,{

\
F*raell Frl+d
Healthr,lrllrJl
Qassim flust*r

Policy Title usE oF THE PALLTATTVE PERFORMANCE SCALE (pps)

lssuing Body Policy Number Replaces No. Policy Level

Model of Care QHC-MOC-PP-045-E-V1 New Cluster
Approval Date Effective Date Revision Date No. of Pages Applicable To
KFSH& Ash Shifa
2210812022 2s10812022 221O812O24 4
Hospital

1. STATEMENT OF PURPOSE
1.1. To document performance measures in palliative care patients by using a reliable and valid toolthat
has been proven to correlate wellwith actual and median survivaltime for cancer patients.
1.2. To identify and track potential care needs of palliative care patients, particularly as these needs
change with disease progression.

2. DEFINITIONS
2.1. Palliative Performance Scale: lt is a tool developed as an excellent communication tool for quickly
describing a patient's current functional level. lt appears to have prognostic value. PPS scores are
determined by reading horizontally at each level to find a 'best fit for the patient which is then
assigned as the PPS% score.
2.2. Ambulation: refers to the extent to which a patient can ambulate, classified as follows:
2.2.L. Mainly sit/lie: the patient can sit up rather than needing to lie down most of the time.
2.2.2. Mainly in bed: patient needs to lie down most of the time.
2.2.3. Totally bed bound; the patient has profound weakness or paralysis, and can't get out of bed
or perform any self-care.
2.2.4. Reduced ambulation: the patient is unable to carry out their normal job, work occupation,
hobbies, and/ or housework activities.
2.3. Activity & Extent of disease: refers to physical and investigative evidence of disease progression,
classified into three progressive categories such as some disease, significant disease, and extensive
disease. Disease extent is also judged in context with the patient's ability to continue to work,
complete hobbies, and/or other physical activities.
2.4. Self-Care: refers to the patient's abilities to independently perform their care, classified as follows:
2.4.L. Occasional assistance: the patient can transfer out of bed, walk, wash, toilet, and eat by their
means, but on occasion (perhaps once daily or a few times weekly) they require minor
assista nce.
2.4.2. Considerable assistance: the patient needs help every day, usually from one person, to do
some activities.
2.4.3. Mainly assistance: the patient needs more help than outlined in 'considerable assistance.
2.4.4. Total care: the patient is completely unable to eat, toilet, or do any self-care without help.
2.5. lntake: refers to a patient's ability to take in food, classified as follows:
2.5.7. Normal intake: the patient is maintaining his/her normal eating habits.
2.5.2. Reduced intake: the patient is experiencing a reduction in the amount of food he/she eats
and is highly variable according to the unique individual circumstances.

Page 1 of 4
t

fflrefll go+i'
Healtht,ln.sreJl
Qassim f luster

Policy Title usE oF THE PALUATTVE PERFORMANCE SCArE (pps)

lssuing Body Policy Number Replaces No. Policy Level

Model of Care QHC-MOC-PP-045-E-V1 New Cluster
ApprovalDate Effective Date Revision Date No. of Pages Applicable To
KFSH& Ash Shifa
2210812022 2sl08l2O22 2210812024 4
Hospital

2.5.3. Minimal intake: the patient is only eating very small amounts, usually pureed or liquid, which
are well below nutritional sustenance.
2.5. Conscious Level: refers to the patient's level of alertness and orientation, classified as follows:
2.6.1. Full consciousness: the patient is fully alert and orientated with good cognitive abilities in
various domains of thinking, memory, etc.
2.6.2. Confusion: the patient has either delirium or dementia and has a reduced level of
consciousness. lt may be mild, moderate, or severe with multiple possible etiologies.
2.6.3. Drowsiness: the patient is less alert and/or orientated as a result of fatigue, drug side effects,
delirium, or closeness to death.
2.6.4. Coma: the patient does not respond to verbal or physical stimuli; some reflexes may or may
not remain. The depth of the coma may fluctuate throughout 24 hours.

