CCC System Framework
CCC System Framework

CCC System version 2.5 offers a new approach to documenting nursing practice in an electronic health record (EHR). It consists of a standardized framework representing four unique levels that represent:

  • 176 nursing diagnoses,
  • 804 nursing interventions/actions
  • 528 nursing outcomes

All are classified by 21 care components representing four healthcare patterns to form one system — CCC System. 

The framework’s four levels make it possible to code the concepts for each level separately so that the coded data can be aggregated upward for summary information or parsed downward to view the atomic level data elements.

  • 1st level: Four healthcare patterns categorize the care components:
    • Physiological
    • Psychological
    • Functional
    • Health behavioral
  • 2nd level: 21 care components classify the CCC System terminologies:
    • Activity, bowel/gastric, cardiac, cognitive/neuro, coping, fluid volume, health behavior, medication, metabolic, nutritional, physical regulation, respiratory, role relationship, safety, self-care, self-concept, sensory, skin integrity, tissue perfusion, urinary elimination, life cycle.
  • 3rd level: Two nursing terminologies that consist of these coded concepts:
    • CCC of 176 nursing diagnoses/problems
    • CCC of 804 nursing interventions/actions (201 core nursing interventions with four action types)
    • CCC of 528 nursing outcomes (176 diagnoses with three outcome qualifiers)
  • 4th level: Two sets of separate concept qualifiers:
    • Three outcome qualifiers (improved, stabilized or deteriorated). 528 outcomes: Each nursing diagnosis is combined with one of three outcomes to depict the expected and/or actual outcomes.
    • Four action type qualifiers (monitor, perform, teach or manage). 804 nursing intervention /actions: Each nursing intervention is combined with one of four action types to expand the scope of the intervention.

Coding structure

The CCC System Coding Structure is similar to ICD-10 (International Statistical Classification of Diseases and Health-Related Problems, 1990). Each concept code consists of five alphanumeric characters for information exchange and interoperability:

1st: Alpha character represents care component = A

2nd: Two or three digits represent nursing concepts = A02.1

  • A nursing concept represents either nursing diagnosis or nursing intervention

3rd: Last digit represents either:

  • One of three outcome qualifiers (last digit), or
  • One of four intervention action types (last digit)