International Journal of Clinical Pharmacy

, Volume 34, Issue 1, pp 43–52 | Cite as

DOCUMENT: a system for classifying drug-related problems in community pharmacy

  • Mackenzie WilliamsEmail author
  • Gregory M. Peterson
  • Peter C. Tenni
  • Ivan K. Bindoff
  • Andrew C. Stafford
Research Article


Background Drug-related problems (DRPs) are a major burden on the Australian healthcare system. Community pharmacists are in an ideal position to detect, prevent, and resolve these DRPs. Objective To develop and validate an easy-to-use documentation system for pharmacists to classify and record DRPs, and to investigate the nature and frequency of clinical interventions undertaken by Australian community pharmacists to prevent or resolve them. Setting Australian community pharmacies. Method The DOCUMENT classification system was developed, validated and refined during two pilot studies. The system was then incorporated into software installed in 185 Australian pharmacies to record DRPs and clinical interventions undertaken by pharmacists during a 12-week trial. Main outcome measure The number and nature of DRPs detected within Australian community pharmacies. Results A total of 5,948 DRPs and clinical interventions were documented from 2,013,923 prescriptions dispensed during the trial (intervention frequency 0.3%). Interventions were commonly related to Drug selection problems (30.7%) or Educational issues (23.7%). Pharmacists made an average of 1.6 recommendations per intervention, commonly relating to A change in therapy (40.1%) and Provision of information (34.7%). Almost half of interventions (42.6%) were classified by recording pharmacists as being at a higher level of clinical significance. Conclusion The DOCUMENT system provided pharmacists with a useful and easy-to-use tool for recording DRPs and clinical interventions. Results from the trial have provided a better understanding of the frequency and nature of clinical interventions performed in Australian community pharmacies, and lead to a national implementation of the system.


Documentation system Australia Classification system Drug-related problems Clinical interventions Pharmacy interventions 



The researchers would like to acknowledge the participating pharmacists and additional people who worked on the project (especially Josie Hughes, Colin Curtain, Dr Shane Jackson, Dr Luke Bereznicki, Lauren Ellerton, Traycee Di Virgilio, Les Vincent, and Peter Brownscombe).


The research was funded by the Australian Government Department of Health and Ageing as part of the Third and Fourth Community Pharmacy Agreement Research and Development Programs managed by the Pharmacy Guild of Australia.

Conflicts of interest

The authors declare there are no conflicts of interest that may involve the subject matter of the manuscript and compromise its integrity.


