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Certified Remote Order Verification Pharmacist (CROVP)
Official Examination Content Outline
This document provides the official content outline for the Certified Remote Order Verification Pharmacist (CROVP) examination. The exam certifies that a pharmacist possesses the specialized skills required to provide safe, efficient, and compliant telepharmacy services, focusing on remote medication order review, interprofessional communication, and mastery of the associated technologies and regulations.
Examination Specifications
| Name of Credential | Certified Remote Order Verification Pharmacist (CROVP) |
|---|---|
| Certification-Issuing Body | The Council on Pharmacy Standards (CPS) |
| Designation Awarded | CROVP |
| Target Population | Pharmacists who provide remote medication order verification services for hospitals and other health systems. |
| Examination Length | 120 multiple-choice items |
| Administration Time | 3.0 hours |
Examination Content Outline
The CROVP examination is weighted according to the five domains listed below, which reflect the advanced competencies required for safe, effective, and ethical telepharmacy practice in modern healthcare environments.
| Domain 1: Regulatory Compliance and Telepharmacy Law | 20% |
| Domain 2: Clinical Order Review and Verification | 30% |
| Domain 3: Technology, Systems, and Workflow Management | 25% |
| Domain 4: Communication and Interprofessional Collaboration | 15% |
| Domain 5: Quality Improvement, Ethics, and Leadership | 10% |
Domain 1: Regulatory Compliance and Telepharmacy Law (20%)
Task 1: Manage multi-state licensure and credentialing requirements.
- Maintain active pharmacist licensure in all required states where patient care is provided.
- Navigate varying state-specific licensure requirements for telepharmacy practice.
- Manage the credentialing and privileging process for obtaining practice privileges at remote facilities.
- Stay current with changes to licensure laws, including interstate compacts.
- Differentiate between the location of the pharmacist and the location of the patient when determining applicable laws.
Task 2: Apply state-specific and federal telepharmacy regulations.
- Interpret and apply the statutes and rules governing telepharmacy and remote order processing for each state.
- Adhere to state-specific requirements for technology, security, and record-keeping.
- Manage state-specific requirements for verifying controlled substance prescriptions.
- Compare and contrast U.S. telepharmacy laws with international regulatory models.
- Resolve conflicts between different state regulations by adhering to the most stringent requirements.
Task 3: Ensure compliance with accreditation and quality standards.
- Apply all relevant Joint Commission (TJC) Medication Management standards to the remote verification process.
- Ensure the remote pharmacy service is compliant with CMS Conditions of Participation.
- Adhere to national patient safety goals related to medication use (e.g., high-alert medications).
- Participate in accreditation surveys for client facilities, providing documentation and interviews as needed.
- Ensure that the quality and safety of the remote service are equivalent to on-site services.
Task 4: Apply HIPAA privacy and security rules in a remote setting.
- Implement robust administrative, physical, and technical safeguards for the remote workstation and network.
- Maintain patient confidentiality at all times in the remote work environment.
- Adhere to all policies regarding the use and disclosure of Protected Health Information (PHI).
- Report any potential privacy incidents or security breaches according to established protocols.
- Understand and operate within the framework of the Business Associate Agreement (BAA).
Task 5: Navigate the legal and liability aspects of telepharmacy.
- Maintain professional liability insurance that provides coverage for multi-state telepharmacy practice.
- Adhere to the policies and procedures of the client facility to align with their standard of care.
- Maintain meticulous documentation of all clinical interventions and communications to mitigate risk.
- Recognize that the standard of care is the same for a remote pharmacist as for an on-site pharmacist.
- Understand the legal implications of technology failures or system downtime on patient care.
Task 6: Manage cross-border practice challenges.
- Identify the legal and regulatory requirements for verifying orders for patients in different states.
- Apply the correct state-specific rules when the pharmacist, patient, and facility are in different jurisdictions.
- Navigate challenges related to prescribing authority and scope of practice across state lines.
- Ensure compliance with controlled substance regulations (e.g., PDMP access) for multiple states.
- Develop workflows that account for variations in state laws regarding pharmacist and technician duties.
Domain 2: Clinical Order Review and Verification (30%)
Task 1: Verify medication orders using a systematic clinical review process.
- Apply a consistent process to screen and verify medication orders within the EHR.
- Ensure the accuracy of the drug, dose, route, frequency, and duration for each order.
- Prioritize order verification based on clinical urgency (e.g., STAT, ASAP, routine).
- Evaluate the appropriateness of the order based on the patient's available clinical information.
- Identify and resolve ambiguous, incomplete, or erroneous orders by contacting on-site staff.
Task 2: Assess orders for clinical appropriateness.
- Evaluate medication doses based on patient-specific factors (e.g., age, weight, organ function).
