Transcript Continuous Passive Motion Machine: An Evidence Based Practice Project Alicia Emaish, RN Jean Cody, MS, RN.

Continuous Passive Motion
Machine:
An Evidence Based Practice Project
Alicia Emaish, RN
Jean Cody, MS, RN
99 Bed, Rural Community Hospital
Magnet Designated since 2002
Objectives
• Describe the physiological evidence for CPM
use
• Describe the state of the science of nursing care
related to CPM therapy.
• Describe how this small, staff nurse developed
project is evolving into a nursing research study.
• Describe how this innovation is a Magnet
Nursing Exemplar for using New Knowledge and
Innovation.
Leadership Opportunity
• Organization became involved in a long
term designee leadership program
• Problem solving the “pebble in your shoe”
• Opportunity for innovation
What is a CPM machine?
 Continuous Passive Motion machine
 Developed in late 1970’s in animals (1)
 Early 1980’s CPM use began after total knee
replacement (TKR) (2)
 Allows the knee to move without engaging muscles
 Provides a favorable environment for the cells to grow
 Reduces the likelihood of the knee joint becoming stiff
CPM Machine
Nursing Innovation:
Creatively timing the
administration of the CPM
machine.
Opportunity
Accuracy
Smaller, more specialized group of
caregivers
Safety
Less equipment
Decreased risk of falls
Amount of therapy
Uninterrupted therapy
Additional PT
Project
Developed the trial innovation
Evaluated 12 pt’s that used CPM’s during
the day
Educated staff of trial
Trialed 12 pt’s using CPM’s during the
night shift hours
Compared lengths of stay
Project Outcomes
Post-operative length of stay was
decreased by 1 day (on average).
Measured by pre and post implementation
data collection.
12 TKR’s reviewed on day shift use.
Average length of stay = 4-6 days.
12 TKR’s trialed on night shift use.
Average length of stay = 3-5 days.
Patient Significance of CPM
Timing Innovation Trial
Decreases the length of hospital stay
Decreases clutter in patient room
Increase patient safety
Increase amount of therapy/ROM
Nurse Significance of CPM Timing
Innovation Trial
• Leadership growth in developing a project
of clinical interest
• Creative nursing to meet patients needs
and goals
• Motivating and influencing others
Great leaders create great structures so
great nurses
can provide exemplary care!
ANCC's Magnet
Recognition
Program© 2008
Evolution
Started out as a leadership
project
“What is the pebble in your
shoe?”
Work fits into our “Inquiry at
the Bedside”
Iowa Model
Iowa Model of
Evidence Based Practice to Promote
Quality of Care (2001)
• Problem focused trigger: Inconsistent
application of the CPM.
• No current consistent metrics of evaluation
• Safe, effective, efficient care goals
Form a Team
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Leadership goal
Multidisciplinary involvement
Physician champion
RN, LPN, LNA’s
Physical Therapy
Physiological Evidence
• Cochran Database of Systematic Reviews,
2003
• 14 studies/952 participants
• Compared CPM + PT vs. PT alone
• Improved knee flexion
• LOS significantly decreased
• Return to OR significantly decreased
Additional Research
• Studies up through 2008 show a wide
range in outcomes; from no difference to
significant decrease in LOS
• Major limitation of the studies: variations in
the study methodology make it difficult to
compare.
Nursing Research
• Procedure oriented literature refers to
original medical research
• Structures and processes of delivering the
care not addressed
Nursing Research
• Does the application of the CPM machine at
night decrease length of stay, pain, and increase
level of function in patients experiencing total
knee replacements when compared to using it
during the day?
• How does the timing of the CPM use effect the
process of care delivery?
Restricted research funds available to continue
work
Protocol development underway and pending
IRB review
Magnet Exemplar
• Transformational Leadership
– Staff Nurse Leaders
– CNS, Dept. Director, CNO
• Structural Empowerment
– Frontline leadership program
– Nurse Scholar Program
• Exemplary Practice
– Accountability, authority, autonomy in applying and expanding
nursing knowledge
• New Knowledge/Innovations in Practice
– Empower and engage staff to creatively practice
– EBP/Research project
Research
New Knowledge,
Innovations,
Improvements
Evidence
Based Practice
Innovation
Thank you
Alicia was recognized along with 5 peers
across the nation for her project.
In January, she will be filmed for an internet
video of this project.
Alicia Emaish [email protected]
Jean Cody [email protected]