The North Wales Clinical Librarian Project Jean Ryan

Overview Background Background Role Role Day-to-day features Day-to-day features Marketing Marketing Progress to date Progress to date Evaluation Successes Barriers / dilemmas Future development

Background What is a Clinical Librarian? What is a Clinical Librarian? Originally conceived by Dr. Gertrude Lamb in 1971 at the University of Missouri, Kansas City Originally conceived by Dr. Gertrude Lamb in 1971 at the University of Missouri, Kansas City to provide information quickly to physicians and other members of the healthcare teams; to influence the information seeking behaviour of clinicians and to improve their library skills; and to establish the medical librarians role as a valid member of the health care team to provide information quickly to physicians and other members of the healthcare teams; to influence the information seeking behaviour of clinicians and to improve their library skills; and to establish the medical librarians role as a valid member of the health care team Cimpl, K. Clinical medical librarianship – a review of the literature. Bulletin of the Medical Library Association 1985, 73, 21-28

Defining the Role Intermediary – takes the library to the user Intermediary – takes the library to the user Educator Educator Disseminator Disseminator Bridge the literature – practice gap Bridge the literature – practice gap The evidence-based medicine process parallels the clinical librarianship process and offers opportunities for the CL to empower and educate users The evidence-based medicine process parallels the clinical librarianship process and offers opportunities for the CL to empower and educate users

Steps in EBM process 1. Formulate an answerable question 2. Track down the best evidence 3. Critically appraise the evidence 4. Integrate with clinical expertise and patient values

Advantages Is part of the Library team & has access to all library resources Is part of the Library team & has access to all library resources Has database and searching expertise Has database and searching expertise Gets to know about users own clinical areas & specialties Gets to know about users own clinical areas & specialties Tailored to specific needs of your teams/users Tailored to specific needs of your teams/users Can ensure questions arising at meetings are answered on the basis of evidence from published literature Can ensure questions arising at meetings are answered on the basis of evidence from published literature Reduce information overload by providing the most clinically relevant material Reduce information overload by providing the most clinically relevant material

How It All Started Long, long ago………… Long, long ago………… Idea to pilot a CL service Idea to pilot a CL service Feb Funding obtained Feb Funding obtained Sept CL starts in post Sept CL starts in post Evaluation Partner Chosen Evaluation Partner Chosen Teams selected Teams selected Nov CL Project operational Nov CL Project operational June 2004 All baseline information complete June 2004 All baseline information complete Feb. 2005Final Report Feb. 2005Final Report

Teams The clinical librarian is working with: The clinical librarian is working with: Conwy and Denbighshire NHS Trust Conwy and Denbighshire NHS Trust North West Wales NHS Trust North West Wales NHS Trust North East Wales NHS Trust North East Wales NHS Trust

Teams Conwy & Denbighshire North West Wales North East Wales ICU Information Skills Training to Entire Community Directorate Psychiatry Journal Club Urology MDT OT Journal Club Psychiatry Evidence- Based Practice Groups Lung MDT Nutrition Support Team CAP Team

Services On Offer Information skills training / User Education Information skills training / User Education Current awareness updates Current awareness updates Expert literature search service Expert literature search service Develop resource lists on requested topics Develop resource lists on requested topics Provide evidence for development of new guidelines / pathways Provide evidence for development of new guidelines / pathways

Day-to-Day Job Variety is key Variety is key Different Models - adopt to different users Different Models - adopt to different users Juggling act - schedules, teams, priorities, locations etc…. Juggling act - schedules, teams, priorities, locations etc…. Carefully manage workload & balance time spent on each team Carefully manage workload & balance time spent on each team Value of Library Teams Support Value of Library Teams Support

Sell! Sell! Sell! Marketing – key to success Marketing – key to success Need to have champions Need to have champions Tailor publicity to specific teams Tailor publicity to specific teams Overcome ambivalence / resistance Overcome ambivalence / resistance Promotion as key to success Promotion as key to success Warning: You will get very tired of hearing your own voice! Warning: You will get very tired of hearing your own voice! If it works it also increases the Librarys visibility & should raise profile If it works it also increases the Librarys visibility & should raise profile

Progress to Date: Six-monthly report, April 2004 – overview of Project to date and indication of service usage Six-monthly report, April 2004 – overview of Project to date and indication of service usage Survey of UK Clinical Librarianship Survey of UK Clinical Librarianship University Hospitals of Leicester University Hospitals of Leicester Record of work practices for the month of February 2004 Record of work practices for the month of February 2004

Working Time Activities February 2004 Working Time activities February 2004: Working Time activities February 2004: Administrative Activities20% Administrative Activities20% Attending Clinical Meetings16.8% Attending Clinical Meetings16.8% Other Meetings with health professionals (outside Library)0.8% Other Meetings with health professionals (outside Library)0.8% Literature Searching25.6% Literature Searching25.6% Teaching information skills17.2% Teaching information skills17.2% Teaching critical appraisal5.6% Teaching critical appraisal5.6% Preparing / Editing Presentations2.4% Preparing / Editing Presentations2.4% Meetings with other Librarians1.6% Meetings with other Librarians1.6% Ethics Committee & Evaluation Project 8.4% Ethics Committee & Evaluation Project 8.4%

