How do you use the FAST Scale?

[NurseAlwaysNForever]

We seem to be disagreeing at work on how this scale is used. I use it just for alzheimer's/dementia and start at the top and work my way down only ranking them on the decline that is related to their alzheimer's/dementia. Another nurse that I work with is telling me that I am wrong. She rates them on the lowest that they can score, regardless of wether or not they have alzheimer's/dementia or not. For example:

89 y/o female with CHF. A&O x 3. Bed to w/c bound, needs assistance with transfers, etc d/t weakness. She would give them a FAST of 7C unable to ambulate without assistance. Without a dx of alzheimer's or dementia I would not use the FAST scale to document any of her confusion/forgetfulness, etc. d/t it just being from regular old age.

Which is correct?

[marachne]

I have not broached the subject with them as of yet, but I did send an e-mail to the compliance officer asking for clarification. I did not mention to her where the confusion was coming from, or mention any names, but did state that "we" were having some confusion, could she please clarify for us. This way I am not actually confronting any one in the office with the information. I felt it would be easier this way. you have been very helpful and I am very grateful. I will be printing off this information and leaving it in places they are sure to see it.

Thanks!!!!

That sounds like a good strategy.

Good luck, and let me know how it goes.

[NurseAlwaysNForever]

Well the compliance officer agrees with them. She states that it is just to document decline and they expect it to decrease as the patient declines. How do I argue this issue with the compliance officer without getting fired? I am at a loss. I know I am right, and I can't bring myself to use the scales the way that they do. It doesn't make since. The compliance officer said to start at the bottom and work my way backwards until I get to the one that fits my patient. AAARRRGGGGh. It is so aggravating.

[marachne]

Well the compliance officer agrees with them. She states that it is just to document decline and they expect it to decrease as the patient declines. How do I argue this issue with the compliance officer without getting fired? I am at a loss. I know I am right, and I can't bring myself to use the scales the way that they do. It doesn't make since. The compliance officer said to start at the bottom and work my way backwards until I get to the one that fits my patient. AAARRRGGGGh. It is so aggravating.

:icon_hug:

I'm so sorry to hear this. I don't know what kind of agency you work for (i.e. are they an independent agency, part of a chain, part of a larger healthcare system like a hospital system, etc.)

Because the only thing I can think of is going outside your immediate situation but w/i you system -- closer to home, your medical director? if you are in a chain, maybe there is someone at a national level? If part of a larger system, a geriatrician or an dementia clinic?

I understand you're frustration -- are you saying that they are insisting that you chart that way? Using FAST scale numbers?

Besides your own integrity, I would be concerned that any kind of chart review could cause serious problems for the agency.

I'm hoping that someone else will speak up and maybe offer you other ideas of how to deal with this.

[twinkle_ears]

I have always been taught that the FAST scale goes from 1 to 7 and you can not go forward without having the previous on the scale therefore, someone that is A&O x3 cannot be a 7C because they are able to speak more than 6 intelligle words throughout a day or conversation. Even if this pt can't walk. If they were incontinent of both B&B they would then only be a 6E. Therefore you cannot use dementia as primary dx. This has caused many a long recertification because our hospice docs will fight tooth and nail to make sure they do not speak more than 6 intelligle words. The person must have severe dementia to use this as a hospice diagnosis and just because they cannot walk does not make them a 7C if they can hold a conversation with you. Hope this helps.

[marachne]

Twinkle ears, the issue is that people at OP's agency are using it for documentation for people without dementia.

The scale is one that is used for a prognosis (and yes, now a certification) tool for people w/AD. The OP's colleagues are using it for people with totally different dx, which I think is not only wrong, but can get the agency in a lot of hot water!

Now they're telling the OP that she has to chart that way too, even though it doesn't make any sense.

[NurseAlwaysNForever]

We actually are doing web based charting and it HAS to be filled out to proceed to the next page. I have been checking a 1 for my patients who do not have dementia/alzheimers, but have been instructed to start at the bottom and work may way up regardless.

