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Codispodi K1, Christie HJ1, Lopes S1, Panchuk S1, Warren S2, Arora RC2,3, McIntyre F1
1St. Boniface Hospital, Rehabilitation Services, Winnipeg, Canada, 2St. Boniface Hospital, Cardiac Sciences Program, Winnipeg, Canada, 3Max Rady College of Medicine, University of Manitoba, Department of Surgery, Winnipeg, Canada
Background: Traditional sternal precautions are part of standard postoperative care and discharge education for patients with a sternotomy. However, these precautions are largely informed by expert opinion and indirect evidence. Following a national survey, it was determined that the content of the strict precautions (load limits and specific movement restrictions) are somewhat arbitrary and vary widely across the continent.
Purpose: We sought to generate a less restrictive sternal precautions protocol to enhance recovery after cardiac surgery. As movement and patient education is a multidisciplinary responsibility, the change of practice needs to be understood and embraced by all caregivers. The objective of this initiative was to develop and implement an enhanced recovery protocol (ERP) in a publicly funded acute care facility in a multicultural city.
Methods: This is a single centre, prospective study at a large Canadian tertiary centre that performs cardiac surgery. An interdisciplinary steering committee was tasked with the implementation of the practice change in two phases. Firstly was the identification of potential new treatment plans as well as potential barriers to implementation of the new ERP. Phase 2 involved the creation of a knowledge working group to develop staff education modules and patient education materials. A staff education blitz was completed over the course of a one month period between phases of a larger research project related to this project. Roll-out of the ERP was completed following this blitz. Formal evaluation of patient comfort and confidence with their movement status has been added to the routine surgical follow-up process.
Results: The literature review identified an evidence based protocol which allowed for earlier movement and weighted activity and was developed in a setting with extensive follow-up care. The use of only a single visualization of the concept was the primary barrier to implementation. The steering committee developed our new ERP which maintained the described kinesiological principles but didn´t rely on a single visualization. A staff training video demonstrating patient mobilization, while respecting the change in focus from restricted movement to pain-free movement and mobility, was developed. Additional modules were developed for those disciplines involved in patient education related to progression of mobility and arm movement. Patient education materials were developed and translated. Fifty-eight Rehabilitation Services, 155 Cardiac Patient Unit, and 49 Diagnostic Imaging staff members were successfully trained (video and practical session) and evaluated (return demonstration) regarding the new ERP. As part of the staff training roll-out, led by Rehabilitation Services staff, trainers for each discipline were also identified for on-going future staff orientation. At two months post implementation, no increase in the sternal dehiscence rate was identified.
Conclusion(s): A new patient-centred ERP for mobilization and activity progression post sternotomy was successfully implemented. We were able to respect the principles of the original evidence based protocol while adapting it to a different multicultural and multilingual setting.
Implications: Culture and language can influence understanding of concepts. However, by working carefully with the evidence, the original authors and a multidisciplinary team, it is possible to adapt concepts to be culturally relevant and embraced by the team.
Keywords: cardiac surgery, sternal precautions, knowledge translation
Funding acknowledgements: No external funding was received for this work. The support of the Cardiac Sciences and Rehabilitation Services Programs is acknowledged.
Purpose: We sought to generate a less restrictive sternal precautions protocol to enhance recovery after cardiac surgery. As movement and patient education is a multidisciplinary responsibility, the change of practice needs to be understood and embraced by all caregivers. The objective of this initiative was to develop and implement an enhanced recovery protocol (ERP) in a publicly funded acute care facility in a multicultural city.
Methods: This is a single centre, prospective study at a large Canadian tertiary centre that performs cardiac surgery. An interdisciplinary steering committee was tasked with the implementation of the practice change in two phases. Firstly was the identification of potential new treatment plans as well as potential barriers to implementation of the new ERP. Phase 2 involved the creation of a knowledge working group to develop staff education modules and patient education materials. A staff education blitz was completed over the course of a one month period between phases of a larger research project related to this project. Roll-out of the ERP was completed following this blitz. Formal evaluation of patient comfort and confidence with their movement status has been added to the routine surgical follow-up process.
Results: The literature review identified an evidence based protocol which allowed for earlier movement and weighted activity and was developed in a setting with extensive follow-up care. The use of only a single visualization of the concept was the primary barrier to implementation. The steering committee developed our new ERP which maintained the described kinesiological principles but didn´t rely on a single visualization. A staff training video demonstrating patient mobilization, while respecting the change in focus from restricted movement to pain-free movement and mobility, was developed. Additional modules were developed for those disciplines involved in patient education related to progression of mobility and arm movement. Patient education materials were developed and translated. Fifty-eight Rehabilitation Services, 155 Cardiac Patient Unit, and 49 Diagnostic Imaging staff members were successfully trained (video and practical session) and evaluated (return demonstration) regarding the new ERP. As part of the staff training roll-out, led by Rehabilitation Services staff, trainers for each discipline were also identified for on-going future staff orientation. At two months post implementation, no increase in the sternal dehiscence rate was identified.
Conclusion(s): A new patient-centred ERP for mobilization and activity progression post sternotomy was successfully implemented. We were able to respect the principles of the original evidence based protocol while adapting it to a different multicultural and multilingual setting.
Implications: Culture and language can influence understanding of concepts. However, by working carefully with the evidence, the original authors and a multidisciplinary team, it is possible to adapt concepts to be culturally relevant and embraced by the team.
Keywords: cardiac surgery, sternal precautions, knowledge translation
Funding acknowledgements: No external funding was received for this work. The support of the Cardiac Sciences and Rehabilitation Services Programs is acknowledged.
Topic: Cardiorespiratory; Education: clinical
Ethics approval required: Yes
Institution: University of Manitoba
Ethics committee: Health Research Ethics Board
Ethics number: HS19436(H2016:052)
All authors, affiliations and abstracts have been published as submitted.
