PCNE Classification for Drug related problems

(revised 01-05-06 vm)

V5.01
2003,2004,2005,2006 Pharmaceutical Care Network Europe Foundation This classification can freely be used in Pharmaceutical Care Research and practice, as long as the Foundation is informed of its use and results of validations. The classification is available both as a Word document and a PDF document. Contact: [email protected] This classification should be referred to as The PCNE Classification V 5.01
PCNE classification

29-05-06 V 5.01

Introduction During the working conference of the Pharmaceutical Care Network Europe in January 1999, a classification scheme was constructed for drug related problems (DRPs). The classification is part of a total set of instruments. The set consists of the classification scheme, reporting forms and cases for training or validation. The classification system is validated and adapted regularly. The current version is V5. It is compatible with previous versions although new items have been added. The numbering of existing items has not been changed. The classification is for use in research into the nature, prevalence, and incidence of DRPs and also as a process indicator in experimental studies of Pharmaceutical Care outcomes. It is also meant to help health care professionals to document DRP-information in the pharmaceutical care process. The hierarchical classification is based upon similar work in the field, but it differs from existing systems because it separates the problems from the causes. The following definition is the basis for the classification:

A Drug-Related Problem is an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes.

The basic classification now has 6 primary domains for problems, 6 primary domains for causes and 5 primary domains for Interventions. However, on a more detailed level there are 21 grouped sub domains for problems, 33 grouped sub domains for causes and 17 grouped sub domains for interventions. Those sub domains can be regarded as explanatory for the principal domains. In 2003 a scale has been added to indicate if or to what extend the problem has been solved.

Zuidlaren, May 2006

N.B. In this version 5.01 an extra Cause is added: C4.10 Patient takes food that interacts with drugs and an extra Outcome O0.0 Outcome not known.

PCNE classification

29-05-06 V 5.01

PCNE Classification scheme for Drug-Related Problems V5.01 -Page 1 The Basic Classification
Code Primary domains V5.01 P1 Adverse reaction(s) Patient suffers from an adverse drug event P2 Drug Choice Problem Patient gets or is going to get a wrong (or no drug) drug for his/her disease and/or condition P3 Dosing problem Patient gets more or less than the amount of drug he/she requires P4 Drug Use Problem Wrong or no drug taken/administered P5 Interactions There is a manifest or potential drug-drug or drug-food interaction P6 Other C1 Drug/Dose Selection The cause of the DRP can be related to the selection of the drug and/or dosage schedule C2 Drug Use Process The cause of the DRP can be related to the way the patient uses the drug, in spite of proper dosage instructions (on the label) C3 Information The cause of the DRP can be related to a lack or misinterpretation of information C4 Patient/Psychological The cause of the DRP can be related to the personality or behaviour of the patient. C5 (Pharmacy) Logistics The cause of the DRP can be related to the logistics of the prescribing or dispensing mechanism C6 Other I0 No intervention I1 At prescriber level I2 At patient (or carer) level I3 At drug level I4 Other O0 Outcome intervention unknown O1 Problem totally solved O2 Problem partially solved O3 Problem not solved

Problems

Causes

Interventions

Outcome of intervention

PCNE classification

29-05-06 V 5.01

PCNE Classification scheme for Drug-Related Problems V5.01 -Page 2 The Detailed Classification-1
The Problems Each problem should be coded separately, but there may be more causes or interventions to one problem.

Primary Domain 1. Adverse reactions Patient suffers from an adverse drug event 2. Drug choice problem Patient gets or is going to get a wrong (or no drug) drug for his/her disease and/or condition