[RN4ustat, BSN, RN]

Wow!! Thanks for the links.......looks like some really good info!! I was very fascinated by the dementia prognostication info, specifically the mention of the Mortality Risk Index as the company I work for has recently started to use it in determining eligibility. Thanks again for the info!!

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This could lead to serious problems for your agency if you're not using the tools the same (which means at least one of you is using it wrong!) And I'm assuming these instruments are being used as part of the continuing certification as well as to document decline from a clinical stand point.

I'm attaching "Fast Fact #150, Prognostication of Dementia" it should help with your documentation. I found it pretty easy just by putting into Google "Dementia Prognostication FAST score" it was the first hit. I guess I've just gotten good at doing searches.

But you should also know about the "Fast Facts" in general -- there's even a downloadable version for a PDA! You can find them here: http://www.eperc.mcw.edu/ff_index.htm

And there's even a search function now.

The PPS is discussed in FF #125

Also, Growth House has a link to various tools here: http://www.growthhouse.org/promotingexcellence/

Good luck. I hope these documents help

Concept 150 Dementia Formatted.pdf

[robbinsg]

Here are the actual instructions on how to score the FAST scale:

INSTRUCTIONS

The FAST Stage is the highest consecutive level of disability. For clinical purposes, in addition to staging the level of disability, additional, non-ordinal (nonconsecutive) deficits should be noted, since these additional deficits are of clear clinical relevance.

For the purpose of therapeutic trials, the FAST can be used to sensitively encompass the full range in functional disability in CNS aging and dementia. For these purposes the FAST Disability Score should be obtained as follows:

(1) Each FAST substage should be converted into a numerical stage. Specifically, the following scoring should be applied: 6a=6.0; 6b=6.2; 6c=6.4; 6d = 6.6; 6e = 6.8; 7a = 7.0; 7b=7.2; 7c=7.4; 7d=7.6; 7e=7.8; 7f=8.0.

(2) The consecutive level of disability (FAST stage) is scored and given a numerical value.

(3) The non-consecutive FAST deficits are scored. A non-consecutive full stage deficit is scored as 1.0. A non-consecutive sub - stage deficit is scored as 0.2.

(4) The FAST Disability Score =( The FAST Stage Score) + (Each Non-Consecutive FAST disability scored as described).

For example, if a patient is at FAST Stage 6a, then the patient's FAST stage score = 6.0. By definition, this patient cannot handle a job, manage their personal finances, independently pick out their clothing properly, or put on their clothing properly without assistance. If, in addition, this patient is incontinent of urine and cannot walk without assistance, then nonconsecutive deficits "6d" and "7c" are scored. The FAST Disability Score for this patient is 6.0 + 0.2+0.2 = 6.4.

[marachne]

Here are the actual instructions on how to score the FAST scale:

INSTRUCTIONS

The FAST Stage is the highest consecutive level of disability. For clinical purposes, in addition to staging the level of disability, additional, non-ordinal (nonconsecutive) deficits should be noted, since these additional deficits are of clear clinical relevance.

For the purpose of therapeutic trials, the FAST can be used to sensitively encompass the full range in functional disability in CNS aging and dementia. For these purposes the FAST Disability Score should be obtained as follows:

[snip] .

So what, exactly do you think is meant by "CNS aging?"

I would also refer back to the article I cited in my earlier post -- the reliability of the FAST has studied and validated with AD, but I'm not so sure about its reliability or validity for other conditions. For example, we know that vascular dementia has a different presentation, and therefore may not progress in the same way. Lewy Body Dementia is even more of a different course, and we're still talking dementias.

(the line in the abstract I'm referring to is: "This system has been studied extensively and proven to be reliable and valid for staging dementia in Alzheimer's disease (AD)"

I guess the caveat/point I'm trying to make is just because a scale/instrument exists, doesn't mean it's the best thing to use. Now if funding is based on using it, then you're stuck until something changes. But my understanding is that even w/CMS no one expects agencies to use the FAST for anything other than dementia.