The Short Stay Unit (SSU) at Monash Medical Centre has partnered with Safer Care Victoria to deliver the “4Ms” framework to promote better patient outcomes for older patients in our care.
As part of the 100,000 Lives program under Safer Care Victoria, Monash Health is committed to improving our age-friendly health system, and is now providing a set of four evidence-based elements of high-quality care, known as the 4Ms, to older adults. Older adults are those over 65 years of age, or over 45 years of age for Aboriginal and Torres Strait Islander populations.
What are the 4Ms?
The 4Ms are defined as:
- “What matters?”
- Mobility
- Mind
- Medication
How do we use the 4Ms?
The below table is a handy guide for using the 4Ms framework:
| 4Ms | Assess the patient | Action |
| What matters? | · what are you most worried about?
· if you were to deteriorate, what is important to you? |
· align the care plan to what matters most to the older person
· complete Goals of Care document |
| Medication | · all critical medications prescribed and given
· medication reconciliation · screen for polypharmacy and high-risk medications |
· ensure medications are charted at SSU handover
· pharmacy review · geriatrician in ED (GED) referral to de-prescribe |
| Mind | · delirium screening using 4AT score at least once in SSU stay
· pharmacological and non-pharmacological interventions · code grey responses |
· 4AT ≥4 refer to GED and Continuous Patient Observation trigger
· delirium prevention and de-escalation using delirium toolbox |
| Mobility | · encourage mobilisation
· screen mobility using “Give it a Go” |
· avoid catheters and other tethering equipment when medically appropriate
· refer to care-coordinator |
As the first SSU in Victoria to deliver the 4Ms framework, Monash Health’s multidisciplinary project team (credited below) attended a workshop at the MCG to share their experience of implementing the framework, and is now looking to expand the project to other areas of Monash Health.
If you are interested in finding out more, please reach out to one of the team members.
Approved by Anjuli Dhulia
Pictured: Left back – Dr Helen Psihogios- ED consultant & project advisory, left front – Nachuma Franck- Care Coordinator, middle left – Dr Alisha Spiteri- Geriatrician consultant & project lead, middle back – Danielle Byrne, Cognitive Clinical Lead, right back – Carlee Shenton- Quality ANUM ED, right front, Sue Viney- consumer representative.
Not pictured: Amelia Wood- ED nurse, Iouri Banakh- Pharmacist, Refija Halilovic-ED critical care nurse