A hospital admits a 90-year-old woman after she fractures her hip. The woman is delirious, so the nurses keep her near their station for most of the day.
Though the woman had been ambulating on her own at home, she loses her muscle tone after just a few bedridden days in the hospital. She now needs inpatient rehab. She starts a cycle of hospitalizations, stints in rehab, pneumonias, CA-UTIs, etc., and she's never quite the same after that initial admission. After a year or two — maybe even just a few months — she dies.
Sounds familiar, doesn’t it? It happens far more often than it should — maybe it’s happened to one of your loved ones.
But what if that all-too-common scenario had a different ending?
That’s the story Lillian Banchero, MSN, RN, of Anne Arundel Medical Center (AAMC) told on the April 20 WIHI, Creating Age Friendly Health Systems. In Banchero’s story, during initial evaluation, the 90-year-old AAMC patient who fractured her hip was agitated and confused and could walk only 10 feet. After the second day, however, a member of the care team helped her walk 80 feet. On the third day, she walked 350 feet. A few days into her hospitalization, she was able to recall her name, age, and reason for her hospitalization . . . all while walking the full length of the hall.
Banchero is the Senior Director, Patient Flow/Nursing Operations/Geriatrics at AAMC, an organization dedicated to keeping their older patients moving because they know it's best practice. With more than 45 percent of all their admissions age 65 and older, improving care for their older patients is a high priority at AAMC. That’s why they are one of five health systems in the US embarking on a new initiative called Creating Age-Friendly Health Systems (CAFHS) to learn how they can reliably deliver the best care to older adults.
The John A. Hartford Foundation has partnered with IHI to develop an Age-Friendly Health System Model and rapidly spread it to 20 percent of US hospitals and health systems by 2020. What is an "age-friendly" health system? It is a health care system in which:
- Older adults get the best care possible
- Health care-related harms to older adults are dramatically reduced and approaching zero
- Older adults are satisfied with their care
- Value is optimized for all — patients, families, caregivers, health care providers and health systems
It is, in effect, the Triple Aim focused on older adults.
Lessons from Anne Arundel
The five CAFHS prototype organizations will test the "the 4Ms" framework:
- Understand and actively support what matters to older adults
- Discuss whether medications are unnecessary or potentially harmful
- Review mobility plans for each patient
- Improve mentation by addressing problems like dementia, delirium, and depression
Though the large-scale campaign to spread effective approaches developed during the current phase won't launch until 2019, you can implement some of what the participants are learning right now. Here are three things you can do to make your care more age-friendly:
- Incorporate "the 4Ms" into nursing bedside shift reports: Most nurses and techs do bedside shift reports to ensure high-quality continuity of care, but at Anne Arundel they've integrated the 4Ms into their hand-offs. Far from adding extra work, Banchero notes that the 4Ms have "blended beautifully into our handoffs" by making it easier to remember the most important patient information the next care providers needs to know. Patient care technicians also use a version of the 4Ms during their hand-offs.
- Prioritize daily exercise for older patients: AAMC provides group physical therapy five days a week for their elderly patients. Family members and volunteers provide assistance and the music and supportive environment make it a lively hour. "[Patients] progress faster as part of group than individually," says Banchero. The group physical therapy has become so popular that return patients often ask to participate.
- Rethink whiteboards: AAMC had whiteboards ostensibly to share pertinent information with and about patients. However, most teams used them inconsistently because they often weren’t very helpful. With input from patients, families, and patient and family advisors, AAMC designed new whiteboards. (See before and after photos above.) By using boards that are larger, easier to read, and have more space to write, they’ve become the useful communication tools they are intended to be. A place to record patient's answers to "What matters to you?" is right at the top.
The CAFHS prototype organizations plan to periodically share what they're learning over the next two years. In the meantime, find out more about the initiative from the audio recording of the program, slides, and additional resources on the April 20 WIHI archive page.
You may also be interested in:
Health Affairs: Age-Friendly Health Systems: How Do We Get There?
Learn more about the Creating Age-Friendly Health Systems initiative.