Accurate documentation is one of the most important tools a nurse or caregiver has when providing hospice or long-term care. Two key assessment tools—the Palliative Performance Scale (PPS) and the Norton Scale—help guide care, monitor patient decline, and support clinical decision-making. 

Knowing how to score and document them effectively ensures patients receive the right care, while helping your team communicate clearly and confidently. 

For nurses and caregivers looking for a comprehensive, step-by-step approach to assessments, our book “The Hospice Assessment Survival Guide” provides practical tips, examples, and templates to simplify documentation and reduce stress during hospice visits.

1. Understanding PPS and Norton Scores

Palliative Performance Scale (PPS):

  • Measures functional status and overall condition in palliative care.
  • Assesses ambulation, activity level, self-care ability, intake, and consciousness.
  • Scores range from 0% (death) to 100% (fully ambulatory, normal function).

Norton Scale:

  • Evaluates risk for pressure injuries (bedsores).
  • Looks at physical condition, mental state, activity, mobility, and incontinence.
  • Scores range from 5 to 20, with lower scores indicating higher risk.

2. Why Proper Documentation Matters

  • Provides a clear record of patient decline or improvement.
  • Guides care planning for nutrition, mobility, skin protection, and symptom management.
  • Ensures compliance with hospice and regulatory standards.
  • Improves communication with families and interdisciplinary teams.

“The Hospice Assessment Survival Guide” includes sample documentation templates that make this process faster, more accurate, and less stressful—perfect for nurses managing multiple patients.

3. Tips for Documenting PPS Effectively

Assess all domains:

  • Ambulation, activity level, self-care, intake, and consciousness.
  • Be specific and objective:
  • Avoid vague statements. Example: “Patient requires full assistance with feeding, grooming, and toileting. PPS 40%.”
  • Document consistently:
  • Reassess at routine intervals or when patient status changes.
  • Use your book as a reference:
  • Checklists and sample phrases in “The Hospice Assessment Survival Guide” make it easy to stay accurate and consistent.

4. Tips for Documenting Norton Scores Effectively

Assess each domain individually:

  • Physical condition, mental state, activity, mobility, and incontinence.
  • Record observations clearly:
  • Example: “Patient is bedbound, minimally alert, incontinent of urine, requires full assistance to reposition. Norton score: 6.”
  • Include interventions:
  • Example: “Pressure-relief mattress in use, repositioning every 2 hours, skin care applied as per protocol.”
  • Refer to the guide:
  • Our book provides real examples and explanations of common scoring pitfalls, helping you feel confident in your assessment.

5. Best Practices for Both Scores

  • Use descriptive language to document exactly what you observe.
  • Highlight changes in functional or cognitive status.
  • Ensure the care team knows the scores and interventions.
  • Link scores to care plans, symptom management, and family education.

Conclusion

PPS and Norton scores are more than numbers—they tell the story of your patient’s functional status, frailty, and risk. Documenting them accurately ensures safer, more compassionate care and supports your professional accountability.For nurses and caregivers seeking a step-by-step, practical guide to every hospice assessment, “The Hospice Assessment Survival Guide” is your go-to resource. It simplifies scoring, documentation, and care planning, helping you save time, reduce stress, and provide the best care possible.