Protocol Development and Quality Improvement
Answer: B
Using evidence-based practice helps provide support in
creating a clinical pathway with support and agreement
among practitioners (Answer B is correct). Using closed-
loop technology is important when implementing
a clinical pathway, as is establishing a physician
champion (Answer A). Developing a clinical protocol
and pathway comes after the evidence is evaluated
(Answer C). Formulary proposals are not a primary
factor in implementing a clinical pathway (Answer D).
A gap analysis compares best practice and current state
to identify opportunities for improvement (Answer C
is correct). Creating a table of the ISMP best practice
recommendations regarding storage and handling of
NMBs and comparing them with current practice would
be the best way to identify opportunity to improve. A
survey could be helpful to learn what other institutions
are doing, but it does not ensure they are in line with
best practices. It could provide additional information
but would not show where gaps exist in current state and
best practice at your institution (Answer A is incorrect).
Answer B is incorrect because it is jumping right to
solutions without completing the gap analysis. Answer
D is also incorrect because surveying the staff would not
provide information on the best practice gaps that exist.
Answer: B
Answer A is incorrect because the patient name and
dose do not need to be on the label per the NPSG
requirements. Both drug name and expiration date/
time should be. Answer B is correct because all of these
must be on the label of a medication drawn up in the
perioperative setting. Answer C is incorrect because
the patient name and drug dose are not needed on the
label but drug name and concentration do. Answer D
is incorrect because drug dose does not need to be on
the label.
Answer: B
Current data show that the critical care pharmacist
affects many areas associated with TJC measures.
According to TJCβs current measures, the critical care
pharmacist affects procoagulant reversal agent initiation
for ICH (Answer B is correct). The ED median time
from ED arrival to ED departure for admitted ED
patients is not affected by the pharmacist (Answer A
is incorrect). Hemorrhage transformation for patients
treated with intravenous alteplase therapy or mechanical
endovascular reperfusion therapy is also not affected by
the pharmacist (Answer C is incorrect). Although the
pharmacist would have impact on the severe sepsis and
septic shock management bundle, this is not currently a
required measurement (Answer D is incorrect).
Answer: A
Defining the problem is the first step in LEAN (Answer
A is correct). The LEAN strategy involves attempting to
remove the team membersβ opinions so their emotions do
not influence the process. Hence, asking the nurses their
opinion for the spike in catheter-related bloodstream
infections influences their emotions (Answer B is
incorrect). Identifying operational barriers is a LEAN
process, however a transportation barrier is not related
to catheter related blood stream infections (Answer C is
incorrect). Describing the past process is not a LEAN
evaluation component (Answer D is incorrect).
Answer: C
An MUE is drug- or disease-specific and is best suited
for reviewing vancomycin dosing and the ordering of
vancomycin blood concentrations (Answer C is correct).
Quality assurance surveys are best suited for monitoring
the medication use process that may not be specific to a
drug or disease, such as the review of a pharmacistβs
notes in the EHR, review of the accuracy of expiration
dates placed on intravenous admixture products, and
review of the frequency of drug interaction warnings on
the CPOE system (Answers A, B, and D are incorrect).
Answer: A
Justification to hospital leadership should provide
financial benefit to the organization as well as
improvement in patient outcomes and safety. Antibiotic
stewardship outcomes as well as cost savings would
provide both of these above and help justify additional
pharmacy FTEs (Answer A is correct). Although
provider education and in-services can be of benefit, it
is difficult to justify these with cost savings or outcome
benefits (Answer B is incorrect). Although many clinical
pharmacists spend time on rounds, this time is not value