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HOMES AND SENIORS SERVICES End of Life Care Plan ChecklistAppendix A Rev. Dec. 2017; Oct.2019Resident Name (Print): ___ Palliative Performance Scale (PPS) Score: ___ Date: ___ Resident/SDM Ensure

How to fill out form palliative performance scale

How to fill out form palliative performance scale

1. To fill out the form Palliative Performance Scale, follow these steps:
2. Start by providing relevant demographic information, such as the patient's name, age, and gender.
3. Assess the patient's level of ambulation and activity. Determine whether they are bedridden, need assistance to walk, or are fully ambulatory.
4. Evaluate the patient's ability to perform self-care activities. Determine if they are independent, require some assistance, or are completely dependent on others for their daily needs.
5. Assess the patient's level of conscious awareness. Determine if they are fully awake, drowsy but arousable, semi-comatose, or comatose.
6. Evaluate the patient's food and oral intake. Determine if they can eat and drink without any difficulties, with some difficulties, or are unable to eat by mouth and require alternative methods of nutrition.
7. Assess the patient's level of edema or ascites. Determine if there is no edema, mild-to-moderate edema, severe edema, or large tense ascites.
8. Evaluate the patient's level of dyspnea or shortness of breath. Determine if they have no dyspnea, dyspnea on exertion, dyspnea at rest, or are unable to speak due to severe dyspnea.
9. Determine the patient's overall performance status by assigning a score to each category mentioned above.
10. Add up the scores for each category to calculate the Palliative Performance Scale score.
11. Document the calculated score and any additional notes or observations related to the patient's performance.
12. Review and validate the filled-out form for accuracy and completeness before finalizing it.

Who needs form palliative performance scale?

1. The form Palliative Performance Scale is particularly useful and necessary for healthcare professionals involved in palliative care.
2. It helps in assessing and monitoring the performance status of patients receiving palliative care.
3. This form is used for patients with advanced illness who may have deteriorating conditions and require specialized care.
4. Healthcare providers, including physicians, nurses, hospice workers, and other professionals involved in palliative care, can benefit from using the Palliative Performance Scale to ensure appropriate care and support for patients.

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What is form palliative performance scale?

The Palliative Performance Scale (PPS) is a tool used to assess the functional status and quality of life of patients with serious illness, helping to guide palliative care decisions.

Who is required to file form palliative performance scale?

Healthcare providers, specifically those involved in palliative care, are required to complete the Palliative Performance Scale for their patients to evaluate their level of functioning and care needs.

How to fill out form palliative performance scale?

To fill out the Palliative Performance Scale, healthcare providers should assess the patient's overall condition, including their mobility, activity level, self-care ability, intake, and conscious level, and then document the appropriate score based on the scale.

What is the purpose of form palliative performance scale?

The purpose of the Palliative Performance Scale is to provide a standardized way to measure a patient's functional status, which assists in planning and delivering appropriate palliative care.

What information must be reported on form palliative performance scale?

The information that must be reported includes the patient's level of ambulation, activity, self-care, food intake, and overall consciousness level to determine their PPS score.