30min presentation on what is palliative approach to care, PPS and how to assign a PPS for staff working in LTC

1. Palliative Approach to Care
PPS in Early Identification and Prognostication Indicators Guide
Dorothy Tsang, RN, BScN, CHPCN(C)
Palliative Pain & Symptom Management Consultant

2. Topics
● What is Palliative Approach to Care
● PPS and Early Identification
● Assigning a PPS

3. What is Palliative Approach to Care?

4. What serious illness does …….… How Palliative Approach responds
Suffering …….… Relieves holistic suffering
Erodes quality of life …….… Improves holistic quality of life
Impact life from diagnosis, …….… Being part of usual care throughout serious
through all disease stages illness from beginning to end
Affects people living in all settings …….… Is provided primary level by all careproviders
Adapted from Ontario Palliative Care Network https://www.ontariopalliativecarenetwork.ca/about-palliative-care
It is NOT:
● Starts when “deemed” palliative or might die soon
● Offered only by a palliative unit, clinic, team or healthcare professional

5. ✔ Recognize residents with Chronic Progressive Life-Limiting Illness
✔ Educate resident/family on Nature of Illness and Illness
Trajectory(s)
✔ Assess and manage Holistic needs
✔ Track functional and health status changes via Early ID and
Prognostication tools (ie. PIG)
✔ Revisit regularly Advance Care Planning and Goals of Care
✔ Careplanning according to changing goals of care
Types of Chronic
Progressive Life-limiting
Illness: Cancer, Heart
disease, Lung disease,
Kidney Disease, Liver
Disease,
Neurodegenerative
Diseases, Dementia,
Frailty

6. PPS in Early ID
Assigning a PPS

7. Early Identification
If the answer is “yes” to the last question “Disease-Specific Indicators?” then, this client would benefit from having
the palliative approach as part of their usual care.

8. General and Disease-Specific Indicators
PPS is a one general indicator
and one disease-specific
indicator to look for in cancer

9. Key points:
● Start from Ambulation. Move through Columns left to right
● Best fit in each column determines where you start in next column
● No arithmetic
● Final score can only be a multiple of 10 (between 0 to 100)
“ The client
is PPS 50. ”

10. Sam
Is totally bed bound and dependent for care. He is on pureed and
thickened texture for dysphagia. He is often shaking his head no and not
opening his mouth for feeding and has increased coughing during
feeding and requires mouth care+++ for pocketing. He is cheyne-stoking
and has respiratory congestion on auscultation.
What is the PPS?

11. Practice: Sarah
Has dementia, end-stage heart disease and peripheral vascular disease.
She is confused most of the time. She has been losing weight the past
few months and even more the past couple of weeks. She is in bed due
to weakness and is dependent on staff for total care. She has a good
appetite. The staff note that she is sleeping more.
What is the PPS?

12. Practice: Pam
Has advanced COPD and requires low-flow oxygen when she takes longer walks in the
garden. She sits up a chair most of the day. She finds her personal care requires too
much energy and she is exhausted, so recently the care staff have been doing it for her.
She gets breathless doing things which didn’t make her breathless before. Her appetite
remains fair. She is awake most of the day and she remains alert and oriented when she
is awake.
What is the PPS?

13. Questions