PCNE classification 1 15-6-2017 V8.02
Classification
for Drug related
problems
V8.02
© 2003-2017 Pharmaceutical Care Network Europe Foundation
This classification can freely be used in Pharmaceutical Care Research and practice, as long as the
PCNE association is informed of its use and results of validations. The classification is available
both as a Word document and a PDF document.
Contact: info@pcne.org
This classification should be referred to as ‘The PCNE Classification V 8.02’
This version is not directly backwards compatible with versions before V8.0.
PCNE classification 2 15-6-2017 V8.02
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 V8, which has been developed during an expert workshop in February 2016 and a
subsequent specialist meeting in April 2017. It is no longer compatible with previous versions because
a number of major sections have been revised. In V 8.01, a necessary code C3.5 (which had dropped
out) is re-added.
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.
Throughout the classification the word ‘drug’ is used, where others might use the term ‘medicine’.
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. Quality experts will recognise that the
causes are often named ‘Medication Errors’ by others.
The following official PCNE-DRP 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 3 primary domains for problems, 8 primary domains for causes and
5 primary domains for Interventions. In V7 a new section, called ‘Acceptance of the Intervention
Proposals’ was added, including 3 domains.
However, on a more detailed level there are 7 grouped sub domains for problems, 35 grouped sub
domains for causes and 16 grouped sub domains for interventions, and 10 subdomains for intervention
acceptance. Those sub-domains can be seen 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, containing
4 primary domains and 7 sub domains.
J.W.Foppe van Mil/ Nejc Horvat / Tommy Westerlund
Zuidlaren, April/May/June/October 2017
Changes between V8.01 and 8.02
The confusing term ‘Therapy failure’ has been removed from P1.1.
An omission has been corrected: C6.6 Administration via wrong route, cause code added.
Changes between V8.0 and 8.01
An omission has been corrected Code C3.5 had dropped out of the tables, and has been reinserted.
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PCNE Classification scheme for Drug-Related Problems V8.02 - Page 1
The basic classification
Code
V8.01
Primary domains
Problems
(also potential)
P1 Treatment effectiveness
There is a (potential) problem with the (lack of) effect of
the pharmacotherapy
P2 Treatment safety
Patient suffers, or could suffer, from an adverse drug event
P3 Others
Causes
(including possible causes
for potential problems)
C1 Drug selection
The cause of the DRP can be related to the selection of the
drug
C2 Drug form
The cause of the DRP is related to the selection of the drug
form
C3 Dose selection
The cause of the DRP can be related to the selection of the
dosage schedule
C4 Treatment duration
The cause of the DRP is related to the duration of treatment
C5 Dispensing
The cause of the DRP can be related to the logistics of the
prescribing and dispensing process
C6 Drug use/ process
The cause of the DRP is related to the way the patient gets
the drug administered by a health professional or carer, in
spite of proper instructions (on the label)
C7 Patient related
The cause of the DRP can be related to the patient and his
behaviour (intentional or non-intentional)
C8 Other
Planned Interventions I0 No intervention
I1 At prescriber level
I2 At patient level
I3 At drug level
I4 Other
Intervention Acceptance A1 Intervention accepted
A2 Intervention not accepted
A3 Other
Status of the DRP O0 Problem status unknown
O1 Problem solved
O2 Problem partially solved
O3 Problem not solved
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PCNE Classification scheme for Drug-Related Problems V8.02 - Page 2
The Problems
Primary Domain Code
V8.01
Problem
