ICML 2009: Great Hall 1 Session 10

Theme: Translating the Evidence

Time: 14.15-15.30
Date: Wednesday 2nd September 2009
Chair: Sarah Sutton

Clinical Practice Guidelines Quality Improvement Program
Trudi Maly, Clinical Librarian, Northern Territory Department of Health and Families Library

Trudi Maly is a clinical librarian at the Health Library of the NT Department of Health and Families. Her role sees her providing clinical information support to the clinical staff at the Royal Darwin Hospital. Trudi also provides support to library staff in other NT hospitals and currently mentors the health librarian at the Katherine Hospital. Trudi is also a key member of the Clinical Guidelines Project Implementation Team which is working toward providing evidence-based, standardised clinical guidelines across all 5 NT hospitals.

Abstract:
The Clinical Librarian's primary objective is to increase the relevance of library services to clinicians and transpose library services into the clinical setting. A key strategy in this refinement of focus has been to engage with clinicians by contributing to their 'business' and this is being achieved through the Clinical Practice Guidelines Quality Improvement Program. The purpose of the Program is to improve clinical governance and, ultimately, patient outcomes by developing evidence-based clinical guidelines, standardised across all 5 DHF hospitals. The Clinical Librarian position was developed to work 0.5 on the clinical guidelines program and was responsible for seeking funding, engaging clinicians and getting the project off the ground.

The role of the Clinical Librarian is not new, and there are numerous examples of the role in the United Kingdom, North America and Australia from the last 30 years of the 1900s. What is new and innovative about Trudi's role is that her responsibilities have included the implementation and ongoing commitment to the Clinical Guidelines Program, which is a first in Australia. Its success is a major achievement, and she has played a leading role in this.

Positioning the nursing librarian on the wards: nursing grand rounds with a difference
Jennifer R Hall, University of Queensland Library, Australia
Ms Bronwyn Richardson, Royal Brisbane & Women's Hospital, Australia

Jenny Hall is the liaison librarian for nursing and internal medicine at the Herston Health Science Library, University of Queensland. She has a background and interest in health, working for some years as a registered nurse. In her current position she enjoys the challenges and urgency of helping health professionals find quality information in a quick and effective manner, with the knowledge that there is often a patient at the other end of the information request. Jenny holds a Bachelor of Nursing degree, a graduate diploma in Library and Information Studies, and a graduate certificate in Education. She is currently enrolled in a Masters of Education.

Bronwyn Richardson is a clinical nurse working at the Royal Brisbane and Women's Hospital

Abstract
The concept, nursing grand rounds (NGR) has been reported in the nursing literature since the 1960’s. Many of the reported initiatives however, are based on a presentation forum in the manner of medical grand rounds, as an approach to undergraduate education, or as a means to monitor patients.

Method: This pilot project was undertaken in a busy surgical ward.

Objective: To investigate the effectiveness of NGR in increasing nurses' work satisfaction and the inclusion of the nursing librarian as an integral part of the NGR team and processes, which previously has not been reported in the literature. The nursing librarian’s role was to search the literature and find the best evidence on the predetermined patient topic prior to the NGR to enable the nurse presenting to integrate the research findings into the presentation of the patient. The nursing librarian attended each NGR and commented where appropriate on the level of evidence of the retrieved studies. Nurses discussed current practice and the impact the retrieved literature would have on patient care comparing best practice with current practice.

Results/Conclusions: Outcomes of this project include in some cases changed clinical practice, change in culture where NGR are now embedded into ward culture; NGR extended to other wards; enthusiasm for Evidence Based Practice; and the initiation of a “super searcher” model. In doing so the nursing librarian develops the searching skills of nominated nurses who become the resource on the ward, with the librarian becoming the consultant.

"I Pull the Curtains": Ward Rounds Six Years On
Mr Lars Eriksson, Herston Health Health Sciences Library, University of Queensland, Australia
Ms Keryl Michener, Herston Health Health Sciences Library, University of Queensland, Australia

Abstract:
Objectives: Clinical librarianship, although gradually gaining acceptance, is still relatively novel in Australian hospitals. We focus on clinical team dynamics and the role of the librarian in ward rounds. We also examine any benefits for the medical team and for the librarians; challenges encountered and how best to move forward with this form of information service delivery.

Methods: Herston Health Sciences librarians have participated in ward rounds for over six years. We present an anecdotal account of our experience as librarians attending ward rounds with the medical assessment and planning unit of a major teaching hospital. We present personal perspectives on dealing with working in the busy clinical environment, the process and group dynamics. We include a brief analysis of the types of questions we have received during clinical rounds, how we have answered them, and feedback we have received. We also highlight some findings from a survey of the doctors involved.

Outcomes: It is difficult to measure the effect of the librarians’ contribution to patient outcomes in isolation. Anecdotally the benefits include:

• Valuable insight for librarians into the complex information environment of hospital clinicians.
• Acquisition of valuable clinical knowledge for the librarians to use in other aspects of their work
• Modelling of good information-seeking behaviour for junior doctors;
• Some slight altering or confirmation of patient-care decisions.

The problems include:

• “Fitting in” to a team and acceptance by new doctors.
• A shortage of time to expand the service
• IT systems compatibility issues

Putting Knowledge To Work - Development Of An Evidence Dissemination Service At Southern Health
Catherine Voutier, Centre for Clinical Effectiveness, Australia

MIM (Master of Information Management) BSocSci(Lib&InfoServ) Catherine Voutier is a Research Officer (Information) at the Centre for Clinical Effectiveness. Her main role is to provide specialist information services and research assistance. Prior to joining the CCE team in April 2002, Catherine worked at the National Herbarium, Melbourne, and as a subject specialist and indexer/abstractor at ABIX (Australasian Business Intelligence). Catherine has a varied background in information services from corporate and special, to medical and academic. She is the Assistant Editor of Health Inform (official journal of Health Libraries Inc.) and is a co-author of the Clinical Librarian: Exploring the Evidence Base blog shared with Terrence Harrison from the Royal Melbourne Hospital, Victoria.

Abstract:
Aims: The aim of this program is to develop, implement and maintain a service to capture, disseminate and utilise evidence to inform decision-making related to health technologies and clinical practice within Southern Health, the largest health service in Victoria. The Evidence Service is part of a wider program addressing introduction of new safe, effective and cost effective procedures and review of potentially harmful, ineffective or inefficient procedures in current practice. Methods: A four-step evidence-based change methodology (identify the need for change, develop a proposal for change, implement the proposal and evaluate the change) was used to develop the Evidence Service. At each step in the model, evidence is sought from the literature, health service personnel and consumers. Issues of sustainability are also addressed. A literature review and formal needs analysis was undertaken, a taxonomy was developed for classification, and the processes were piloted and refined.

Results: We developed a framework as part of the proposal for change to identify potential sources of information and methods of capture, storage, processing, dissemination and utilisation. We sought feedback and received executive support and endorsement for the development of our proposal as an organisation-wide process to inform decision-making at clinical, management and policy-making levels. Conclusion: An evidence-based approach to process change can be used to develop, implement and evaluate a system to capture, disseminate and utilise evidence in decision-making. The successes, failures and challenges encountered will be presented.