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Certified Sterile Compounding Pharmacist (CSCP)
Official Examination Content Outline
This document provides the official content outline for the Certified Sterile Compounding Pharmacist (CSCP) examination. This gold-standard blueprint certifies that a pharmacist possesses the advanced, performance-based competencies required to oversee all aspects of a sterile compounding operation, ensuring that all Compounded Sterile Preparations (CSPs) are prepared, stored, and dispensed in compliance with USP standards to guarantee patient safety.
Examination Specifications
Name of Credential | Certified Sterile Compounding Pharmacist (CSCP) |
---|---|
Certification-Issuing Body | The Council on Pharmacy Standards (CPS) |
Designation Awarded | CSCP |
Target Population | Pharmacists, designated persons, and operational leaders responsible for sterile compounding in settings such as hospitals, infusion centers, and 503A/B compounding facilities. |
Examination Length | 120 multiple-choice items |
Administration Time | 3.0 hours |
Examination Content Outline
The CSCP examination is weighted according to the five domains listed below. This structure reflects a comprehensive, risk-based approach to sterile compounding, aligning with USP General Chapter <797> and other relevant standards. The domains cover foundational knowledge, facility control, personnel competency, preparation integrity, and quality management systems.
Domain 1: Foundations, Standards, and Regulations | 15% |
Domain 2: The Sterile Compounding Environment | 25% |
Domain 3: Personnel Training, Competency, and Aseptic Technique | 30% |
Domain 4: Formulation, Preparation, and Release of CSPs | 20% |
Domain 5: Quality Management Systems and Documentation | 10% |
Domain 1: Foundations, Standards, and Regulations (15%)
- Define the scope of USP <797> and its applicability to different practice settings.
- Differentiate between CSP Categories 1, 2, and 3 based on compounding conditions and BUD limits.
- Identify the roles and responsibilities of the designated person(s) overseeing the compounding program.
- Explain the importance of a risk-based approach to sterile compounding policies and procedures.
- Interpret the relationship between USP <797>, <795>, and <800>.
- Identify common sources of microbial contamination in the cleanroom environment (e.g., personnel, air, surfaces).
- Describe the characteristics of microorganisms relevant to sterile compounding (e.g., bacteria, fungi, endotoxins).
- Explain the mechanisms of action and appropriate uses of various disinfecting and sterilizing agents.
- Apply first-air principles during aseptic manipulations to prevent contamination.
- Analyze microbial growth kinetics and its implications for beyond-use dating.
- Apply principles from USP <71> Sterility Tests and USP <85> Bacterial Endotoxins Test.
- Recognize the applicability of FDA cGMP (21 CFR Parts 210/211) for 503B outsourcing facilities.
- Incorporate principles from USP <1163> Quality Assurance in Pharmaceutical Compounding into the QMS.
- Adhere to applicable state board of pharmacy, FDA, and DEA regulations for sterile compounding.
- Incorporate guidance from organizations like ASHP and ISMP into sterile compounding practices.
- Develop procedures to prevent common medication errors in compounding (e.g., wrong drug, wrong concentration).
- Implement strategies to mitigate risks associated with high-alert medications.
- Analyze look-alike/sound-alike (LASA) risks within the compounding pharmacy.
- Utilize failure mode and effects analysis (FMEA) to proactively identify process risks.
- Establish a non-punitive reporting system for compounding errors and near misses.
Domain 2: The Sterile Compounding Environment (25%)
- Differentiate between the ante-room, buffer room, and primary engineering control (PEC) areas.
- Verify that cleanroom suites meet the required ISO classifications (e.g., ISO 7 buffer room, ISO 5 PEC).
- Assess the placement of equipment and fixtures to ensure proper airflow and cleanability.
- Ensure proper pressure differentials and airflow between adjacent classified areas.
- Evaluate the design of segregated compounding areas (SCAs) and their limitations.
- Differentiate between various PECs (e.g., laminar airflow workbenches, biological safety cabinets, compounding aseptic isolators).
- Ensure all PECs and SECs are certified according to CETA standards at least every 6 months and when moved.
- Review and maintain certification reports for all engineering controls.
- Develop procedures for the proper daily use and cleaning of PECs.
- Manage the response to any out-of-specification results from engineering control certification.
- Develop evidence-based standard operating procedures (SOPs) for cleaning and disinfecting all classified areas.
- Select appropriate agents for cleaning, disinfection, and sporicidal treatment based on their properties and dwell times.
- Establish and verify the frequency of cleaning for all surfaces (daily, monthly).
- Ensure proper cleaning techniques, materials (e.g., low-lint wipes), and solution application.
- Train and validate the competency of all personnel responsible for cleaning.
- Develop a comprehensive environmental monitoring plan based on risk assessment.
- Manage the collection of viable air and surface samples according to the required frequency.
- Establish alert and action levels for microbial contamination.
