At St. John’s Riverside Hospital, two-thirds of the patient population is over the age of 65. The leadership team at the hospital in Yonkers, New York, has made providing age-friendly care a priority. They know that providing care that is age friendly helps older adults enjoy a better quality of life.
Throughout the journey to become an Age-Friendly Health System, the St. John’s Riverside team implemented an evidence-based approach called the 4Ms framework: what matters, medications, mentation and mobility. To effectively implement the 4Ms, an age-friendly multidisciplinary committee was formed, with representatives from nursing, medicine, pharmacy, physical therapy and IT
Here’s how St. John’s Riverside Hospital has adopted and integrated the 4Ms.
What matters: The hospital’s social work and case management teams conduct daily rounds with every older adult patient to discuss goals of care, special needs and discharge planning. Reponses are documented in the electronic medical record and recorded on a white board located at each patient’s bedside.
Medications: All physicians and nurse practitioners speak to patients and their families and develop a plan of care which they document as part of the EMR. Care teams perform medication reconciliation on admissions, and comments about medications to avoid in patients age 65 and older are flagged.
Mentation: Since 2019, nurses have performed mental status assessment and neurology checks when ordered on admission of a patient. Tools for delirium screening also are used.
Mobility: St. John’s Riverside has an established physical therapy program, and the nursing staff uses a bedside mobility assessment tool when patients are admitted. The hospital has now increased focus on physical therapy consults for all patients age 65 and older when appropriate, which includes writing physical therapy goals on white boards.
After implementing age-friendly care strategies, the hospital’s IT department developed a centralized dashboard for every patient age 65 and older; it’s called the Age-Friendly Clinical Panel. This panel incorporates the input of multiple disciplines on the 4Ms and includes notes from medical providers; nursing documentation; and notes from the nutrition, pharmacy, physical therapy, and palliative and spiritual care teams.
St. John’s Riverside Hospital participated in an AHA Age-Friendly Health Systems Action Community and was recognized as being “committed to care excellence.” Read the case study.