OU Health Edmond Medical Center Uses '4Ms' to Guide Care of Older Adults

Even as the COVID-19 pandemic continues to challenge health systems, the OU Health Edmond Medical Center is making significant strides in improving the health of older adults through its designation as an Age-Friendly Health System.

Edmond Medical Center, as part of the OU Health hospital system, received the certification from the Institute for Healthcare Improvement, which works to improve and sustain better health outcomes for people across the world. The four essential elements of an Age-Friendly Health System are known as the 4Ms:

• What Matters: Asking older adults what matters most to them and aligning care with those goals in mind
• Medication: Using age-friendly medications that do not interfere with what is important to the older adult
• Mentation: Preventing, identifying, treating and managing dementia, delirium, depression and other mental health issues
• Mobility: Ensuring older adults move safely every day and maintain their function for activities that are important to them

"The 4Ms are helping us to provide better, safer care for our 65-and-older population," said Darrin Nobis, RN, MSN, director of the Medical-Surgical Unit at Edmond Medical Center. "Asking our patients what matters is so important. Because of that, we're using fewer medications, more appropriate medications and are helping patients move around more, which reduces falls. It is making a difference in their health outcomes."

Healthcare providers may naturally use some of the 4Ms concepts in patient care, but having a framework ensures they will be addressed at every patient visit. In addition, the 4Ms have been incorporated into the hospital's electronic health record so that providers can track improvement over time.

Asking patients what matters not only guides the other three M's, but it creates a rapport. It's not unusual, Nobis said, for patients to express surprise and delight when a nurse asks what's important for them to do after their hospital stay.

"When patients know that their healthcare providers will prioritize their wishes when making treatment decisions, they are more engaged and more likely to be compliant with the plan of care," he said. "We are also asking 'what matters' at different stages of their stay in the hospital - if they come in through the ER, for example, then go to the ICU or a regular floor. When we discharge them, our goal is to communicate their wishes to the next step in their care, like home health or a skilled nursing facility, so that the 'what matters' thread gets pulled all the way through."

When patients are asked what matters to them, their answers vary but are often related to family activities. One patient, who had fallen at his home, wanted to return home and be able to walk around safely with his wife. For patients like him, nurses prioritized getting him out of bed and walking, which in turn would give him more strength and reduce the risk of falls. Even a week in a hospital bed without much mobility can significantly decrease a patient's chances of moving about safely in the future.

Edmond Medical Center also places a high priority on a patient's mental state and choosing medications that are most likely to be effective without impairing their cognition or increasing the risk for falls. Nurses assess patients for delirium at least twice a day, and they work with physicians to prescribe medications that don't increase the risk of delirium or interact with other drugs in a negative way.

Currently, there are more than 46 million Americans age 65 and older, and that number is expected to double by 2060. The 4Ms framework will be crucial for helping that population age well, Nobis said. "We will have a massive influx of baby boomers into the hospital system," he said, "and the 4Ms will help us deliver the outcomes that are important to their health and quality of life."

The OU Health University of Oklahoma Medical Center in Oklahoma City is also part of the Age-Friendly Health System designation. Nobis served as co-manager for the project with Teri Round, MS, RN, Executive Director of Clinical Operations and Assistant Director, Reynolds Center of Geriatric Nursing Excellence, for the Fran and Earl Ziegler College of Nursing at the OU Health Sciences Center.