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6 Tips for Answering N0415-High-Risk Drug Classes

    The launch of OASIS-E on January 1, 2023, introduced several new assessment items, including N0415 High-Risk Drug Classes: Use and Indication, to ensure consistency across various post-acute care settings.

    The purpose of the OASIS item is to determine if the patient is taking any medications in high-risk drug classes, ensuring there is a patient-specific indication noted and that the patient or caregiver has been educated about these high-risk medications. It also aims to confirm that a drug regimen review was conducted and to assess the patient’s ability to manage both oral and injectable medications.

    Understanding N0415 in the OASIS

    Data for N0415 is collected in OASIS Start of Care (SOC), Resumption of Care (ROC) and Discharge. This OASIS item requires the assessing clinician to review the patient’s current reconciled drug regimen while they are under the care of the home health agency. It asks 1) whether the patient is taking any prescribed medications that fall into one of six high-risk drug classes, and 2) whether these prescribed medications have a patient-specific indication noted. The six  high-risk drug classes are Antipsychotics, Anticoagulants, Antibiotics, Opioids, Antiplatelets, and Hypoglycemics – including insulin.

    Tips for answering N0415

    1. When coding a patient’s current reconciled drug regimen, include all medications, even if they were not taken at the time of assessment. This includes new medications the patient has not yet started and those taken infrequently, such as every few weeks or monthly.
    2. It is not necessary for the drug’s classification to align with the reason the patient is taking it. For instance, a drug might be classified as an antipsychotic but is being used to treat severe agitation (associated with advanced dementia). As long as the medication belongs to one of the specified high-risk drug classes and there is a specific reason noted for the patient taking it, both column 1 (indicating the drug class) and column 2 (indicating the patient-specific reason) should be checked for that drug. The key is that the medication falls into a high-risk category and there is a documented, specific reason for the patient using it.
    3. If a single drug could be classified into two different drug classes, then both drug classes should be checked for that drug.
    4. Do not include flushes used to keep an IV port patent or herbal and alternative medicine products when collecting data for N0415. These items should not be considered even if they are part of the current reconciled medication drug regimen.
    5. If at least one of the drug classes A-J is selected, do not select Z – None of the above. Conversely, if Z – None of the above is selected, ensure that no drug classes A-J are selected.
    6. Do not code N0415 based on what is expected to occur at discharge.