(BQ) Part 1 book Pharmacy technician exam certification and review has contents: Pharmacology for technicians, pharmacy law and regulations for the pharmacy technician, sterile and nonsterile compounding, medication safety,... and other contents.
NOTICE Medicine is an ever-changing science As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work Readers are encouraged to confirm the information contained herein with other sources For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration This recommendation is of particular importance in connection with new or infrequently used drugs Copyright © 2015 by McGraw-Hill Education All rights reserved Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher ISBN: 978-0-07-184302-7 MHID: 0-07-184302-7 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-182689-1, MHID: 0-07-182689-0 eBook conversion by codeMantra Version 1.0 All trademarks are trademarks of their respective owners Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark Where such designations appear in this book, they have been printed with initial caps McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs To contact a representative please visit the Contact Us page at www.mhprofessional.com TERMS OF USE This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the work Use of this work is subject to these terms Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill Education’s prior consent You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited Your right to use the work may be terminated if you fail to comply with these terms THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE McGraw-Hill Education and its licensors not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom McGraw-Hill Education has no responsibility for the content of any information accessed through the work Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise Dedication We would like to dedicate this book to our families Thank you for allowing us to put countless hours into this book and supporting us throughout We would also like to thank Michael, Robert, and Shruti for their assistance during this process Finally, this book is dedicated to pharmacy technicians Your hard work and dedication to the profession of pharmacy is invaluable and often underappreciated Jodi, Kristy, Allison, Eric Key Features of Pharmacy Technician Certification and Review Exam • Organized to mimic the outline of the Pharmacy Technician Certification Board test Chapters mirror the Pharmacy Technician Certification Exam Knowledge domains • Patient cases and real pharmacy examples are integrated throughout the book to make information more applicable • CD-ROM allows you to create an endless number of PTCE tests Question bank with more than 2,000 questions Each test is a timed, 90-question test that follows the exact PTCE content The test is presented in similar format to that of the Pearson Vue testing center to help you feel at ease during the actual PTCE • Extra chapter on pharmacy math—includes step-by-step instructions and explanations of answers • Key terms at the beginning of each chapter highlight unfamiliar terms • Check point review questions throughout the chapter to assess your learning • Chapters contain “Tech Alerts” to highlight facts that may be applicable to pharmacy practice • End of each chapter contains 50 test questions • Appendices highlight the Top 200 medications, over-the-counter medications, and herbal products Contents Reviewers Preface About the Authors Test-Taking Strategies Math Review Introduction Roman Numerals Decimals Fractions Adding and Subtracting Fractions Multiplying Fractions Dividing Fractions Ratios and Proportions Measurement Systems Medical Measurement Systems Temperature Measurements Conversion Between Units Concentrations Converting a Ratio Into a Metric Concentration Converting a Percentage Into a Metric Concentration Converting a Metric Concentration Into a Percentage Chapter Summary Answers to Quick Quizzes Quick Quiz MR-1 Quick Quiz MR-2 Quick Quiz MR-3 Analyzing Errors When an error occurs, a health care organization should examine the error to investigate where the system failed, or if it was a product of human error Two common methods to examine errors are RCA and FMEA A root cause analysis (RCA) is a retrospective approach after an event occurs It helps identify a system or process a problem after an event occurs A failure mode and effects analysis (FMEA) is a proactive risk assessment of a high-risk process that occurs before an event occurs Communication Channels The purpose of effective communication is to disseminate information about a subject to an audience Communication is crucial in pharmacy practice It is used to ensure ongoing quality improvement through education about issues (ie, recalls, drug shortages, etc) and also problem resolution (ie, change in process due to an error, editing a policy to be in compliance, etc) For example, wholesalers, professional pharmacy networks, national organizations, and word of mouth are some of the communication channels used to identify upcoming, current, and continuous medication shortages These shortages must be communicated to specific patients and prescribers in order to set the expectation that a necessary medication may not be available for use for a period of time Viable alternatives may or may not be available for a patient and in some cases the medication may not ever be available again Regardless of the medication, every member of the pharmacy team should be apprised of the current shortages Again, communication is a key component of the pharmacy’s quality improvement process