Unit 6.4: Medicines Safety

• Topic 01

  High-Risk Medicines

  51 questions
• Topic 02

  Double-Checking Procedures

  45 questions
• Topic 03

  Safe Storage Requirements for Medicines

  45 questions
• Topic 04

  Reporting Near Misses and Medication Incidents

  45 questions

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

1. A nurse discovers that medicines have been stored alongside patient food in the ward fridge. What is the MOST appropriate response?

   • A
     Report the incident but continue using the medicines as they appear unaffected
   • B
     Remove the medicines immediately, quarantine them pending pharmacy review, and arrange for them to be stored in a dedicated pharmaceutical-grade refrigerator; report the incident
     Correct answer
   • C
     Label the medicines 'stored with food' in the patient's record and use them cautiously
   • D
     Move the food to another fridge and continue using the same fridge for medicines
   Explanation

   Medicines must never be stored with patient food. A combined food/medicine fridge does not provide the required pharmaceutical-grade temperature consistency, raises contamination risks, and creates confusion between medicines and food items.

   Affected medicines must be quarantined and pharmacy contacted to assess their fitness for use. A dedicated pharmaceutical fridge must be sourced. The incident should be reported as a governance matter.

2. Which of the following correctly identifies the reversal agent for warfarin-associated major bleeding requiring urgent reversal?

   • A
     Vitamin K alone at a dose of 1–2 mg IV
   • B
     Fresh frozen plasma as a supplementary measure
   • C
     Four-factor prothrombin complex concentrate (4-factor PCC, e.g. Beriplex)
     Correct answer
   • D
     Idarucizumab (for dabigatran reversal)
   Explanation

   For major, life-threatening bleeding in a patient on warfarin, the treatment of choice for urgent reversal is four-factor prothrombin complex concentrate (4-factor PCC, e.g. Beriplex) combined with IV vitamin K. 4-factor PCC acts within minutes, whereas vitamin K alone takes 6–12 hours for full effect.

   Idarucizumab and andexanet alfa are for DOAC reversal. Protamine reverses heparin. Fresh frozen plasma may be used if PCC is unavailable but is less effective and involves a larger volume.

3. A nurse notices a prescribed drug was dispensed in the wrong concentration by pharmacy but it has not yet been administered. What type of incident is this?

   • A
     A dispensing error that has been intercepted as a near miss; it must be reported via local incident reporting and the medicine returned to pharmacy
     Correct answer
   • B
     An administration error, as the nurse is responsible for all aspects of the drug from dispensing to administration
   • C
     An adverse drug reaction, as the wrong concentration could cause unintended patient harm
   • D
     A prescribing error, as the prescriber should have specified the concentration more clearly
   Explanation

   A dispensing error intercepted before administration is a near miss. Although no harm has reached the patient, it must be reported via the local incident reporting system (Datix) because near misses reveal system weaknesses and their reporting prevents future errors.

   The incorrectly dispensed medicine must be returned to pharmacy and the correct preparation obtained. The prescriber should be informed if the prescription was unclear, and a LFPSE report may be appropriate.