Using PPS Palliative Performance Scale

tewdles, RN · Dec 19, 2012

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 :)

Are you confusing the FAST with the PPS?

The FAST has a level 7c which describes the ambulatory ability of the patient and is used in determining how severe the dementia may be. It is the "Functional Assessment Staging" that is used to document decline in dementia patients.

So...along those lines, if the patient is able to ambulate independently they do not meet that level of functional decline. Even if they are a significant fall risk. The question is "are they functionally able to ambulate", not are they safe when they ambulate.

military spouse · Dec 19, 2012

That's how it was when I worked for a national hospice. Current employer, they say 7C can still ambulate, but if unsafe and would BENEFIT from personal assistance than they should be 7c. Was just looking for confirmation since I can only compare the two. Thanks so much for your input.

military spouse · Dec 19, 2012

Oops....wrote this too early this morning. Yes, I do mean FAST and not PPS.

tewdles, RN · Dec 20, 2012

The problem with scoring patients that way is that it then becomes difficult to document their actual decline.

Good luck.

Daisy_08, BSN, RN · Dec 21, 2012

We don't use FAST where I work, so I'm NO help

I find these scales way too subjective. On a PPS this week I scored a guy a 70% and went to look what he was last week, a 30! He was Independently ambulating, doing his own care, eating well (inappropriate for our floor - a total dump, beside the point).

tewdles, RN · Dec 21, 2012

We don't use FAST where I work, so I'm NO help
I find these scales way too subjective. On a PPS this week I scored a guy a 70% and went to look what he was last week, a 30! He was Independently ambulating, doing his own care, eating well (inappropriate for our floor - a total dump, beside the point).

The person who had evaluated earlier either hadn't been properly trained in the use of the tool...OR...the patient improved significantly in one week.

Daisy_08, BSN, RN · Dec 21, 2012

The person who had evaluated earlier either hadn't been properly trained in the use of the tool...OR...the patient improved significantly in one week.

That one was extreme, I think they did it without looking at the pt, but I very often see two different scores and can see how either one would come to that conclusion.

military spouse · Dec 22, 2012

Yes, these tools are extremely subjective. It is hard to score properly and different companies seem to have very different opinions.

Ginapixi, BSN, RN · Dec 27, 2012

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.

Daisy_08, BSN, RN · Dec 27, 2012

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.

Ginapixi, BSN, RN · Dec 28, 2012

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 :)