Table 5-3 lists common communication methods TABLE 5-3 Communication Methods For more information about pharmacy recall, please refer to Chapter 2: Pharmacy Law and Regulations for the Pharmacy Technician PRODUCTIVITY, EFFICIENCY, AND CUSTOMER SATISFACTION MEASURES Every team needs to know how well it is performing and whether or not changes are necessary in order to perform at a higher level and to meet the expectations of the business Pharmacies are held to specific budgets and are required to meet expectations related to filling prescriptions as well as maintaining a level of quality and patient satisfaction in order to continue business * TECH ALERT: “Key performance indicators” as well as “dashboards” are ways to understand how much work is being done, by whom, and how efficiently These tools can be very valuable when evaluating performance Productivity Productivity is a measure of the activities being performed during a period of time In pharmacy, there are many common productivity measures Pharmacies may measure prescriptions checked per hour worked, phone orders completed per hour worked, and prescriptions filled per hour worked These numbers should be reviewed frequently with a pharmacy manager or team leader Understanding individual goals and whether more training, coaching, or support is needed to reach a goal is a great way to get involved with improving your performance Productivity improvements may occur when new technology is introduced or when a process is modified in order to speed up a transaction or reduce a “bottleneck” in the workflow Technology helps technicians choose the right medication the first time and therefore reduces the number of return trips to the shelves in order to find the correct bottle A pharmacist using barcode readers with updated software will easily identify the tablet or capsule in the bottle instead of relying on opening a stock bottle or thumbing through catalogs of pictures to verify correct medications In the end, if productivity can be increased, there will be more time available to provide assistance to customers: answering questions, maintaining documentation requirements, and enhancing the overall experience Efficiency Efficiency is the time, effort, or cost of producing an outcome Pharmacies may measure efficiency by average wait time per patient, prescription turnaround time, number of prescription errors per month, or inventory turnover rates Similar to productivity, efficiency goals should be reviewed with each staff member Efficiency can also be improved with technology and constant discussion with staff to improve goals Customer Satisfaction The key piece of any business is maintaining a customer base that will recommend your service, store, people, and product and will keep coming back The philosophy of high-quality customer satisfaction is simple, but the execution of this is a continuous challenge Most pharmacies use a survey technique after a patient has visited that location Hospital pharmacy services are typically reviewed by nursing staff and physicians through annual nursing or medical staff surveys Inpatients are mailed a survey after a hospital stay, and although the questions are based on the whole experience of the hospital, some questions are directed at pharmacy services and the ability to provide drug information or counseling to a patient It is important to examine the feedback received regardless Customer service is important for all pharmacy technicians, regardless of the practice setting Keep in mind that the customer does not always need to be right, but the customer is your only source of information related to the perceived quality of your product and therefore deserves attention Table 5-4 describes useful customer service skills TABLE 5-4 Customer Service Skills Patience: Remember, many of your patients may be ill and may not feel well Take the time to help them understand their medication, by offering counseling by a pharmacist Pay attention: Listen to your patient Do not interrupt them and ask openended questions to get the most information Clearly communicate: Speak clearly so that your patients can understand what you are saying Pleasant attitude: Smile; use kind words; speak nicely about others Handle surprises: Be prepared for all situations; be adaptable to changes Work under pressure: The pharmacy is often busy and fast paced, be prepared Know your product: Be knowledgeable of medications, your job responsibilities, and your workplace procedures Take the extra step: Going one extra step to help your patient will help increase customer satisfaction Caring: Be compassionate and kind to your patients; treat them how you would like to be treated 10 Learn from mistakes: Remember your own mistakes and use that information to improve on your skills CASE STUDY REVIEWED Mr Smith calls your pharmacy and has a question about the tablets in his prescription bottle He tells you that there are tablets, one is orange and the other is white He is concerned that these are not the same medication and that an error has occurred which may be harmful to him You gather all the information from Mr Smith You ask him to describe the tablets and from his profile you verify the dispensing dates from his previous fills All this information is given to the pharmacist to review Self-Assessment Questions • What has occurred? Mr Smith does have different tablets in his prescription bottle Somewhere along the way there was a mix-up of tablets • What are the facts? At this point, facts need to be gathered Mr Smith should be asked if he had poured tablets from one bottle to another Stock bottles on the