Patient Safety & Quality Improvement USMLE Step 1 Practice Question
A 73-year-old woman with mild cognitive impairment and limited English proficiency is discharged from the hospital after treatment for community-acquired pneumonia. She is prescribed five medications with varying dosing schedules (twice daily, three times daily, and once daily at bedtime). Her daughter, who speaks Spanish at home, accompanies her to discharge but works during weekday hours. At the follow-up visit 2 weeks later, the patient reports confusion about medication timing, has missed several doses, and presents with recurrent respiratory symptoms. The medical team reviews the discharge process and identifies that the discharge nurse provided written instructions only in English without verbal confirmation of understanding. Which of the following interventions would have been most effective in preventing this medication error?
Answer choices
- AAutomatic substitution of all prescribed medications with once-daily formulations at the time of discharge
- BImmediate admission to a skilled nursing facility for supervised medication administration
- CReferral to the outpatient pharmacy for a comprehensive medication review within 48 hours of discharge
- DUse of teach-back method with professional medical interpreter, simplified written instructions with pictographs, and consolidation of doses into a single daily regimen when clinically appropriateCorrect answer
- EScheduling weekly in-person follow-up appointments with the primary care physician for the first month after discharge
- FProvision of detailed written discharge instructions in English supplemented by a brief telephone call to the patient's daughter within 24 hours
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