What We Tried

AAMC volunteered to be one of five pilot organizations in the Age-Friendly Health Systems initiative focusing on the 4M model:

• What Matters – Know and align care with each older adult’s specific health outcome goals and care preferences including, but not limited to end-of-life, and across settings of care.
• Medication – If medications are necessary, use Age-Friendly medications that do not interfere with What Matters to the older adult, Mobility, or Mentation across settings of care.
• Mentation – Prevent, identify, treat, and manage dementia, depression, and delirium across care settings of care.
• Mobility – Ensure that older adults move safely every day in order to maintain function and do What Matters.

We began by educating the nurses and other staff on AAMC’s geriatric inpatient unit about the initiative. Staff enthusiastically embraced the concepts and identified a number of ways to roll out the “4Ms”, including the following:

Integrating 4Ms into shift reports. Nurses and patient care technicians are using the 4Ms to help guide patient handoffs between shifts. This was a simple adjustment to the nursing reports since the 4Ms reflect the traditional head-to-toe assessments nurses conduct.

Incorporating “what matters” into the EHR and whiteboards. We added a section to our electronic health record (EHR) that reminds staff to learn and document what matters to the patient. We also replaced the small whiteboards in patient rooms with larger ones that older patients can read more easily. Front and center on the boards is a section to document “what matters” to the patient.

Team rounding is also helping to drive this mindset. During team meetings, physicians, nurses and care managers discuss how to prioritize each patient’s preferences and needs. For instance, what mattered to one patient was having her dog with her. Since her dog was well-behaved and small, we were able to grant her request and believe she recovered faster than she would have without her pet.

Daily exercise sessions. Now patients are brought together for a 40-minute group session that is part physical therapy (PT), part social gathering. The sessions end with a challenge: “Walk back to your room.” The first day a patient may only walk 10 feet, but most can walk to their room by the third day.

Our patients progress faster in group PT than individual therapy, and family members love the approach. Our patient care technicians also help ensure patients maintain mobility. Physical therapists place orders specifying how many feet a patient needs to walk that day, and the technician is responsible for helping the patient meet that goal.