Using the FAST scale in Hospice

[Axelsmomma]

There has been some discussion within our Hospice as how to use the FAST scale for dementia patients. Our clinical manager says that even if the patient is ambulatory (whether independantly using walker, merry walker etc) but does not have the cognitive ability to go into the bathroom if told to they are marked nonambulatory. Any information that I can find on this indicate that the patient is marked 7c Nonambulatory only if they are unable to walk w/o assistance. How do others interpret this?

[tewdles, RN]

The FAST scale is reasonably clear about this. Ambulation is separate from continence in the assessment. Loss of ability to ambulate is an indication of severe dementia while incontinence generally rears it's ugly head first in moderate levels.

[Axelsmomma]

I'm not referring to the issue of incontinence, but to the cognitive ability to know where or what a bathroom is. We are being told that even though the patient is able to ambulate w/a merry walker etc and basically just wanders the facility all day, if she does not have the cognitive ability to go to her room when asked to, we should be marking them as nonambulatory because of this cognitive deficit. I disagree but can find nothing to back it up.

[tewdles, RN]

Walking with a merry walker is not ambulating un-assisted, IMHO. The merry walker fact is important in that assessment.

[Kendra278]

If they are ambulatory, then you cannot go beyond that staging in the FAST scoring. You should not skip FAST scoring levels. Unfortunately, not every Dementia patient follows the same path.

[tewdles, RN]

How about adding another functional assessment tool to the practice to help you qualify the borderline patients? For instance, the Palliative Performance Scale works well for us and may be more predictive of prognosis (according to some studies).