Implementation of the Age Friendly Health Systems 4Ms Framework in a Specialist Palliative Care Inpatient Unit–A Quality Improvement Project

Background: In line with policy in Ireland including Sláintecare and the National Adult Palliative Care policy a key priority is

integrating and providing the right care for older adults with an ageing population. The internationally recognised Institute of Health Initiative (IHI) Age Friendly Health System (AFHS) 4Ms framework is an evidence-based framework for older adults that incorporates Medication, Mobility and Mentation aligning with What Matters Most to the person. The Health Service Executive (HSE) Southwest has been chosen as a proof-of-concept region for introduction of AFHS. Currently, no care description exists for the Specialist Palliative Care (SPC) Inpatient Unit and to date implementation of AFHS has not been studied in this care setting.

 

Aim: s and Objectives: To implement the AFHS 4Ms framework in care for patients in a SPC inpatient unit.

 

Approach: A Plan Do Study Act (PDSA) approach was adopted. Approval was granted by the hospice executive committee. Formal training was pursued by a clinical champion, a collaborative approach with colleagues who were leaders of an early adopter site in Cork was pursued complimented by membership of an IHI action community, all provided expert facilitation. Multidisciplinary key stakeholders and local champions were identified and engaged.

 

 Consensus was gained that target patient population would be all inpatients and not limited to those older than 65 years. In collaboration with IHI, an application for recognition through the ambulatory care pathway was agreed. Plan to measure outcomes and

delivery of 4Ms care formulated.

 

Results: Validated screening tools for the palliative care population differ from the Geriatric population. Although delirium screening is not included in the ambulatory care pathway consensus determined the importance of this as part of mentation in addition to cognition and depression screening. 4Ms care incorporated into consultant led bi-weekly MDT with a continued focus on What Matters Most.

 

Implications: To the teams knowledge, this is the first SPC inpatient unit in Ireland to incorporate AFHS 4Ms framework into patient care. Introduction requires a bespoke approach. Ongoing audit will demonstrate reliable practice and outcomes.