- Screen for therapeutic duplications and assess for contraindications.
- Confirm that the prescribed medication is appropriate for the given indication.
- Review relevant laboratory data to ensure the safety and efficacy of the ordered therapy.
- Question orders that deviate from evidence-based guidelines or institutional protocols.
Task 3: Manage drug interactions and allergies.
- Utilize clinical decision support systems to screen for potential drug-drug interactions.
- Differentiate between clinically significant and minor interactions to reduce alert fatigue.
- Develop and communicate management plans for significant interactions.
- Review the patient's documented allergies and assess for potential cross-sensitivities.
- Screen for drug-laboratory and drug-disease interactions based on the patient's profile.
Task 4: Apply verification safeguards for high-risk populations and restricted medications.
- Verify complex orders for pediatric and neonatal patients, including all weight-based calculations and concentrations.
- Perform independent double-checks for oncology, investigational drug, and complex sterile compounding orders.
- Manage orders for medications governed by REMS programs, ensuring all requirements are met.
- Assess the appropriateness of orders for critically ill patients in ICU and ED settings.
- Adhere to strict protocols for high-alert medications (e.g., insulin, heparin, chemotherapy).
Task 5: Evaluate and act on advanced clinical decision support alerts.
- Differentiate between standard rule-based alerts and those generated by AI or machine learning.
- Assess the clinical relevance of predictive analytics alerts (e.g., patient risk scores).
- Investigate complex alerts by synthesizing data from multiple sources within the EHR.
- Override alerts with appropriate justification when clinically warranted.
- Provide feedback to informatics teams on the performance and utility of decision support tools.
Task 6: Adapt the verification process based on available patient data.
- Develop a systematic approach for verifying orders when complete patient information is not readily available.
- Recognize when there is insufficient information to safely verify an order and place it on hold.
- Formulate targeted questions for on-site staff to gather necessary clinical information efficiently.
- Prioritize direct communication with the prescriber for high-risk medications or ambiguous situations.
- Clearly document any clinical assumptions made or information that was unavailable during verification.
Domain 3: Technology, Systems, and Workflow Management (25%)
Task 1: Manage remote order queues and workflows.
- Develop and use a systematic process for triaging and prioritizing orders in a remote queue.
- Manage multiple order queues simultaneously if covering more than one facility.
- Maintain service level agreements (SLAs) for order verification turnaround times.
- Develop strategies to manage high-volume periods while ensuring safety and accuracy.
- Coordinate seamless handoffs with other remote pharmacists at shift changes.
Task 2: Optimize the use of telepharmacy technology and information systems.
- Navigate multiple different EHR and pharmacy information systems efficiently.
- Manage challenges related to EHR interoperability and data exchange between disparate systems.
- Utilize advanced features of the EHR, such as filters and reporting tools, to manage work.
- Troubleshoot basic issues with remote workstations, network connectivity, and software.
- Follow established downtime procedures to ensure patient safety during system failures.
Task 3: Evaluate the impact of AI and automation on order verification.
- Assess the role of AI-assisted verification in identifying potential errors.
- Differentiate between tasks that can be automated and those requiring professional judgment.
- Utilize systems with predictive analytics for automated error detection.
- Understand how remote verification integrates with on-site automation (e.g., ADCs, robotics).
- Maintain vigilance to avoid automation complacency and confirmation bias.
Task 4: Manage cybersecurity risks and recovery protocols.
- Adhere to all security policies, including multi-factor authentication and secure network protocols.
- Identify and respond to potential phishing attempts and other social engineering threats.
- Implement recovery protocols in response to cybersecurity events like ransomware or data breaches.
- Assess the security of emerging technologies, such as advanced audit trail systems (e.g., blockchain).
- Report any potential security vulnerabilities or incidents immediately.
Task 5: Apply principles of human factors engineering to the remote workspace.
- Design the remote work environment to optimize focus and minimize distractions.
- Utilize ergonomic best practices to reduce physical fatigue and repetitive strain injuries.
- Develop strategies to manage cognitive load and prevent burnout during high-volume shifts.
- Provide feedback on system usability to reduce clicks and improve workflow efficiency.
- Implement work-break strategies to maintain high levels of vigilance and performance.
Task 6: Manage remote supervision of pharmacy technicians.
- Understand and apply state-specific regulations governing remote supervision.
- Utilize technology (e.g., audio/video links, image capture) to conduct effective remote supervision.
- Ensure that technicians are performing tasks within their legally defined scope of practice.
- Perform and document the final verification of technician-prepared products as required.
- Provide real-time feedback and guidance to on-site technicians to ensure accuracy.
Domain 4: Communication and Interprofessional Collaboration (15%)
Task 1: Collaborate with on-site prescribers to resolve clinical issues.
