The Clinical Care Classification (CCC) System is a standardized, coded nursing terminology that identifies the discrete elements of nursing practice. The CCC provides a unique framework and coding structure. Used for documenting the plan of care; following the nursing process in all health care settings.Saba, V. K. (2005). Clinical Care Classification (CCC) of Nursing Interventions. Retrieved December 15, 2005, from http://www.sabacare.com.
The Clinical Care Classification (CCC), previously the Home Health Care Classification (HHCC), was originally created to document nursing care in home health and ambulatory care settings. Specifically designed for clinical information systems, the CCC facilitates nursing documentation at the point-of-care. The CCC was developed empirically through the examination of approximately 40,000 textual phrases representing nursing diagnoses/patient problems, and 72,000 phrases depicting patient care services and/or actions. The use of the CCC has expanded into other settings, and it is claimed to be appropriate for multidisciplinary documentation.
The CCC, capturing the essence of patient care, consists of two interrelated terminologies – the CCC of Nursing Diagnoses & Outcomes and the CCC of Nursing Interventions & and Actions – classified by 21 Care Components that link the two together. This merge enables a roadmap to other health-related classification systems.
The Clinical Care Classification (CCC) System is an American Nurses Association (ANA)-recognized comprehensive, coded, nursing terminology standard. In 2007, the CCC was accepted by the Department of Health and Human Services as the first national nursing terminology.American Health Information Community Meeting 31 October 2006, Alliance for Nursing Informatics (ANI), News of 12 February 2007 http://www.allianceni.org/docs/news012007.pdf The computable structure of the CCC System allows nurses, allied health professionals, and researchers to determine; care needs (resources), workload (productivity), and outcomes (quality).
History In 1988 to 1990, Harriet Werley established the Nursing Minimum Data Set, which consisted of 12 variables: 8 variables focused on patient demographics and the remaining 4 focused on nursing practice. These were (a) nursing diagnoses, (b) nursing interventions, (c) nursing outcomes, and (d) nursing intensity. The Nursing Minimum Data Set became the basis for the nursing classification standards recognized by the ANA.(Werley & Lang, 1988. Identification of Nursing Minimum Data Set (NMDS). In 1990, the CCAIN was renamed the Database Steering Committee.
In 1991, the Database Steering Committee submitted to the Congress on Nursing Practice a resolution that NI be adopted as a new nursing specialty. This submission which was accepted, leading to the development of the Nursing Informatics: Scope and Standards of Practice(ANA, 2008). Nursing Informatics: Scope and Standards of Practice. Sliver Spring, MD:ANA and the certification of NI specialists. In 1992, the Database Steering Committee developed the criteria, recognizing the first 4 of 12 nursing classifications/terminologies. One being the CCC System. Previously known as the Home Health Care Classification System, as nursing standards for the documentation of nursing practice using computer technology systems.(Saba, 2011). Overview of the Clinical Care Classification: A national nursing standard coded terminology. The ANA subsequently submitted the four of six classifications/terminologies to the National Library of Medicine for input into its developing Unified Medical Language System's (UMLS) Metathesaurus.
In 2006, President George W. Bush issued an Executive Order (No. 13410) that every person in the country should have an EHR by 2014. In 2007/2008, the Healthcare Information Technology Standards Panel selected and recommended the Clinical Care Classification (CCC) System as the first national nursing terminology inter operable for the exchange of information among HIT systems. The CCC System was one of the standards in the first set of 55 national standards approved for use in the EHR, by the Department of Health and Human Services (AHIC, 2006) and the only national nursing terminology standard.
In 2020, HCA Healthcare became the new custodian of Dr. Virginia Saba's Clinical Care Classification (CCC) System.
Major features Consists of discrete atomic-level concepts using qualifiers to enhance and expand the concepts. Data are collected once and used many times for many purposes including efficient aggregation. Copyrighted and in the public domain; available with permission without any cost or license. Specifically designed for electronic health records (EHRs) and healthcare information technology (HIT) systems as well as other electronic information processing systems. Tested and applicable in ALL healthcare settings. Conforms to Cimino (1998) criteria for a standardized healthcare terminology. Coded standardized framework for electronic documentation, retrieval, and analysis. Codes based on ICD-10 (WHO, 1992) structure for information exchange promoting interoperability. Uses a coding structure of five alphanumeric digits to link the two CCC System terminologies to each other and to map to other EHR/HIT systems. Designed for determining workload (productivity), resources (needs), outcomes (quality), and care costs. Concept terminology with online source files so public and private organizations may harmonize nursing information formats for cross-organizational sharing of information. Facilitates the electronic documentation of patient care at the point of care. Uses a framework of care components to classify the two CCC System terminologies and represent 4 healthcare patterns focusing on a holistic approach to patient care. Consists of flexible, adaptable, and expandable concepts/data elements.