shelves should be checked for any tablets that are mixed in (which is why you should not return medication to stock bottles) • What are the steps necessary for resolution? In many cases it is not possible to determine the exact origin of the error, but through careful documentation of processes and positive identification of personnel responsible for each step along the way, it is possible to get further input directly from those who took care of Mr Smith’s prescriptions • How can an error like this be prevented from happening again? Identifying potential problems in the workflow Evaluating processes not being followed according to policy CHAPTER SUMMARY • Quality assurance and quality control help ensure appropriate standards are met and helps improve the safety of the patient • Basic pharmacy dispensing requires the correct patient to get the correct medication with the correct instructions in a timely manner Efficient, accurate, and safe medication dispensing is aided by the use of product double check including the use of technology to guide and assist the technicians and pharmacists • Patient safety organizations help health care facilities and pharmacies perform their best by collecting, analyzing, and reporting data submitted by pharmacists and technicians and other health care professionals Learning from the experiences of other organizations can prevent future errors and lead to efficient and productive workflow systems • Medication recalls and drug shortages are certainly botherations to the pharmacy enterprise But, these annoyances, if properly planned for and communicated to patients and prescribers not have to interrupt proper care of the patient A well-written medication recall and drug shortage policy and procedure provide peace of mind that quality patient care will continue despite the challenges of recalls and shortages • Customer satisfaction is generally accomplished by maintaining integrity, responding to patient requests, and treating others with respect Every patient has the right to get your best professional effort with every prescription filled Errors will happen in the workplace Pharmacy errors have the potential to be very dangerous and could result in serious harm for a patient Minimize the risk of a serious error occurring by participating in risk management strategies with your pharmacy team Evaluate your performance and hold everyone to the same high standards ANSWERS TO QUICK QUIZ Quick Quiz 5-1 12345-1234-12 Scooping method of recapping needles Shoe covers, face mask, wash hands, gown, and gloves Confirmation bias Quality assurance CHAPTER QUESTIONS What is an NDC? a An optical machine-readable representation of information related to the object to which it is attached b A unique, 3-segment number that identifies drug products c Issued by the DEA d Issued by the State Board of Pharmacy Which of the following organizations oversees MERP? a ISMP b FDA c DEA d TJC What is the quality of being productive or being able to produce? a Risk management b Productivity c CQI d PSO Which method of communication is most efficient for a policy announcement? a Face-to-face b Telephone c Loud speaker d Written memo What does the acronym DEA stand for? a Drug Enforcement Area b Disease Enforcing Agency c Department of Enforcement Agency d Drug Enforcement Agency Before a high-risk process is implemented, what type of risk analysis may be performed? a Root cause analysis b Productivity analysis c Failure mode and effects analysis d Efficiency analysis What is the time, effort, or cost of producing an outcome? a Efficiency b Productivity c Customer satisfaction d Analysis Which line of communication is a formal line of communication? a Pharmacy technician to pharmacist b Pharmacy technician to pharmacy technician c Pharmacy technician to patient d Pharmacy technician to hospital chief executive officer Who sets standards for medications, biologics, medical devices, and compounded products? a OSHA b TJC c USP d P&T 10 Who issues a medication recall? a TJC b FDA c DEA d P&T 11 A drug company is required to remove its medication from market due to the risk of death What type of recall is this? a Class I b Class II c Class III d Market withdrawal 12 Who created patient safety organizations? a The FDA b The Department of Health and Human Services c The DEA d The State Board of Pharmacy 13 What is the Agency for Healthcare Research and Quality (AHRQ)? a An agency in the Department of Health and Human services b An agency dedicated to improve quality, safety, and efficiency of health care c Both a and b d a only 14 Which segment of the NDC code represents the labeler code? a The first or digits b The second or digits c The third or digits d a and c 15 Which organization oversees Medwatch? a FDA b DEA c USP d TJC 16 When does quality control investigate a product? a Before completion b During manufacturing c After completion d None of the above 17 What is continuous quality improvement? a The quality of being productive or able to produce b The identification of risk and the avoidance or minimization of risk c A process to ensure programs are intentionally improving services d Only for large corporate businesses 18 How are evaluations of productivity usually measured? a Amount of work accomplished during a set time period b Organizations to determine efficiency c Supervisors in order to thoroughly evaluate an employee d All of the above 19 The Patient Safety and Quality Improvement Act established the PSO What does the acronym stand for? a Patient safety organization b Patient satisfaction organization c Pharmacist safety organization d Pharmacist