Using PPS Palliative Performance Scale

[military spouse]

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 would benefit from personal assistance, would you rate them a 7c? I would appreciate any input. I really want to do the right thing and have asked at my current employer and the answers seem very vague and seem to change a bit at times. Would love to hear how all of you handle this :)

[tewdles, RN]

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.

[areensee]

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.

[areensee]

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)

[areensee]

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.