Code V5.01 P1.1 P1.2 P1.3 P2.1 P2.2 P2.3 P2.4 P2.5 P2.6 P3.1 P3.2 P3.3 P3.4 P4.1 P4.2 P5.1 P5.2

Problem Side effect suffered (non-allergic) Side effect suffered (allergic) Toxic effects suffered Inappropriate drug (not most appropriate for indication) Inappropriate drug form (not most appropriate for indication) Inappropriate duplication of therapeutic group or active ingredient Contra-indication for drug (incl. Pregnancy/breast feeding) No clear indication for drug use No drug prescribed but clear indication Drug dose too low or dosage regime not frequent enough Drug dose too high or dosage regime too frequent Duration of treatment too short Duration of treatment too long Drug not taken/administered at all Wrong drug taken/administered Potential interaction Manifest interaction

3. Dosing problem Patient gets more or less than the amount of drug he/she requires 4. Drug use problem Wrong or no drug taken/administered 5. Interactions There is a manifest or potential drug-drug or drug-food interaction 6. Others

P6.1 P6.2 P6.3 P6.4

Patient dissatisfied with therapy despite taking drug(s) correctly Insufficient awareness of health and diseases (possibly leading to future problems) Unclear complaints. Further clarification necessary Therapy failure (reason unknown)

PCNE classification

29-05-06 V 5.01

PCNE Classification scheme for Drug Related Problems V5.01 -Page 3 The Detailed Classification-2
The Causes N.B. One problem can have more causes

Primary Domain

Code V5.01 1. Drug/Dose selection C1.1 The cause of the DRP is related to C1.2 the selection of the drug and/or C1.3 dosage schedule C1.4 C1.5 C1.6 C1.7 C1.8 C2.1 C2.2 C2.3 C2.4 C2.5 C2.6 C3.1 C3.2 C3.3 C3.4 C3.5 4. Patient/Psychological
The cause of the DRP can be related to the personality or behaviour of the patient.

Cause Inappropriate drug selection Inappropriate dosage selection More cost-effective drug available Pharmacokinetic problems, incl. ageing/deterioration in organ function and interactions Synergistic/preventive drug required and not given Deterioration/improvement of disease state New symptom or indication revealed/presented Manifest side effect, no other cause Inappropriate timing of administration and/or dosing intervals Drug underused/ under-administered Drug overused/ over-administered Therapeutic drug level not monitored Drug abused (unregulated overuse) Patient unable to use drug/form as directed Instructions for use/taking not known Patient unaware of reason for drug treatment Patient has difficulties reading/understanding Patient Information Form/Leaflet Patient unable to understand local language Lack of communication between healthcare professionals Patient forgets to use/take drug Patient has concerns with drugs Patent suspects side-effect Patient unwilling to carry financial costs Patient unwilling to bother physician Patient unwilling to change drugs Patient unwilling to adapt life-style Burden of therapy Treatment not in line with health beliefs Patient takes food that interacts with drugs Prescribed drug not available (anymore) Prescribing error (only in case of slip of the pen) Dispensing error (wrong drug or dose dispensed)

2. Drug use process

3. Information
The cause of the DRP can be related to a lack or misinterpretation of information

5. Logistics
The cause of the DRP can be related to the logistics of the prescribing or dispensing mechanism

C4.1 C4.2 C4.3 C4.4 C4.5 C4.6 C4.7 C4.8 C4.9 C4.10 C5.1 C5.2 C5.3

6. Others

C6.1 Other cause; specify C6.2 No obvious cause

PCNE classification

29-05-06 V 5.01

PCNE Classification scheme for Drug-Related Problems V5.01 -Page 4 The Detailed Classification-3
The Interventions N.B. One problem can lead to more interventions

Primary Domain No intervention 1. At prescriber level

2. At patient/carer level

3. At drug level

4. Other intervention or activity

Code V5.01 I0.0 I1.1 I1.2 I1.3 I1.4 I1.5 I2.1 I2.2 I2.3 I2.4 I3.1 I3.2 I3.3 I3.4 I3.5 I3.6 I4.1 I4.2

Intervention No Intervention Prescriber informed only Prescriber asked for information Intervention proposed, approved by Prescriber Intervention proposed, not approved by Prescriber Intervention proposed, outcome unknown Patient (medication) counselling Written information provided only Patient referred to prescriber Spoken to family member/caregiver Drug changed to . Dosage changed to . Formulation changed to .. Instructions for use changed to .. Drug stopped New drug started Other intervention (specify) Side effect reported to authorities