Working Activities Feb. 2004

Training in North West Wales 109 people trained in Community to date 109 people trained in Community to date Two training sessions for GPs Two training sessions for GPs One training session for General Practice staff & LHB staff One training session for General Practice staff & LHB staff Internet searching, database searching, critical appraisal skills are most in demand Internet searching, database searching, critical appraisal skills are most in demand

Evaluation Evaluated by a team led by Dr. Christine Urquhart from the Department of Information Studies, University of Wales, Aberystwyth Evaluated by a team led by Dr. Christine Urquhart from the Department of Information Studies, University of Wales, Aberystwyth Final report in March 2005 will recommend Final report in March 2005 will recommend whether service should continue and how it should evolve

Evaluation Goals Indicate whether the service has been successful and if it should continue Indicate whether the service has been successful and if it should continue How the service has affected clinical practice How the service has affected clinical practice Success factors and problem areas Success factors and problem areas Comparisons between the sites and teams Comparisons between the sites and teams Recommendations for future development Recommendations for future development

Research Research into clinical librarianship has been lacking in the past Research into clinical librarianship has been lacking in the past Opportunity to produce a seminal piece of work to guide the further development of these services Opportunity to produce a seminal piece of work to guide the further development of these services See article by Kay Cimpl Wagner – Evaluating the effectiveness of clinical medical librarian programs : a systematic review of the literature; J Med Libr Assoc 92 (1) January 2004 FOR MORE INFO...

Methodology Variety of Evaluation methods to be used Variety of Evaluation methods to be used Qualitative: Qualitative: Questionnaires, Interviews, Feedback Forms, Reflective Practice Diary Questionnaires, Interviews, Feedback Forms, Reflective Practice Diary Quantitative Quantitative Statistical data based on ILL requests and time spent on searches will provide an economic analysis of the service Statistical data based on ILL requests and time spent on searches will provide an economic analysis of the service

Schedule Three questionnaires will be given to participants at beginning, middle and end of project. Interviews will also be held over the three phases of the project Three questionnaires will be given to participants at beginning, middle and end of project. Interviews will also be held over the three phases of the project JanFebMarAprMayJunJulySepOctNovDec Phase 1 Phase 2 Phase 3

Issues to be Examined How CL fits into clinical team How CL fits into clinical team Contribution made to clinical work of team Contribution made to clinical work of team How CL supports clinical governance How CL supports clinical governance Changes in users information seeking behaviour Changes in users information seeking behaviour Cost-benefit analysis – time spent searching Users awareness of evidence-based resources Information skills – improved searching etc… Is CL service empowering enabling for users?

WARNING! Ethics Committees – a lot of Red Tape Ethics Committees – a lot of Red Tape Plan in advance Plan in advance This takes a lot of time This takes a lot of time Can hold up research Can hold up research

Successes OT Journal Club OT Journal Club Information Outreach Training Information Outreach Training Nutrition Team Nutrition Team CAP Team CAP Team Psychiatry especially the Nurses EBP groups Psychiatry especially the Nurses EBP groups ICU ???? ICU ????

Impact New ICU critical care protocol was developed on use of steroids in sepsis New ICU critical care protocol was developed on use of steroids in sepsis Provided evidence to develop protocol for rapid tranquilisation in psychiatric patients Provided evidence to develop protocol for rapid tranquilisation in psychiatric patients Evidence used to develop leaflet & questionnaire for Benzodiazepine Service Evidence used to develop leaflet & questionnaire for Benzodiazepine Service Literature to support development of audit tool for breathlessness in lung cancer Literature to support development of audit tool for breathlessness in lung cancer Data to support update of TPN regimes for Pharmacy Data to support update of TPN regimes for Pharmacy Evidence to support choice of cognitive screening tool in OT Evidence to support choice of cognitive screening tool in OT Have identified research gap for OT in CAP team Have identified research gap for OT in CAP team

Dilemmas / Problems Resistance Resistance Lack of time vs. Lack of priority Lack of time vs. Lack of priority Lack of feedback Lack of feedback Scheduling – ICU Scheduling – ICU Rapid rotation of staff Rapid rotation of staff

Future Plans Library Clinics for community Library Clinics for community Database of questions and use of CATmaker software at Psychiatry Journal Club Database of questions and use of CATmaker software at Psychiatry Journal Club Overhaul of ICU and Psychiatry Journal Clubs Overhaul of ICU and Psychiatry Journal Clubs Psychiatry Nurses EBP Group – training Psychiatry Nurses EBP Group – training Evaluation Evaluation

Key Characteristics of a CL Flexible Flexible Patient Patient Optimistic Optimistic Motivated Motivated Good Communicator Good Communicator Teaching Skills Teaching Skills Patient Patient Proactive Proactive Long Arms! Long Arms! No standard. Innovation is key.

Should We All Be Doing It? Over to you! Over to you! Jean Ryan Jean Ryan Clinical Librarian Glan Clwyd Hospital Library Ph: (01745)