg). A dose of 2.5 mg is 10 times the usual maximum dose and would be lethal. This is a critical incorrect dose error, likely caused by a misplaced decimal.
- The technician should alert the pharmacist to a potential error regarding the:
Answer: Route of administration
FML Forte (fluorometholone) is an ophthalmic (eye) preparation. The instructions are for otic (ear) use. Prescribing an eye drop for the ear is an incorrect route and requires clarification, as the formulation and delivery device are specific to the eye.
- What type of error is present on this prescription?
Answer: Incorrect quantity
The prescribed course of therapy requires 2 tablets on day 1 and 1 tablet for the next 4 days, for a total of 6 tablets. This corresponds to a standard Z-Pak. The quantity of 30 is incorrect for the directions provided and should be clarified with the prescriber.
- The instruction to crush the tablet is a dangerous error related to the drug's:
Answer: Dosage form
MS Contin is a long-acting, controlled-release formulation of morphine sulfate. Crushing the tablet destroys this mechanism, causing the entire 12-hour dose to be released at once (dose dumping). This can lead to a fatal overdose. This is an incorrect administration error related to the drug's specific dosage form.
- The technician should flag this prescription for pharmacist review because Cipro is generally not recommended in children, representing a potential:
Answer: Incorrect drug for the patient's age
Fluoroquinolones like ciprofloxacin are generally avoided in pediatric patients due to the risk of cartilage and tendon damage. While there are specific exceptions, its use for a routine infection in a child is a red flag, representing a potential 'incorrect drug' error for this patient population.
- This prescription likely contains an incorrect drug error. Based on the indication, which look-alike/sound-alike drug was most likely intended?
Answer: Celexa
Celebrex (celecoxib) is a nonsteroidal anti-inflammatory drug (NSAID) for pain and inflammation. Celexa (citalopram) is a selective serotonin reuptake inhibitor (SSRI) used to treat depression. This is a classic LASA pair, and the indication of depression points directly to Celexa as the intended medication.
- The technician should recognize this as a potentially harmful error in the:
Answer: Route of administration
Debrox (carbamide peroxide) is an otic solution used to remove earwax. It is not formulated for ophthalmic (eye) use and would cause severe irritation and chemical injury if instilled in the eye. This is a critical incorrect route of administration error.
- The technician should identify an issue with the prescription's:
Answer: Quantity
A 5-day supply at the maximum dose would be (2 tabs 6 times/day) 5 days = 60 tablets. The prescribed quantity of 180 tablets far exceeds the legal limit for an initial prescription for acute pain in many states. This is an incorrect quantity error based on legal restrictions, which requires pharmacist intervention.
- This situation presents a high risk for which two types of medication errors?
Answer: Incorrect patient and incorrect drug
There is a risk of selecting the wrong patient (the other Jane Smith). More critically, even if the correct patient is selected, amoxicillin is a penicillin antibiotic. Dispensing it to a patient with a known penicillin allergy would be a severe 'incorrect drug for this patient' error. The technician must alert the pharmacist immediately.
- What type of error should the technician suspect?
Answer: Incorrect dose
First, calculate the recommended daily dose range. Lower end: 20 kg 25 mg/kg/day = 500 mg/day. Upper end: 20 kg 45 mg/kg/day = 900 mg/day. The prescribed daily dose is 750 mg * 2 = 1500 mg/day. This prescribed dose is significantly higher than the recommended maximum, indicating a potential incorrect dose error that requires pharmacist intervention.