Outcome of intervention N.B. One problem (or the combination of interventions) can only lead to one level of solving the problem

Primary Domain 0. Not known 1. Solved 2. Partially solved 3. Not solved

Code V5.01 O0.0 O1.0 O2.0 O3.1 O3.2 O3.3 O3.4

Outcome of intervention Outcome intervention not known Problem totally solved Problem partially solved Problem not solved, lack of cooperation of patient Problem not solved, lack of cooperation of prescriber Problem not solved, intervention not effective No need or possibility to solve problem

PCNE classification

29-05-06 V 5.01

PCNE Classification for Drug related problems

V5.01
2003,2004,2005,2006 Pharmaceutical Care Network Europe Foundation This classification can freely be used in Pharmaceutical Care Research and practice, as long as the Foundation is informed of its use and results of validations. The classification is available both as a Word document and a PDF document. Contact: [email protected] This help document is related to The PCNE Classification V 5.01
PCNE classification Help

29-05-06V 5.01

Finding or selecting codes in the PCNE classification

A Drug-Related Problem is an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes.

For the use of the PCNE classification it is important to separate the real problem (that affects or is going to affect the outcome) from its cause. Often such problems are caused by a certain type of error e.g. prescribing errors or drug-use or administration errors. But there might be no error at all involved. Also, a medication error does not necessarily have to lead to a drugrelated problem. The cause is usually the behaviour that has caused the problem. A cause or a combination of causes and a problem together, will usually lead to one or more interventions. The classification can be used in two ways, depending on the level of information needed. If only the main domains are used, there is in general enough information for research purposed If the system is used for documenting pharmaceutical care activities in practice, the sub domains can be used.

Problem section Basically, the problem is defined as the expected or unexpected event or circumstance that is, or might be wrong, in therapy with medicines. (the P-codes) There are 6 major domains in the problem section. The following descriptions could help to find the right problem domain: Patient suffers or is going to suffer from an adverse drug event such as a side effect or toxicity. This can be prescribing error, but unexpected ADRs may also occur at normal dosages of a well selected drug. Patient gets or is going to get a wrong (or no drug) drug for his/her disease and/or condition. This is usually a prescribing error. Patient has or gets the right drug, but gets more or less than the amount of drug than he/she requires. This can be a prescribing error but also a drug use error. Patient uses or gets administered the wrong drug or no drug. This can be drug use or administration errors but also a filling error in the pharmacy. There is a manifest or potential drug-drug or drug-food interaction. This is a form of prescribing or drug-use error. Any other problem See P1

See P2 See P3 See P4 See P5 See P6

PCNE classification Help

29-05-06V 5.01

Causes section Each problem has a cause. The cause is the action (or lack of action) that leads up to the occurrence of a potential or real problem. There may be more causes for a problem. (The Ccode) The cause of the DRP can be related to the selection of the drug and/or dosage schedule The cause of the DRP can be related to the way the patient uses the drug, in spite of proper dosage instructions (on the label or in the information leaflet) The cause of the DRP can be related to a lack or misinterpretation of information by the patient The cause of the DRP can be related to the personality or behaviour of the patient. The cause of the DRP can be related to the logistics of the prescribing or dispensing mechanism Any other cause See C1 See C2 See C3 See C4 See C5 See C6

Intervention section The problem will usually lead to one or more in interventions to correct the cause of the problem. (The I-code) There is or can be no intervention Intervention through the prescriber Intervention through the patient, his carers or relatives Intervention directly by changing drug or indicating change in drug use Other intervention See I0 See I1 See I2 See I3 See I4

Outcome section For evaluation purposes it is desirable to indicate if the problem has been solved by doing the intervention (the O-code). This scale has been added in V5 (2003) Problem totally solved Problem partially solved Problem not solved See O1 See O2 See O3

PCNE classification Help

29-05-06V 5.01