3. GENERAL GUIDELINES
3.1. For all admitted palliative care patients the PPS shall be completed daily.
3.2. ln other settings, palliative care consultants' shall utilize the PPS upon initial assessment and at each
follow-up visit.
3.3. When utilizing the PPS Physicians/Nursing Staff are to note that:
3.3.1. PPS scores in "leftward" columns (columns to the left of any specific column) are 'stronger'
determinants and generally take precedence over others.
3.3.2. The PPS score shall be determined only in increments of 10%. A "best fit" decision must be
made if patients appear to be in between values by using a combination of clinicaljudgment and
"leftward" precedence.

4. ASSESSMENT AND MANAGEMENT

4.1. Discuss the use of PPS with the patient and determine scores by reading the chart horizontally,
beginning with
the left column (Ambulation) is as follows:
4.1.L. Read the Ambulation column untilthe appropriate ambulation level is reached then
4.L.2. Read the next column moving downwards again until the activity/evidence of disease is
located
4.L.3. Repeat these steps until all five columns have been completed in the same manner
4.L.4. Assign the actual PPS by utilizing leftward precedence and clinical judgment

Page 2 of 4
 F*r:6JI Fo+I
HealthUtrreJI
Qassim Cluster

Policy Title usE oF THE pATLtATtVE PERFORMANCE SCALE (pps)

lssuing Body Policy Number Replaces No. Policy Level

Model of Care QHG-MOC-PP-045-E-V1 New Cluster
ApprovalDate Effective Date Revision Date No. of Pages Applicable To
KFSH& Ash Shifa
2210812022 2sl08l2O22 2210812024 4
Hospital

5. APPENDIX
5.1. Appendix One: Palliative Performance Scale (PPSv2)version 2
5.2. Appendix Two: PPS Scoring Examples

Appendix One: Palliative Performance Scale (PPSv2) version 2 Form.

Appendix Two: PPS scoring examples :

1.1. Patient One: Spends the majority of the day sitting or lying down due to fatigue from advanced
disease and requires considerable assistance to walk even for short distances but who is otherwise
fully conscious level with good intake would be scored at PPS 50%.
1.2. Patient Two: A patient who has become paralyzed and quadriplegic requiring total care would be
PPS 30%. Although this patient may be placed in a wheelchair (and perhaps seem initially to be at
50%), the score is 30% because he or she would be otherwise totally bedbound due to the disease
or complication if it were not for caregivers providing total care including lift/transfer. The patient
may have normal intake and a fully conscious level.
1.3. Patient Three: However, if patient 2 was paraplegic and bed bound but still able to do some self-care
such as feeding themselves, then the PPS would be higher at 40 or 50% since he or she is not'in total
ca re.

Page 3 of 4
 p*.trfiJl F.o+ri
Healthr.lr:nJl
tassim CNuster

Policy Title usE oF THE PALLIATTVE PERFORMANCE SCATE (pps)

lssuing Body Policy Number Replaces No. Policy Level

Model of Care QHG-MOC-PP-045-E-Vl New Cluster
Approval Date Effective Date Revision Date No. of Pages Applicable To
KFSH& Ash Shifa
2210812022 2sl08l2022 2210812024 4
Hospital

5. APPROVALPROCEDURES
Prepared by:

Name Title Signature Date

Dr.Musaad Aljaloud Project Manager L9/g/,r."2..
W
-4*,
Ms.Rabaih Alfrhidiy Project Manager zS-B -L1

Reviewed by

Name Title Signature Date

Dr. Ahmad Saeed Almutaari

Dr. Luay Alhamad

Consultant of Family
Medicine, MoC Lead

Service Line lead

ffi
G
Director of Therapeutic
Dr. Sultan Alanazi
Services Department
-4
Dr. Abdullelah Alhudaithi VP Of Health Care Delivery ,z-4.\ )
Chairman, Standardization
\ Mr. Ayed Awadh AlReshidi
Steering Committee

Approved by:

Name Title Signature Date

Dr. Sultan Saud Alshaya

President, Qassim
Cluster
Health-
-l e5: =

Page 4 of 4