1.Treatment effectiveness
There is a (potential) problem
with the (lack of) effect of
the pharmacotherapy
P1.1 No effect of drug treatment
P1.2 Effect of drug treatment not optimal
P1.3 Untreated symptoms or indication
2. Treatment safety
Patient suffers, or could
suffer, from an adverse drug
event
P2.1 Adverse drug event (possibly) occurring
3. Others P3.1 Problem with cost-effectiveness of the treatment
P3.2 Unnecessary drug-treatment
P3.3 Unclear problem/complaint. Further clarification
necessary (please use as escape only)
 Potential Problem
 Manifest Problem
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PCNE Classification scheme for Drug-Related Problems V8.02 -Page 3
The Causes (including possible causes for potential problems)
N.B. One problem can have more causes
Primary Domain Code
V8.01
Cause
Prescribing
1. Drug selection
The cause of the (potential)
DRP is related to the selection
of the drug
C1.1 Inappropriate drug according to guidelines/formulary
C1.2 Inappropriate drug (within guidelines but otherwise
contra-indicated)
C1.3 No indication for drug
C1.4 Inappropriate combination of drugs or drugs and herbal
medication
C1.5 Inappropriate duplication of therapeutic group or active
ingredient
C1.6 No drug treatment in spite of existing indication
C1.7 Too many drugs prescribed for indication
2. Drug form
The cause of the DRP is related
to the selection of the drug form
C2.1 Inappropriate drug form (for this patient)
3. Dose selection
The cause of the DRP is related
to the selection of the dose or
dosage
C3.1 Drug dose too low
C3.2 Drug dose too high
C3.3 Dosage regimen not frequent enough
C3.4 Dosage regimen too frequent
C3.5 Dose timing instructions wrong, unclear or missing
4. Treatment duration
The cause of the DRP is related
to the duration of treatment
C4.1 Duration of treatment too short
C4.2 Duration of treatment too long
Disp
5. Dispensing
The cause of the DRP is related
to the logistics of the
prescribing and dispensing
process
C5.1 Prescribed drug not available
C5.2 Necessary information not provided
C5.3 Wrong drug, strength or dosage advised (OTC)
C5.4 Wrong drug or strength dispensed
Use
6. Drug use process
The cause of the DRP is related
to the way the patient gets the
drug administered by a health
professional or carer, despite
proper dosage instructions (on
the label)
C6.1 Inappropriate timing of administration and/or dosing
intervals
C6.2 Drug under-administered
C6.3 Drug over-administered
C6.4 Drug not administered at all
C6.5 Wrong drug administered
C6.6 Drug administered via wrong route
7. Patient related
The cause of the DRP is related
to the patient and his behaviour
(intentional or non-intentional)
C7.1 Patient uses/takes less drug than prescribed or does not
take the drug at all
C7.2 Patient uses/takes more drug than prescribed
C7.3 Patient abuses drug (unregulated overuse)
C7.4 Patient uses unnecessary drug
C7.5 Patient takes food that interacts
C7.6 Patient stores drug inappropriately
C7.7 Inappropriate timing or dosing intervals
C7.8 Patient administers/uses the drug in a wrong way
C7.9 Patient unable to use drug/form as directed
8. Other C8.1 No or inappropriate outcome monitoring (incl. TDM)
C8.2 Other cause; specify
C8.3 No obvious cause
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PCNE Classification scheme for Drug-Related Problems V8.02 -Page 4
The Planned Interventions
N.B. One problem can lead to more interventions
Primary Domain Code
V8.01
Intervention
No intervention I0.1 No Intervention
1. At prescriber level I1.1 Prescriber informed only
I1.2 Prescriber asked for information
I1.3 Intervention proposed to prescriber
I1.4 Intervention discussed with prescriber
2. At patient level I2.1 Patient (drug) counselling
I2.2 Written information provided (only)
I2.3 Patient referred to prescriber
I2.4 Spoken to family member/caregiver
3. At drug level I3.1 Drug changed to ….
I3.2 Dosage changed to ….
I3.3 Formulation changed to …..
I3.4 Instructions for use changed to …..
