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

2. 99 Bed, Rural Community Hospital Magnet Designated since 2002

3. 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.

4. Leadership Opportunity
Organization became involved in a long term designee leadership program
Problem solving the “pebble in your shoe”
Opportunity for innovation
Opportunity:
Improve the application of the therapy & associated outcomes
Address safety
Potential to decrease LOS

5. 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
1. Salter RB. The biological concept of continuous passive motion of synovial joints: The first 18 years of basic research and its clinical application. In: Ewing JW, ed. Articular Cartilage and Knee Joint Function. New York, NY: Raven Press; 1990.
2. Coutts RD, Toth C, Kaita JH. The role of continuous passive motion machine in the rehabilitation of the total knee patient. TKA: a Comprehensive Approach. Baltimore, Md: Williams & Wilkins; 1984:

6. CPM Machine

7. Nursing Innovation:
Creatively timing the administration of the CPM machine.

8. Opportunity Accuracy Safety Amount of therapy
Smaller, more specialized group of caregivers
Safety
Less equipment
Decreased risk of falls
Amount of therapy
Uninterrupted therapy
Additional PT
Less people involved in working with the machines
More accurately monitored time in machines, and advancement of settings.
Less need for pain meds
Extended periods of time receiving range of motion, PLUS receiving PT
Shorter hospital stays
Better chance of going home rather than rehab
Not having to take pt's in and out of machines 100 times during the day or eve for meals, PT, families, BR breaks 8

9. 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

10. 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.

11. 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

12. 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

13. Great leaders create great structures so great nurses can provide exemplary care!
ANCC's Magnet Recognition Program© 2008

14. Evolution Started out as a leadership project
“What is the pebble in your shoe?”
Work fits into our “Inquiry at the Bedside”
Iowa Model 14

15. 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
Topic a priority: safe efficient effective care

16. Form a Team Leadership goal Multidisciplinary involvement
Physician champion
RN, LPN, LNA’s
Physical Therapy

17. 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
Critique and synthesize evidence

18. 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.
Denis M, Moffet H, Caron F. at al. Effectiveness of continuous passive motion and conventional physical therapy after total knee arthroplasty: a randomized clinical trial. Physical Therapy 2006;86:
Intervention 35 minutes per day, 2 hours a day, etc.

19. Nursing Research
Procedure oriented literature refers to original medical research
Structures and processes of delivering the care not addressed

20. 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

21. Magnet Exemplar Transformational Leadership Structural Empowerment
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
What is key to all this is that she had access to information, resources, & support and the opportunity to take advantage of them.

22. Evidence Based Practice Innovation
Research
New Knowledge, Innovations, Improvements
Evidence Based Practice
Innovation

23. Jean Cody CODJ@phin.org
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
Jean Cody