satisfaction organization 20 What is the unique, 3-segment number that identifies drug products? a The bar code b The NDC c The federal legend d The schedule 21 Which organization is solely dedicated to medication error prevention? a OSHA b FDA c TJC d ISMP 22 Name the process to ensure programs are intentionally improving service and increasing positive outcomes a Risk management b Productivity c Entrepreneurship d Continuous quality improvement 23 Which of the following organizations is classified by the Department of Health and Human Services to improve quality and safety of health care services? a PSO b CQI c HIPAA d DEA 24 Risk management involves which of the following in order to eliminate or minimize risk? a Analysis of workflow b Identification of complex high-risk tasks c Avoidance of risk through education and process change d All of the above 25 What is identifying, analyzing, assessing, and controlling risk? a CQI b PSO c Risk management d Productivity 26 Which strategy can help prevent eye fatigue while working? a Dim the lights b Move closer to the computer screen c Focus on areas close to you and far away at frequent intervals d All of the above 27 What type of recall would be a situation in which use or exposure to a product is not likely to cause adverse health consequences? a Class I b Class II c Class III d Class IV 28 Which segment of the NDC code represents the product code? a The first or digits b The second or digits c The third or digits d a and c 29 What is a sentinel event? a Minor medication filling error b Minor medication adverse drug event c Unexpected death due to a medication error d Class IV medication recall 30 Which of the following strategies will help a technician efficiently choose the correct product from the stock shelves? a Audible cue barcode scanner b Bringing a second technician to the shelf to check the stock with you c Bringing the pharmacist to the shelf to check the stock with you d None of the above 31 To prevent eye fatigue your computer screen should be how far away from you? a More than ft b Between 20 and 26 in c Closer than 12 in d Between 12 and 20 in 32 Which of the following may help improve customer satisfaction? a New procedures b Change in workflow c Education of staff d All of the above 33 This agency in the Department of Health and Human Services is responsible for improving quality, safety, and efficiency in the health care system a PSO b CQI c AHRQ d DEA 34 Why is it is necessary to perform software updates on your systems? a The latest drug information can be loaded into your system b The latest drug interaction information is available c Software glitches and bugs will be fixed d All of the above 35 All errors are preventable in a pharmacy and should never occur a True b False 36 What is a bar code? a An optical machine-readable representation of information related to the object to which it is attached b A unique, 3-segment number that identifies drug products c Issued by the DEA d Issued by the State Board of Pharmacy 37 Which of the following recalls is related to serious health problems from dangerous or defective products? a Class I b Class II c Class III d Market withdrawal 38 Which organization is in charge of product recalls? a DEA b FDA c The State Board of Pharmacy d TJC 39 Where should recalled medications be stored? a In the refrigerator b On the shelf in alphabetical order c Segregated from normal stock d In the narcotic cabinet 40 Which of the following quality measures improve patient safety? a Computer software updates b Calibrated counting trays c Barcode scanners d All of the above 41 After an error has occurred, what type of analysis may be performed? a FMEA b Productivity report c RCA d Efficiency report 42 When a sentinel event occurs in a hospital, which organization is this information reported to? a FDA b DEA c USP d TJC 43 Which method of communication is best for interactive discussion? a E-mail b Written memo c Face-to-face discussion d Broadcast media 44 Which of the agency ensures safe and healthful working conditions? a OSHA b FDA c DEA d TJC 45 Which organization creates a culture of safety throughout the Veterans Health Administration? a OSHA b FDA c NCPS d USP 46 Which organization is in charge of licensing pharmacists? a DEA b FDA c BOP d TJC 47 Which of the following methods is preferred for prescription generation? a Telephone b E-prescribing c Handwritten d Faxed copy 48 What method helps decrease errors in a retail pharmacy setting? a Pick the NDC for the medication based on which it is listed first b Use the NDC from the medication stock bottle during data entry c Choose the NDC based on memory d There is no need to verify NDC during data entry 49 In what order should medications be stored in a retail pharmacy? a A to Z regardless of type of medication b A to Z separating fast movers c Separated by type of medication d A to Z separated by brand and generic medication 50 Which organization requires material safety data sheets be available? a FDA b OSHA c P&T d DEA ... the outline of the Pharmacy Technician Certification Board test Chapters mirror the Pharmacy Technician Certification Exam Knowledge domains • Patient cases and real pharmacy examples are integrated... Exam Practice Exam Answers to Practice Exams Appendix A Pharmacy Technician Certification Board Guidelines and Requirements Appendix B Updated Pharmacy Technician Certification Examination Blueprint... all pharmacy technicians become certified pharmacy technicians by 2 015 Pharmacy technicians who meet all eligibility requirements and who pass a national examination are considered certified pharmacy