- Contact prescribers to clarify orders and recommend evidence-based therapeutic changes.
- Present the clinical rationale for recommendations in a clear and convincing manner.
- Build trust and credibility with the medical staff through professional and competent interactions.
- Prioritize calls to prescribers to respect their time and focus on the most critical issues.
- Document all recommendations and the prescriber's response in the medical record.
Task 2: Apply assertive communication and conflict resolution skills.
- Employ assertive yet professional communication techniques to resolve clinical disagreements and ensure patient safety.
- Utilize de-escalation techniques when faced with challenging or stressful interactions.
- Mediate disagreements regarding clinical or operational issues in a professional manner.
- Foster a culture of mutual respect between remote and on-site teams.
- Escalate unresolved conflicts to leadership when appropriate.
Task 3: Lead and participate in remote team communication.
- Participate effectively in remote shift handoffs and team huddles to ensure continuity of care.
- Lead remote case discussions or clinical presentations.
- Contribute to multidisciplinary rounds via teleconference when required.
- Build strong working relationships with colleagues in a virtual environment.
- Use communication tools to foster a sense of presence and teamwork despite physical distance.
Task 4: Adapt communication for cultural competence and health literacy.
- Recognize and address potential communication barriers in a digital environment.
- Adapt communication strategies to account for the health literacy of patients when involved in remote counseling.
- Utilize interpreter services and other tools to communicate with patients with limited English proficiency.
- Demonstrate cultural humility in all interactions with a diverse patient population and workforce.
- Ensure that remote communication methods do not create barriers for patients with disabilities.
Task 5: Communicate effectively with on-site nursing and pharmacy staff.
- Establish a positive and collaborative relationship with on-site teams.
- Provide clear and concise answers to medication-related questions.
- Communicate proactively about any potential delays or issues with medication orders.
- Use closed-loop communication to ensure that critical messages are received and understood.
- Serve as a reliable and accessible clinical resource for the on-site care team.
Task 6: Document communications and interventions clearly and professionally.
- Adhere to a high standard of documentation for all clinical activities and communications.
- Document interventions using a standardized format (e.g., problem, recommendation, outcome).
- Ensure that documentation is visible and accessible to the entire care team.
- Recognize that clear documentation is the primary tool for communication and accountability in a remote setting.
- Use documentation to demonstrate the value and impact of the remote pharmacy service.
Domain 5: Quality Improvement, Ethics, and Leadership (10%)
Task 1: Apply ethical principles to telepharmacy practice.
- Analyze and resolve ethical dilemmas unique to remote practice (e.g., managing errors from a distance).
- Balance efficiency and productivity demands with the primary duty of ensuring patient safety.
- Demonstrate full accountability for clinical decisions made in a multi-state or cross-border practice.
- Ensure patient autonomy is respected in a technology-mediated environment.
- Manage potential conflicts of interest and maintain professional boundaries.
Task 2: Participate in medication safety and quality improvement initiatives.
- Monitor and identify medication error trends from the remote verification process.
- Report medication safety events, near misses, and adverse drug reactions into safety event reporting systems.
- Analyze safety data to identify opportunities for system-level improvements.
- Participate in root cause analyses of medication errors originating from or identified by remote staff.
- Develop and implement corrective action plans to prevent future errors.
Task 3: Contribute to clinical governance and P&T processes.
- Participate remotely in facility-specific P&T committee meetings.
- Provide data and analysis on medication use trends observed during remote verification.
- Contribute to the development and review of institutional medication use policies and protocols.
- Conduct medication use evaluations (MUEs) from a remote setting.
- Serve as a subject matter expert for the on-site teams.
Task 4: Demonstrate professional leadership and accountability.
- Take ownership of the entire medication use process, from order to administration.
- Mentor and train new remote verification pharmacists.
- Model professional behavior and a commitment to lifelong learning.
- Contribute to the development of best practices for telepharmacy.
- Participate in the peer review process to ensure high standards of care across the remote team.
Task 5: Develop and monitor quality dashboards for telepharmacy.
- Identify key performance indicators (KPIs) for a remote verification service (e.g., turnaround time, intervention rate).
- Collect and analyze data on personal and team performance.
- Utilize quality dashboards to identify areas for improvement in efficiency and safety.
- Present performance data to leadership and client facilities.
- Use data to benchmark performance against industry standards.
Task 6: Promote equity in digital access and care.
- Analyze how telepharmacy models can be used to reduce health disparities in underserved communities.
- Advocate for technology and workflows that are accessible to patients and facilities with varying levels of digital literacy or resources.
- Evaluate whether telepharmacy implementation creates or exacerbates inequities in care.
- Ensure that communication strategies are effective for diverse patient populations.
- Promote the role of telepharmacy in providing expert clinical pharmacy services to rural and critical access hospitals.
