HOPE Guidance Manual v1.02, Item N0510

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 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 PRN opioid initiated or continued?

• Code 0, No, if a PRN opioid was neither initiated nor continued and/or the clinical record indicates

that a PRN opioid was neither initiated nor continued from the previous care setting.

• Code 1, Yes, if a PRN opioid was initiated or continued and/or the clinical record indicates that a PRN

opioid was initiated or continued from the previous care setting.

B. Date PRN 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 PRN opioid order (whether hospice initiated or continued from prior care setting) was

received, irrespective of if/when the first dose was given (assuming instructions have been provided to

initiate).

o If the patient received instructions for different types of PRN 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 PRN 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 N0510B.

• 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 1, Yes, if the clinical record indicates that a PRN opioid was initiated for any reason, regardless of

symptom.

• For the purposes of completing Item N0510, an “opioid” includes Schedule II– Schedule IV opioids,

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