I3.5 Drug stopped
I3.6 New drug started
4. Other intervention or
activity
I4.1 Other intervention (specify)
I4.2 Side effect reported to authorities
Acceptance of the Intervention proposals
N.B. One level of acceptance per intervention proposal
Primary domain Code
V8.01
Implementation
1. Intervention accepted
(by prescriber or patient)
A1.1 Intervention accepted and fully implemented
A1.2 Intervention accepted, partially implemented
A1.3 Intervention accepted but not implemented
A1.4 Intervention accepted, implementation unknown
2. Intervention not
accepted
(by prescriber or patient)
A2.1 Intervention not accepted: not feasible
A2.2 Intervention not accepted: no agreement
A2.3 Intervention not accepted: other reason (specify)
A2.4 Intervention not accepted: unknown reason
3. Other (no information on
acceptance)
A3.1 Intervention proposed, acceptance unknown
A3.2 Intervention not proposed
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PCNE Classification scheme for Drug-Related Problems V8.02 -Page 5
Status of the DRP
N.B. This domain depicts the outcome of the intervention. One problem (or the combination of
interventions) can only lead to one level of solving the problem
Primary Domain Code
V8.01
Outcome of intervention
0. Not known O0.1 Problem status unknown
1. Solved O1.1 Problem totally solved
2. Partially solved O2.1 Problem partially solved
3. Not solved O3.1 Problem not solved, lack of cooperation of patient
O3.2 Problem not solved, lack of cooperation of prescriber
O3.3 Problem not solved, intervention not effective
O3.4 No need or possibility to solve problem
PCNE classification Help 8 15-6-2017 V8.02
PCNE
Classification
for Drug
related
problems
Help
V8.02
© 2003-2017 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: info@pcne.org
This help document is related to as ‘Help to the PCNE Classification V 8.02
PCNE classification Help 9 15-6-2017 V8.02
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 (or potential) problem
(that affects or is going to affect the outcome) from its cause(s). 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
drug-related problem, there can be no problem or the problem is potential. The cause is usually
the behaviour that has caused (or will cause) the problem, and most often that is a medication
error. 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 purposes.
If the system is used for documenting pharmaceutical care activities in practice, the sub domains
can be useful.
Problem section
Basically, the problem is defined as ‘the expected or unexpected event or circumstance that is,
or might be wrong, in therapy with drugs’. (the P-codes)
There are 3 major domains in the problem section. The following descriptions could help to find
the right problem domain:
The clinical effect of the treatment is not as expected or there is no treatment See P1
The patient suffers from an ADR at normal dose or from a toxic reaction See P2
Nothing seems wrong in the treatment, but there is another problem. See P3
Causes section
Each (potential) 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 (potential) causes for a
problem. (The C-code)
The cause of the DRP is related to the selection of the drug See C1
The cause of the DRP is related to the selection of the drug form See C2
The cause of the DRP is related to the selection of a dose or dosage schedule See C3
The cause of the DRP is related to the duration of the therapy See C4
The cause of the DRP is related to the logistics of the prescribing or dispensing
process
See C5
The cause of the DRP is related to the way the patient gets the drug administered by
a health professional or carer, despite proper dosage instructions (on the label).
(principally used for hospital or home-care by caregivers)
See C6
The cause of the DRP is related to the personality or the behaviour of the patient See C7
Other See C8
PCNE classification Help 10 15-6-2017 V8.02
Planned 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 See I0
Intervention through the prescriber See I1
Intervention through the patient, his carers or relatives See I2
Intervention directly by changing drug or indicating change in drug use See I3
Other intervention See I4
Level of acceptance of intervention proposals
In this section you can indicate if the suggestion for the intervention to patient or prescriber has
been accepted.
Intervention accepted (by prescriber or patient) See A1
Intervention not accepted (by prescriber or patient) See A2
No intervention proposed or acceptance unknown (no information) See A3
Status of the DRP
Previously called Outcome’, this section can be used to document if a problem has been solved.
For evaluation purposes it is desirable to indicate if the problem has been solved by a specific
intervention (the I-code), that has been not, partially or fully accepted by the prescriber and
patient (the A code).
Problem totally solved See O1
Problem partially solved See O2
Problem not solved See O3