No products in the cart.
CROVP Certification Review
A Review Guide for the Certified Remote Order Verification Pharmacist (CROVP) Exam
API: Application Programming Interface
BAA: Business Associate Agreement
BCMA: Bar Code Medication Administration
BOP: Board of Pharmacy
CPOE: Computerized Provider Order Entry
DDI: Drug-Drug Interaction
DUE: Drug Use Evaluation
EHR: Electronic Health Record
HIPAA: Health Insurance Portability and Accountability Act
ISMP: Institute for Safe Medication Practices
IT: Information Technology
KPI: Key Performance Indicator
MAR: Medication Administration Record
Med Rec: Medication Reconciliation
NABP: National Association of Boards of Pharmacy
P&P: Policies and Procedures
PHI: Protected Health Information
PIS: Pharmacy Information System
QA: Quality Assurance
QI: Quality Improvement
SLA: Service Level Agreement
SOP: Standard Operating Procedure
TAT: Turnaround Time
VoIP: Voice over Internet Protocol
VPN: Virtual Private Network
- Definition: The practice where a licensed pharmacist at a remote location performs the prospective review and verification of medication orders for a healthcare facility (e.g., hospital, skilled nursing facility).
- Primary Purpose: To provide continuous, 24/7 pharmacist oversight of medication orders, thereby improving patient safety, especially during overnight hours, weekends, or at facilities without a full-time on-site pharmacist.
- Differentiating from Telepharmacy Dispensing: Remote order verification is a cognitive service focused on order review. It is distinct from remote dispensing, which involves the direct supervision of a technician preparing and dispensing a final product.
- Common Practice Settings: Primarily used by hospitals (especially small, rural, or critical access hospitals), hospital systems for after-hours coverage, and long-term care facilities.
- The "Safety Net" Concept: The remote pharmacist acts as a critical safety net, ensuring that every medication order is prospectively reviewed for appropriateness and safety before it is administered to the patient.
- State-Based Regulation: The practice of pharmacy is regulated by individual state Boards of Pharmacy (BOPs). Regulations for remote order verification vary significantly by state.
- Pharmacist Licensure: The remote pharmacist MUST be licensed in the state where the patient is located, not just the state where the pharmacist is physically located.
- Technician Registration/Licensure: Understanding the state-specific requirements for the on-site personnel (nurses or technicians) who are accessing the medications after remote verification.
- HIPAA & Data Security: Ensuring that the technology platform and all connections (e.g., VPN) are secure and HIPAA-compliant to protect patient privacy and PHI. This includes having a Business Associate Agreement (BAA) with the technology vendor.
- Policies & Procedures (P&Ps): The requirement for a comprehensive P&P manual that details all aspects of the remote verification operation, including communication protocols, downtime procedures, and quality assurance.
- Record Keeping: Maintaining complete and retrievable electronic records of all verified orders and clinical interventions, in accordance with state and federal law.
- Core Technology: The foundation is a secure, reliable connection (typically a VPN) that gives the remote pharmacist access to the facility's Electronic Health Record (EHR) and Pharmacy Information System (PIS).
- The Verification Queue: The electronic queue of medication orders that are routed to the remote pharmacist for review and verification.
- Computerized Provider Order Entry (CPOE): The system used by prescribers to enter medication orders electronically. The pharmacist verifies these orders directly within the system.
- Automated Dispensing Cabinets (ADCs): The remote pharmacist's verification often "releases" the medication in the on-site ADC, allowing the nurse to retrieve it for administration.
- Communication Tools: The use of secure, integrated communication tools (e.g., secure chat, VoIP) to communicate in real-time with on-site nurses and prescribers.
- System Downtime Procedures: Having a clear, documented plan for how medication orders will be managed safely in the event of a system or network failure.
- Prospective Order Review: The core function of reviewing each medication order BEFORE the first dose is administered to ensure it is safe and appropriate for the specific patient.
- Comprehensive Patient Profile Review: For every order, the pharmacist must review the patient's complete profile, including allergies, height, weight, organ function (especially renal and hepatic), current medications, and relevant lab values.
- Assessing for Medication-Related Problems (MRPs): Systematically screening for potential issues, such as therapeutic duplication, drug-drug interactions, incorrect dose or frequency, and contraindications.
