Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Palliative Performance Scale (PPS) Version 2
Palliative Performance Scale (PPS) Version 2
 
Instructions for Using the PPS
1.      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.      Begin at the left column and read downward until the appropriate ambulation level is reached; then read across to the next column and downward again until the activity/evidence of disease is located. These steps are repeated until all five columns are covered before assigning the actual PPS for that patient. In this way, ”leftward” columns (columns to the left of any specific column) are ‘stronger’ determinants and generally take precedence over others. Example 1: A patient who 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 with good intake would be scored at PPS 50%.
3.      PPS scores are in 10% increments only. Sometimes, several columns are easily placed at one level, but oneor two which seem better at a higher or lower level. One then needs to make a ‘best fit’ decision. Choosing a “half-fit”value of PPS 45%, for example, is not correct. The combination of clinical judgment and ”leftward precedence”is used to determine whether 40% or 50% is the more accurate score for that patient.
4.      PPS may be used for several purposes. First, it is an excellent communication tool for quickly describing a patient’s current functional level. Second, it may have value in criteria for workload assessment or other measurements and comparisons. Finally, it appears to have prognostic value.

 

PPS level
Ambulation
Activity & evidence of disease
Self-care
Intake
Conscious level
100%
Full
Normal activity & work
No evidence of disease
Full
Normal
Full
90%
Full
Normal activity & work
Some evidence of disease
Full
Normal
Full
80%
Full
Normal activity with effort
Some evidence of disease
Full
Normal or reduced
Full
70%
Reduced
Unable normal job/work
Significant disease
Occasional assistance necessary
Normal or reduced
Full
60%
Reduced
Unable hobby/house work
Significant disease
Considerable assistance required
Normal or reduced
Full or confusion
50%
Mainly sit/lie
Unable to do any work
Extensive disease
Mainly assistance
Normal or reduced
Full or confusion
40%
Mainly sit/lie
Unable to do most activity
Extensive disease
Total care
Normal or reduced
Full or drowsy ± confusion
30%
Totally bedbound
Unable to do any activity
Extensive disease
Total care
Normal or reduced
Full or drowsy ± confusion
20%
Totally bedbound
Unable to do any activity
Extensive disease
Total care
Minimal to sips
Full or drowsy ± confusion
10%
Totally bedbound
Unable to do any activity
Extensive disease
Total care
Mouth care only
Drowsy or coma ± confusion
0%
Death

 © Victoria Hospice Society, BC, Canada (2001), www.victoriahospice.org
For more information about this tool, please visit www.victoriahospice.org/sites/default/files/pps_english.pdf