Continuous Passive Motion Machine: An Evidence Based Practice Project Alicia Emaish, RN Jean Cody,...
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Transcript of Continuous Passive Motion Machine: An Evidence Based Practice Project Alicia Emaish, RN Jean Cody,...
Continuous Passive Continuous Passive Motion Machine: Motion Machine:
An Evidence Based Practice ProjectAn Evidence Based Practice Project
Alicia Emaish, RN
Jean Cody, MS, RN
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
OpportunityAccuracy
Smaller, more specialized group of caregivers
SafetyLess equipmentDecreased risk of falls
Amount of therapyUninterrupted therapyAdditional PT
ProjectDeveloped the trial innovationEvaluated 12 pt’s that used CPM’s during
the dayEducated staff of trialTrialed 12 pt’s using CPM’s during the
night shift hoursCompared 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 stayDecreases clutter in patient roomIncrease patient safetyIncrease 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
EvolutionStarted 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
• 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
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]