Continuous Passive Continuous Passive Motion Machine: Motion Machine:

An Evidence Based Practice ProjectAn 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.

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

New Knowledge, Innovations, Improvements

Research

InnovationEvidence Based Practice

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 VACA@phin.org

Jean Cody CODJ@phin.org