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PPS in LTC
- 1. Palliative Approach toCare PPS in Early Identification and Prognostication Indicators Guide Dorothy Tsang, RN, BScN, CHPCN(C) Palliative Pain & Symptom Management Consultant
- 2. Topics ● What isPalliative Approach to Care ● PPS and Early Identification ● Assigning a PPS
- 3. What is PalliativeApproach to Care?
- 4. What serious illnessdoes …….… 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 residentswith 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 EarlyID Assigning a PPS
- 7. Early Identification If theanswer 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-SpecificIndicators PPS is a one general indicator and one disease-specific indicator to look for in cancer
- 9. Key points: ● Startfrom 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 bedbound 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 advancedCOPD 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?
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