HOPE Guidance Manual v1.02, Item N0500

Timepoint(s) Item Completed

Admission (ADM)

HOPE Update Visit 1 (HUV1)

HOPE Update Visit 2 (HUV2)

Item-Specific Instructions

• Item completion should be based on what is determined during the assessment visit. and/or included in

the clinical record. Do not use sources external to the clinical record.

• Review the clinical record for information regarding medications and prescriptions.

• Review all response choices before making a selection.

A. Was a scheduled opioid initiated or continued?

• Code 0, No, if a regularly scheduled opioid was neither initiated nor continued and/or the clinical

record indicates that a scheduled opioid was neither initiated nor continued by the hospice and skip to

Item N0510, PRN Opioid.

• Code 1, Yes, if a regularly scheduled opioid was initiated or continued and/or the clinical record

indicates that a scheduled opioid was initiated or continued from the previous care setting.

B. Date scheduled opioid initiated or continued

• Treatment is considered initiated when the hospice has received the order and there is documentation

that the patient/caregiver was instructed to begin use of the medication or treatment.

o An order may be verbal (when permitted) or written.

o Responses should be based on whichever was used to determine the start of treatment.

• Enter date the scheduled opioid order was received, irrespective of if/when the first dose was given.

o If the patient received instructions for different types of regularly scheduled opioids in sequence over

time, enter the date that the order for the first type of opioid treatment was received.

o Note: In order to continue regularly scheduled opioids from a previous care setting, the hospice must

receive a new order to continue the treatment. Once this order is received, the date the hospice

received the order is entered in N0500B.

• For comfort kits or pre-printed admission orders:

o Proactive education on medications in a comfort kit in anticipation of symptoms is not considered

initiation.

o Code based on when the order was both received and initiated.

o If the date the hospice received the order is different than the date the hospice instructed the

patient/caregiver to begin using the treatment/medication, “date treatment initiated” would be the

date when both conditions were met (that is, the date the hospice received the order and instructed

patient/caregiver to begin use).

Coding Tips

• Code response 1, Yes if the clinical record indicates that a regularly scheduled opioid was initiated for

any reason, regardless of symptom.

• For the purposes of completing Item N0500, an “opioid” includes Schedule II – Schedule IV opioids,

including hydrocodone and tramadol, because of the side effect profile, which includes constipation.