Patient Safety: Librarians have nothing to do with that, right?
According to modern wisdom, the patient safety field came into prominence with the Institute of Medicine’s “To Err is Human”1 report in 2000. This report recognized that harm resulting from medical care was a significant problem, and patient safety moved to the top of the national healthcare reform agenda. Since that time considerable time, skill, and resources have been applied to the problem, however, to date, little recognition has been given to the impact of evidence and information on the issue.
Members of the health sciences library community remember the consequences of an incomplete literature search with the death of Ellen Roche in a clinical trial at Johns Hopkins University in 2001. Even though the patient safety community at large has not tracked adverse events occurring at least partially due to inadequate evidence/information in clinical care, some members of the medical library community have approached the problem and incorporated patient safety concepts into their library practices.2 The following are three examples of librarians in the MCR that have accepted the challenge of improving patient safety practices and are contributing their skills and expertise in their individual environments.
J. Otto Lottes Health Sciences Library
University of Missouri
From 2003 through 2013, I teamed up with a member of our nursing faculty and the nurse education coordinator to teach a course to our staff nurses on Evidence Based Practice. While the format of the course changed over the years, the basic premise of teaching EBP using problems and questions that the staff nurses were currently facing remained consistent. We taught the nurses over multiple sessions how to take their questions, fashion them into PICO statements and then use those to search the literature. I guided them through searching in CINAHL, Cochrane, and MEDLINE (to name a few databases) covering the use of search tools such as truncation and Boolean operators. The nurses were also guided in gathering data from their own units on current practice (as compared to the best practice guidelines they found in the literature.)
With the data from their literature searches and their units, the nurses presented their findings to their managers, the physicians and the administrators. The nurses reported back that their projects often adjusted current practices resulting in changes such as reducing hospital-acquired infections or readmissions back to ICU.
A sample of the questions tackled:
- Evaluation of rectal tube use in critical care patients population
- Does the effect of hypothermia improve outcomes in the patient with a traumatic closed head injury?
- Evaluation of the current disinfectant policy for central line placement in the NICU
Intermountain Medical Center
We have a pretty steady flow of work from the Quality Consultants in our region of Intermountain Healthcare. While they are not one of the top three groups of patrons we serve each month, we are an important part of their work. The librarians have been involved for a long time with this group of patrons, including Outcome Analysts and others. Often the research starts in my office with a detailed explanation of a sentinel event and what the investigator wishes to learn. The results of our work led to changes in processes and procedures in the hospital to prevent similar events from occurring. When I coordinated with my hospital’s systems improvement director and she notified her team that we were willing to push some information out to them, I added three new names to my distribution list.
I became aware of the librarians’ role in patient safety efforts by taking the Patient Safety seminar for my CHIS Tier II certification. That’s when I realized that a lot of what I do at this hospital falls under the patient safety umbrella. I would like to see the librarians be more closely integrated with the quality team in our region. I have made some contacts with the systems improvement director and hope to have some productive conversations soon. For example, if there is a schedule of open projects and we were privy to that information, we could proactively do literature searches.
A few topics I have worked on so far in 2015 include predictors of unexpected outcomes after urgent care visits; use of tranexamic acid in total knee and/or hip arthroplasty; surgical wound infection protocol for hysterectomy; and how a spine clinic saves money and results in better outcomes.
Saint Louis Children’s Hospital
St. Louis, Missouri
Hospitals focus on patient safety with laser intensity and the push for constant improvement in patient safety is anything but subtle. As a librarian serving a hospital I’m not physically implementing new protocols, scrubbing the hub, or practicing safe handoff (although I foam in and foam out like a champ), but I am doing the research support to assess, change, and implement new and better protocols to keep our patients safe.
Being embedded in the hospital and working with clinicians allows me to better support patient safety by being in meetings where events are discussed that I can then find information on. It allows me to create relationships with clinicians so they think to call me when they are tasked with guideline or protocol updates.
Clinical rounding is another area in which I support patient safety. Providing evidence based research to support clinical decision making in a timely manner takes the burden off the physician to look up good relevant research and still puts supportive information in their hands when they can use it for the patient. According to the Journal of Evaluation in Clinical Practice, “One of the main barriers against the implementation of evidence-based medicine (EBM) is the lack of search skills, an element that affects the finding of the best available evidence.”3 Teaching, offering 1:1 trainings, and following up after rounding with a mini EBP searching session are all ways I close the knowledge gap of question and information.
In a pilot run at St. Louis Children’s Hospital Emergency Unit, with Becker Medical Library and the CMIO, the library integrated point of care decision making resources into the electronic health record to make resources available in the clinical workflow. The idea was to reduce misdiagnosis and support meaningful use therefore supporting patient safety. Being knowledgeable about what resources are most useful at the point of decision making was one way the library supports patient safety. When using the tools the physicians might not be thinking of the library and librarians but we are the ones to select and package information in a meaningful way.
Patient safety is more than a buzzword, it can make or break a hospital’s reputation and librarians who have little to no contact with patients and patient care can be an integral part of supporting best practice in patient care. Librarians have the knowledge and tools to influence patient care and safety practices by providing their skills and expertise to providers on the front line.
If we accept the definition of patient safety from the Committee on Quality of Health Care in America 2001 as promoting action that “avoid(s) injuries to patients from the care that is intended to help them,” these three examples qualify as contributing to that effort. As you can see, the contributions these three librarians have made and are making toward improving patient safety are varied, and suited to their individual job descriptions and the institutions they serve. However, they share common characteristics:
- Willingness to be proactive,
- Awareness of the clinicians’ priorities,
- Willingness to learn more about new initiatives and priorities and increase their skills in those areas,
- The ability to see the larger system’s needs for evidence/information and apply their skills to those needs.
These three cases are among the many librarians in our region whose work contributes to the safe care of patients. Kudos to these three for offering to share what they contribute. We can all learn something from these three to apply to our own practice and the patient safety effort.
- Kohn, LT, Corrigan, JM and Donaldson, MS, (eds) 2000. To Err is Human: Building a Safer Health System. Washington, DC: Institute of Medicine.
- Craven CK, Jones BB, and Zipperer L. “ Potential for Harm Due to Failures in the EI&K Process” in Patient Safety: Perspectives on Evidence, Information and Knowledge Transfer. L Zipperer, ed., Gower Publishing Limited. 2014.
- Sadeghi-Ghyassi, F., Nosraty, L., Ghojazadeh, M., & Mostafaie, A. (2013). Evidence databases application: Comparison of university faculties versus clinical residents in a developing country. Journal of Evaluation in Clinical Practice, 19(2), 292-7. Retrieved March 25, 2015, from http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2753.2012.01821.x/abstract