The CCC Model The CCC Model depicts the documentation of patient care by nurses and allied health providers in any health care setting as an interactive, interrelated, and continuous feedback process. The CCC Model illustrates the relationship between the CCC of Nursing Diagnoses and Outcomes and the CCC of Nursing Interventions and Actions. The arrows are bi-directional indicating the continual flow and feedback among the three major concepts: Nursing Diagnoses Interventions Outcomes.
System framework Components: A nursing care component is defined as a cluster of elements that represents a unique pattern of clinical care nursing practice; namely, Health Behavioral, Functional, Physiological, and Psychological. Nursing Diagnoses: A clinical judgment about the healthcare consumer's response to actual or potential health conditions or needs. The diagnosis provides the basis for determination of a plan to achieve expected outcomes. Registered nurses utilize nursing and medical diagnoses depending upon education and clinical preparation and legal authority."American Nurses Association (2010). Nursing: Scrope and Standards of Practice. Sliver Spring, p. 64 Nursing Interventions: A nursing intervention is defined as a single nursing action – treatment, procedure or activity – designed to achieve an outcome to a diagnosis, nursing or medical, for which the nurse is accountable.Saba, V. K. (2007). Clinical Care Classification (CCC) System manual: A guide to nursing documentation. New York: Springer Publishing. Patient services are usually initiated as medical orders by a referring physician and reviewed by the admitting nurse. As part of the admission assessment the primary nurse also determines the nursing orders based on the signs and symptoms, diagnoses, and expected outcomes/goals; and together, form the plan of care that requires the nursing interventions following the nursing process. Nursing Outcomes: The CCC of Nursing Outcomes Version 2.5 consists of 528 concepts derived from the three qualifiers used to modify the 176 Nursing Diagnoses: Improve(d), Stabilize(d), or Deteriorate(d). These three qualifiers depict the Expected Outcomes and Actual Outcomes – totaling 528 nursing outcome concepts. The Expected Outcomes represent the goal of patient care in future tense as Will: Improve, Stabilize, or Deteriorate whereas the Actual Outcomes represent whether the goals were met or not met using the qualifiers in the past tense as Improved, Stabilized, or Deteriorated.
The CCC System consists of discrete atomic-level data elements that encompasses nursing diagnoses, interventions, and outcomes. The CCC is a nursing terminology specifically developed for computerization: e.g. electronic healthcare information systems (EHR), computer-based patient records (CPR), and Clinical Information Systems (CIS), from research which collected live patient care data. The CCC System describes the six steps of the nursing process: Assessment Diagnosis Outcome Identification Planning Implementation Evaluation
The nursing process is the standard of professional nursing practice recognized by the ANA for clinical decision making in a coded, standardized framework. The CCC supports the exchange of nursing information and makes available for data retrieval and analysis in the electronic health record and health information record systems databases specifically linking nursing diagnoses to nursing interventions to nursing outcomes. Open Architecture Specifically designed for computer-based systems – EHR, CIS, and PHR Tested and applicable in ALL healthcare settings.Gartee, R. & Beale, S. (2011). Electronic Health Records and Nursing. Upper Saddle River, NJ: Pearson/Prentice Hall.Feeg, V. D., Saba, V. K., & Feeg, A. (2008). Development and testing of a bedside personal computer (PC) Clinical Care Classification System for nursing students using Microsoft Access, Computers in Nursing, 26 (6), 339-49.Moss, J., Damrongsak, M., & Gallichio, K. (2005). Representing critical care data using the Clinical Care Classification. In C. P. Friedman, J. Ash, & P. Tarcy-Hornoch (Eds.), American Medical Informatics Association 2005 Proceedings: CD-ROM (pp. 545–549). Washington, Dc: OmniPress, Omipro-CD. Atomic-Level Concepts Approved as an interoperable terminology by the American National Standards Institute (ANSI) Standards Development Organization (SDO) Health Level Seven (HL7®). Conforms to Cimino criteria for a standardized terminologyIn Defense of the Desiderata, by James J. Cimino, Journal of Biomedical Informatics – JBI, vol. 39, no. 3, pp. 299-306, 2006 Coded standardized framework for electronic documentation, retrieval & analysis Codes based on ICD structure for information exchange promoting interoperability Designed for determining care costs Integrated in the Metathesaurus of the Unified Medical Language System (UMLS) of the National Library of Medicine (NLM) and SNOMED CT Integrated in the Cumulative Index to Nursing and Allied Health Literature® (CINAHL) Used in the Clinical LOINC System for documenting diagnoses outcomes Tested as an international nursing standard based on the An Integrated Reference Terminology Model for Nursing approved by the International Organization for Standardization (ISO/TC 215:Health Informatics) in October 2003. Concept terminology with online source files so public and private organizations may harmonize nursing information formats for the cross organizational sharing of information.ANSI/HISB (1998/1999) Home health care classification (HHCC) of nursing diagnosis and nursing interventions. Inventory of Clinical Information Standards. Washington, DC: ANSI. One of the contributed terminologies used as the basis for the original alpha version of the International Classification of Nursing Practice (ICNP®) developed by the International Council of Nurses (ICN).