Using PPS Palliative Performance Scale - page 2

by military spouse

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Hello all, I've worked for two different hospices with varying opinions and I was interested in how all of you use the PPS. I'm mostly concerned with 7c. If they ambulate independently, but are a fall risk with hx of falls and... Read More


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    Quote from Ginapixi
    I can see that some may take offense at my comment, but it has bothered me for quite some time that nursing, even hospice nursing, has become such a business. We need to fit people into categories in order to get the needed support for them; some patients really need the help but are not willing to accept it even if they qualify; others really need the help but we cannot get it for them because they do not quite qualify; then we get the ones who will take any thing because they qualify. How many times have I done the "aid's work" because it was needed at the time of my visit, then was told I spent too much time there, yet we are also not allowed to give help off the time sheet. To me it will always be a financially driven business (and i worked for a non profit!) and not a patient driven care service as long as we have categories and constantly growing regulations.
    I'm not offended, but I do think these tools are needed. I work in an in pt palliatve unit of a hospital. We accept pts on who needs the service the most. 2 pts at home, the family can no longer provide the needed care. As long as they have a life expectancy of less then three months we'll take them, however we only have one bed. So who do we take? That's when the pps is used. I understand your point, but think they do have a place.
    tewdles and Ginapixi like this.
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    I'm not offended, but I do think these tools are needed. I work in an in pt palliatve unit of a hospital. We accept pts on who needs the service the most. 2 pts at home, the family can no longer provide the needed care. As long as they have a life expectancy of less then three months we'll take them, however we only have one bed. So who do we take? That's when the pps is used. I understand your point, but think they do have a place.
    yes, I was not implying they are no good, they can be helpful, I just think we put too much emphasis on them; I am so sorry to hear about the shortage of beds, but we used to have to pick and chose (unfortunately many times the choice fell to the ones that could pay, but not always)
    and thanks for not misunderstanding
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    Our job as nurses, is to take the info from the various tools and paint the picture of the "whole" patient for the team.

    Without the tools the picture becomes too narrative and subjective.

    We have to be professional enough to use them correctly.
    Last edit by tewdles on Dec 31, '12 : Reason: spelling
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    You are getting your scales mixed up. The FAST scale uses numbers 1-7 and is used to rate dementia symptoms. PPS is a general scale of functionality and is used on all patients. It is scored in percentages, 0-100%. Patients on hospice are generally 40% or less (except cancer patients, which can be 70% or less).

    A FAST score of 7c is "ambulatory ability is lost (cannot walk without personal assistance)." To me this means that unless the patient requires someone at their side assisting with every ambulation, they don't meet the criteria for a FAST of 7c. I suspect our regulators would see it this way as well.
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    I am curious, if you are in hospice and you don't use FAST, how to do you document dementia? Medicare requires FAST documentation (at least in our neck of the woods the regional CMS requires it)
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    I would say your current employer's approach is just plan wrong! I sure wouldn't want to defend that on a Medicare audit! I think the language is pretty clear, if the patient is able to ambulate independently, they don't meet the criteria for a 7c FAST score.


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