- Dose Optimization: Ensuring the dose is appropriate for the patient's age, weight, and organ function. This includes renal and hepatic dose adjustments and verifying weight-based dosing for pediatric and adult patients.
- Clinical Guideline Adherence: Verifying that the ordered therapy is consistent with current evidence-based clinical practice guidelines (e.g., for antimicrobial stewardship, VTE prophylaxis).
- Intervention & Documentation: If a problem is identified, the pharmacist must intervene by contacting the prescriber with a clear, concise, and evidence-based recommendation. All interventions must be meticulously documented.
- STAT Orders: Developing a workflow to prioritize and rapidly verify urgent STAT orders while maintaining safety.
- Code Blue / Emergency Response: Understanding the pharmacist's role during a medical emergency, which may include verifying orders for code medications and providing drug information support to the on-site team.
- Complex Order Sets: The verification of multi-line, protocol-driven order sets, such as those for chemotherapy, parenteral nutrition, or insulin infusions.
- Transitions of Care: Performing admission and discharge medication reconciliation remotely to identify and resolve discrepancies.
- Pediatrics & Neonates: The critical importance of weight-based dosing, concentration limits, and avoiding toxic excipients in this vulnerable population. Requires access to specialized pediatric references.
- Geriatrics: Applying the principles of geriatric pharmacotherapy, including using the AGS Beers Criteria® to identify potentially inappropriate medications and being vigilant for anticholinergic burden.
- Critical Care: Verifying complex orders for ICU patients, including continuous infusions of vasopressors, sedatives, and paralytics.
- Oncology: The verification of chemotherapy orders, which requires double-checks and strict adherence to treatment protocols.
- High-Alert Medications: Applying extra vigilance when verifying orders for medications on the ISMP list of high-alert drugs (e.g., insulin, anticoagulants, concentrated electrolytes).
- Look-Alike, Sound-Alike (LASA) Drugs: Using strategies to prevent errors with LASA drug pairs, such as using Tall Man lettering in the PIS.
- Error Prevention Strategies: The pharmacist's role in preventing errors at the prescribing stage (e.g., clarifying ambiguous orders) and the administration stage (e.g., ensuring correct ADC configuration).
- Quality Assurance (QA) Program: Implementing a QA program that includes peer review of verified orders, tracking and trending of clinical interventions, and monitoring key performance metrics.
- Medication Error Reporting: Having a clear process for documenting and reporting medication errors and near misses that occur at the client facility to support their internal QI efforts.
Order Verification Turnaround Time (TAT)
The time from when an order is entered into the system to when it is verified by the remote pharmacist. A key metric in Service Level Agreements (SLAs).
Clinical Intervention Rate
(Number of Orders Requiring Intervention / Total Orders Verified) * 100
Measures the frequency of pharmacist interventions and demonstrates the clinical value of the service.
Intervention Acceptance Rate
(Number of Interventions Accepted by Prescriber / Total Interventions Made) * 100
A measure of the quality and appropriateness of the pharmacist's recommendations.
Prevented Medication Error Rate
Tracking the number and severity (using a scale like the NCC MERP Index) of potential medication errors that were intercepted by the remote pharmacist.
- The Pharmacist as the Ultimate Safety Net: The core function of this role is to be the final, critical check that protects the patient from potentially harmful medication orders before they can be administered.
- Vigilance and Focus are Paramount: The remote environment requires an exceptional level of focus and a systematic process to avoid distractions and ensure every order receives the same high level of scrutiny.
- Communication is the Lifeline: In the absence of face-to-face interaction, clear, concise, and professional communication with on-site staff is the absolute lifeline for ensuring safe and effective patient care.
- Trust is Earned, Not Given: The remote pharmacist must consistently provide high-quality, reliable, and timely service to earn the trust and respect of the on-site nurses and prescribers.
- Technology is the Enabler, Clinical Judgment is the Skill: The understanding that technology is simply the tool that allows the pharmacist to apply their clinical expertise and judgment to protect patients from afar.
- You Are an Extension of the On-Site Team: The mindset that despite being physically remote, you are an integral part of the patient's care team and share responsibility for their outcomes.
