Page 184 - CHHA Binder 2.3.20

4/11/2019

Interpreting the Stages on the PPS

Stage PPS level Special Concerns
Stable 100-80% • Patient/family need for education re: disease management,
medications, personal care, nutrition, symptom management,
crisis/distress management plan
• Referrals to optimize functioning: rehabilitation, CDE

Transitional 70-40% • Most difficult stage for patient - impacts on all spheres of life
• Requires greatest amount of nursing care
• Increasing emotional, care, and educational needs
End-of-Life <30% • Pain/symptom management
• Ensure affairs are in order-e.g. Advance Directives, wills, custody
arrangements for children, etc.
• Prepare family for death-what do they expect? What are their past
experiences with death?
• Psychosocial assessment
• Spiritual support resources

Discuss findings with referrer

• Contact referring physician to discuss which VNSNY program can best
meet the patient’s needs

• Discuss in an SBAR format
(Situation, Background, Assessment, Recommendation)

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