- Investigate any out-of-specification results, identify the root cause, and implement corrective actions.
- Analyze environmental monitoring data over time to identify trends and proactively address potential issues.
Domain 3: Personnel Training, Competency, and Aseptic Technique (30%)
- Develop a didactic training curriculum covering all aspects of sterile compounding theory and practice.
- Ensure training includes principles of microbiology, aseptic technique, and cleanroom conduct.
- Provide education on medication safety, calculations, and proper documentation.
- Incorporate training on the proper use of all equipment used in the compounding process.
- Maintain complete documentation of all initial and ongoing training activities for each employee.
- Develop and enforce strict SOPs for hand hygiene and garbing based on USP <797> requirements.
- Ensure proper sequence for donning and doffing all personal protective equipment (PPE).
- Select appropriate garb (e.g., sterile gloves, gowns) based on the compounding activity.
- Train personnel on the importance of garbing as a critical contamination control measure.
- Regularly observe and provide feedback on garbing practices.
- Conduct initial and recurring competency validation for hand hygiene and garbing.
- Perform gloved fingertip and thumb sampling (GFTS) after garbing to assess aseptic technique.
- Establish passing criteria for GFTS based on USP <797> action levels.
- Investigate and remediate any GFTS failures through retraining and re-evaluation.
- Document all competency validation activities for regulatory review.
- Design media-fill tests that simulate the most complex and challenging compounding procedures performed.
- Oversee the aseptic conduct of media-fill tests for all compounding personnel.
- Ensure proper incubation and examination of completed media-fill units for any signs of microbial growth.
- Investigate the root cause of any media-fill test failure and implement corrective actions.
- Conduct and document successful media-fill testing initially and at required intervals for all staff.
Domain 4: Formulation, Preparation, and Release of CSPs (20%)
- Assess the clinical appropriateness of the prescribed formulation for the patient.
- Verify the accuracy and completeness of the medication order.
- Perform all necessary pharmaceutical calculations (e.g., dose, volume, infusion rate).
- Consult Master Formulation Records and Compounding Records for preparation instructions.
- Ensure all required information is documented before compounding begins.
- Assign BUDs based on the CSP Category and storage conditions as defined in USP <797>.
- Utilize peer-reviewed literature and stability data to assign BUDs that ensure chemical and physical stability.
- Differentiate between sterility-based BUDs and stability-based BUDs.
- Develop policies for assigning BUDs to different types of preparations (e.g., single-dose, multi-dose).
- Understand the requirements and testing needed to extend BUDs beyond default limits.
- Ensure proper aseptic technique is used throughout the entire compounding process.
- Manage the introduction and disinfection of components into the PEC.
- Implement and manage technologies to enhance safety (e.g., IV workflow systems, barcode scanning, gravimetrics, image capture, robotics).
- Develop procedures for visual inspection of CSPs against a lighted background for particulate matter and defects.
- Oversee the final verification of the CSP, including checking ingredients, volumes, and final product integrity.
- Ensure all CSP labels contain the required information in a clear and standardized format.
- Verify that storage conditions (e.g., refrigeration, protection from light) are met after compounding.
- Develop procedures to maintain the integrity and sterility of CSPs during transport.
- Use temperature-controlled packaging and monitoring when necessary.
- Provide clear instructions for patients or caregivers on proper handling and storage at home.
Domain 5: Quality Management Systems and Documentation (10%)
- Develop a written quality assurance and quality control plan for the compounding facility.
- Ensure all policies and procedures (SOPs) are well-documented, approved, and reviewed regularly.
- Utilize data analytics and dashboards to monitor quality trends (e.g., environmental monitoring, deviations, personnel competency).
- Manage a change control program to evaluate and approve any changes to processes or facilities.
- Conduct routine audits of the QMS to ensure ongoing compliance and effectiveness.
- Develop a system for documenting, investigating, and resolving any deviations from SOPs.
- Perform a thorough root cause analysis (RCA) for any significant event or out-of-specification result.
- Implement a formal process for handling product complaints and reports of adverse drug events.
- Establish and test a recall procedure for any potentially non-sterile or defective CSPs.
- Analyze event data to identify trends and implement preventative actions.
- Establish procedures for qualifying vendors and verifying the quality of all components and supplies.
- Manage the process for sterility and endotoxin testing for CSPs requiring it.
- Interpret the results of release testing and take appropriate action.
- Ensure that no CSP requiring release testing is dispensed before satisfactory results are received.
- Maintain complete documentation of all component verification and release testing activities.
- Ensure Master Formulation Records and Compounding Records are accurate, complete, and properly maintained.
- Maintain all records related to personnel training, competency, and qualifications.
- Keep organized records of facility certification, environmental monitoring, and equipment maintenance.
- Ensure all documentation is readily retrievable for review by regulatory and accrediting bodies.
- Adhere to all record-keeping requirements for controlled substances used in compounding.