ACE Unit Becomes the First Level Two Age-Friendly Health System in Tennessee

Older adults have unique needs when it comes to their health and well-being. Older adults often have more complex medical problems and as a result are more likely to be harmed by the hospital system compared to younger adults. This harm can come through many ways ranging from unnecessary medications, excessive bedrest, little attention to brain health, and giving care not aligned with a patient’s values or goals. To address this problem, the Institute for Health care improvement partnered with the John A. Hartford foundation, the Catholic health care association, and the American Hospital Association to develop the 4M’s of age friendly health care, an evidence based best practice model. The 4Ms Framework (Medications, Mobility, Mentation, and what Matters Most) centers on learning what matters most to each patient and ensuring that each person’s care plan is aligned with what is most important to them.

At Vanderbilt University Medical Center, a local team of interdisciplinary health care workers started implementing the four M’s in 2019 on the Acute Care for Elders (ACE) Unit At Vanderbilt University Hospital. Implementation was slow initially and accelerated with the support of the West End Home Foundation, which enabled hiring of a nurse educator and a data analyst. A core team was created that met weekly to accelerate the implementation of the four M’s, and we supported 4 subcommittees, one for each M, who met regularly.

The core team reviewed weekly data on how well each M was adhered to, and worked using quality improvement approaches to improve nursing staff knowledge and performance on 4Ms care. The team held monthly meetings with patient and family advisors to ensure a patient-centered approach. A dashboard is in development that will assist other units in the hospital to receive data on their performance related to 4Ms adherence, so we can work to make these units age-friendly.

The West End Home Foundation’s support also enabled the team to purchase supplies that make our unit more age-friendly (e.g. glasses, hearing aid batteries, sound amplifiers, dolls for doll therapy for persons living with dementia, and comfort items).

In March 2022, the unit became the first in the state to be recognized by the Institute for Healthcare Improvement as a level-two Age-Friendly Health System, signifying consistently providing 4Ms care to older adults. The ACE Unit has provided 4Ms care to over 2,400 patients. The team continues to work to spread the 4Ms throughout all of the Vanderbilt health system.