  1. 1.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533–43.PubMedGoogle Scholar
  2. 2.
    Bourgeois FT, Shannon MW, Valim C, Mandl KD. Adverse drug events in the outpatient setting: an 11-year national analysis. Pharmacoepidemiol Drug Saf. 2010;19:901–10. doi: 10.1002/pds.1984.PubMedCrossRefGoogle Scholar
  3. 3.
    Wu TY, Jen MH, Bottle A, Molokhia M, Aylin P, Bell D, et al. Ten-year trends in hospital admissions for adverse drug reactions in England 1999–2009. J R Soc Med. 2010;103:239–50. doi: 10.1258/jrsm.2010.100113.PubMedCrossRefGoogle Scholar
  4. 4.
    Roughead EE, Semple SJ. Medication safety in acute care in Australia: where are we now? Part 1: a review of the extent and causes of medication problems 2002–2008. Aust N Z Health Policy. 2009;6:18. doi: 10.1186/1743-8462-6-18.CrossRefGoogle Scholar
  5. 5.
    Winterstein AG, Sauer BC, Hepler CD, Poole C, Suarez EC, Kaiser J-M. Preventable drug-related hospital admissions. Ann Pharmacother. 2002;36:1238–48.PubMedCrossRefGoogle Scholar
  6. 6.
    Howard RL, Avery AJ, Slavenburg S, Royal S, Pipe G, Lucassen P, et al. Which drugs cause preventable admissions to hospital? A systematic review. Br J Clin Pharmacol. 2007;63:136–47. doi: 10.1111/j.1365-2125.2006.02698.x.PubMedCrossRefGoogle Scholar
  7. 7.
    Gandhi TK, Weingart SN, Borus J, Seger AC, Peterson J, Burdick E, et al. Adverse drug events in ambulatory care. N Engl J Med. 2003;348:1556–64. doi: 10.1056/NEJMsa020703.PubMedCrossRefGoogle Scholar
  8. 8.
    Tache SV, Sonnichsen A, Ashcroft DM. Prevalence of adverse drug events in ambulatory care: a systematic review (July/August). Ann Pharmacother. 2011. doi: 10.1345/aph.1P627.
  9. 9.
    Berenguer B, La Casa C, de la Matta MJ, Martin-Calero MJ. Pharmaceutical care: past, present and future. Curr Pharm Des. 2004;10:3931–46.PubMedCrossRefGoogle Scholar
  10. 10.
    Schaefer MA. Discussing basic principles for a coding system of drug-related problems: the case of PI-Doc(r). Pharm World Sci. 2002;24:120–7.PubMedCrossRefGoogle Scholar
  11. 11.
    PCNE DRP Classification System 2006: Available from:
  12. 12.
    Eichenberger PM, Lampert ML, Kahmann IV, van Mil JW, Hersberger KE. Classification of drug-related problems with new prescriptions using a modified PCNE classification system. Pharm World Sci. 2010;32:362–72. doi: 10.1007/s11096-010-9377-x.PubMedCrossRefGoogle Scholar
  13. 13.
    Westerlund T, Almarsdottir AB, Melander A. Drug-related problems and pharmacy interventions in community practice. Int J Pharm Pract. 1999;7:40–50.CrossRefGoogle Scholar
  14. 14.
    McKenzie D, Peterson GM. Interventions in community pharmacies [Honours]. Hobart: University of Tasmania; 2002.Google Scholar
  15. 15.
    Peterson GM, Tenni PC. Evaluation of clinical interventions within community pharmacy (PROMISe II): Pharmacy Guild of Australia 2007. Available from:
  16. 16.
    Peterson GM, Tenni PC, Jackson SL, Bereznicki LRE, Hughes JD, Kong DCM, et al. Documenting clinical interventions in community pharmacy: PROMISe III: Pharmacy Guild of Australia 2010. Available from:
  17. 17.
    Granas AG, Berg C, Hjellvik V, Haukereid C, Kronstad A, Blix HS, et al. Evaluating categorisation and clinical relevance of drug-related problems in medication reviews. Pharm World Sci. 2010;32:394–403. doi: 10.1007/s11096-010-9385-x.PubMedCrossRefGoogle Scholar
  18. 18.
    Tenni P, Peterson G, Williams M. Abstracts of the PCNE 7th working conference: clinical interventions in Australian community pharmacies. Pharm World Sci. 2009;31:494–508. doi: 10.1007/s11096-009-9298-8.CrossRefGoogle Scholar
  19. 19.
    Lampert ML, Kraehenbuehl S, Hug BL. Drug-related problems: evaluation of a classification system in the daily practice of a Swiss University Hospital. Pharm World Sci. 2008;30:768–76. doi: 10.1007/s11096-008-9213-8.PubMedCrossRefGoogle Scholar
  20. 20.
    Krahenbuhl JM, Kremer B, Guignard B, Bugnon O. Practical evaluation of the drug-related problem management process in Swiss community pharmacies. Pharm World Sci. 2008;30:777–86. doi: 10.1007/s11096-008-9217-4.PubMedCrossRefGoogle Scholar
  21. 21.
    Leemans L, Veroeveren L, Bulens J, Hendrickx C, Keyenberg W, Niesten F, et al. Frequency and trends of interventions of prescriptions in Flemish community pharmacies. Pharm World Sci. 2003;25:65–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Kwint HF, Faber A, Gussekloo J, Bouvy ML. Effects of medication review on drug-related problems in patients using automated drug-dispensing systems: a pragmatic randomized controlled study. Drugs Aging. 2011;28:305–14. doi: 10.2165/11586850-000000000-00000.PubMedCrossRefGoogle Scholar
  23. 23.
    Westerlund LT, Bjork HT. Pharmaceutical care in community pharmacies: practice and research in Sweden. Ann Pharmacother. 2006;40:1162–9. doi: 10.1345/aph.1G680.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Mackenzie Williams
    • 1
    Email author
  • Gregory M. Peterson
    • 1
  • Peter C. Tenni
    • 1
  • Ivan K. Bindoff
    • 1
  • Andrew C. Stafford
    • 1
  1. 1.School of PharmacyUniversity of TasmaniaHobartAustralia

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