Patient Safety and Quality Assurance Study Guide for the PTCB Exam

The PTCB® exam was revised in January 2020 and our materials cover everything that is assessed on the newest version of the test. You’ll note that there are now only four sections of study as opposed to the previous nine. The new test basically covers the same material, with a few additions which we have added to our test preparation.

General Information

Your knowledge of Patient Safety and Quality Assurance concepts covered in this study guide will be assessed by about 26.25% of the questions on the newest (2020) version of the PTCB® Exam. This means that answering them correctly affects about one-fourth of your test score. You need to be proficient in all of these topics.

The topics come from four different sections of the old test. Many are, of course, from the old sections on Medication Safety and the one about Quality Assurance. But the new test also pulls topics from the old sections on Laws and Regulations and Information Systems.

There is one topic on this new test that was not specifically present in the old test content: prescription errors. Within this topic, such concerns as abnormal doses, early refill, incorrect quantity, incorrect patient, and incorrect drug are covered. Questions about this topic will likely involve calculations.

Potential for Risk

When working as a pharmacy technician, there is always risk for the occurence of a medication error. There are numerous steps in place to help mitigate and reduce the potential for risk. However, being mindful and aware of these certain strategies set in place will help you perform your daily tasks in the pharmacy more efficiently and error free.

High Alert/Risk Medications

High-alert and high-risk medications are those medications that are more likely to cause harm to a patient if used incorrectly or in error. For example, the blood-thinning drug warfarin has the potential to cause significant bleeding in the case of a drug overdose, drug interaction, or drug monitoring error. The Institute for Safe Medication Practices (ISMP) is the primary resource for identifying high-alert medications, like warfarin.

Look-Alike/Sound-Alike (LASA) Medications

Similar medications are a serious safety concern and a common cause of medication errors. Just because two medications’ names look or sound alike does not mean they can be used interchangeably. Moreover, errors in communication or drug selection can have potentially fatal consequences.

For drugs that look like other drugs, pharmacy technicians should always double-check the drug name and strength. Tall man lettering is used on many drug products and implemented in many pharmacy systems to help pharmacy personnel differentiate two very similar looking medication names. Please refer to the Tall Man Lettering subsection below for more.

As is the case of look-alike drugs, pharmacy technicians should always double-check the drug name and strength of sound-alike drugs. Again, tall man lettering may be used when communicating in writing. Simply asking the person speaking to spell the drug name can help clarify that the correct drug is being discussed.

Error Prevention Strategies

Everybody makes mistakes.

You’ve heard this before and it’s certainly true, even in a pharmacy. But, when dealing with people’s health, a mistake can be extremely dangerous, so the goal of good pharmacy workers is to identify and acknowledge errors and reduce their occurrence. The best way to deal with medication errors is to prevent them from occurring in the first place. Many practices can be implemented, used by themselves or in combination, to reduce the chances of a medication error and, if it does occur, to reduce the likelihood that it will reach the patient.

Correct Order to Correct Patient

It is important to remember the five “rights” of medication administration: right drug, right dose, right time, right route, and right patient. Remembering these five rights will help prevent a medication error from occurring. When ringing out a customer at the register or drive-thru, it is easy to grab the wrong order and dispense it to the wrong patient, as retail pharmacies can sometimes be a fast-paced environment.

In addition to staying vigilant, performing these strategies will help get the correct order to the correct patient every time:

• Verify name and date of birth
• Verify street address
• Briefly mention what you have for the patient to pick up, like “I have your blood pressure and heartburn medication here. Was there anything else you were looking for?”

These three simple verification steps will help reduce the risk of a dispensing error.

Tall Man Lettering

Tall man lettering is used to help differentiate portions of sound-alike/look-alike drug names that are different so as to draw one’s eye to a potential source of error. Consider the example of hydralazine (an antihypertensive) and hydroxyzine (an antihistamine). These drugs look the same except for the middle three letters. Therefore, on the bottle and when communicating the drug name in writing, those different letters will be capitalized to draw the reader’s eye to the potential discrepancy (e.g., hydrALAzine vs. hydrOXYzine).

Inventory Separation

Inventory management accounts for a significant portion of a pharmacy team’s workload. Inventory management may include ordering and receiving products, identifying specific storage requirements, and removing expired or recalled medications. Schedule 2 (C-II) controlled substances are subject to additional inventory checks and balances. Within a pharmacy, different strategies to separate medications may be employed. For example, high-risk medications may be stored separately from other medications and/or medications with similar formulations may be stored together so the pharmacy employee can compare “like” products to identify the correct drug.

Leading and Trailing Zeros

Leading and trailing zeros are an important concept for a pharmacy technician to understand, especially during data entry and when performing calculations. For whole numbers, do not use trailing zeros, as in the case of 5.0; instead, simply write the whole number (5) and add units. Of note, a zero should be added before a decimal point (as in the case of 0.5 mg or 0.75 mL) to minimize the risk of overdose.

Barcodes

Similar to NDC codes, each drug’s barcode is unique and can be used to verify that the correct product is chosen. It is impossible to do this with the naked eye. Instead, a scanner may be used to scan the individual drug product into the system and to verify the correct drug is chosen in the filling process.

Abbreviation Use

Abbreviations should be avoided whenever possible. For example, “QD” should be written out as “once a day” or “daily” to avoid confusion with QID (four times a day) or QOD (every other day). In the busy work environment, abbreviations may seem faster or easier to use, but spelling out what you mean will save time—and prevent errors—in the long run.