1. Clinical Medical Librarian Services for Nurses Clista Clanton, MSLS, AHIP Ellen Sayed, MSLS, AHIP University of South Alabama Biomedical Library

2. As nursing became involved in this movement, the quest to define best practices began, often resulting in complex challenges that have no easy solutions. What is clear is the responsibility of nurses to deliver care based on evidence, for nurses to be able to access, evaluate, integrate and use the best available evidence in order to improve practice and patient outcomes (Rycroft- Malone, Bucknall, Melnyk, 2004). The imperative is to reduce the gap between knowledge development and knowledge use to improve the health of people. 1

3. Sigma Theta Tau International: conducted survey among non- member nurses about their familiarity and use of evidence-based practice (EBP) within the workplace. –Most nurses consistently need to find, access and provide care based on evidence. Nearly two in three (64%) indicate this need arises at least weekly and nine in ten (90%) say it happens at least occasionally. –Just over 40% of the nurses surveyed indicated a high level of comfort about their knowledge and experience of the EBP process. About half indicated a moderate comfort level and just one in ten indicated a lower level of confidence. –When asked to list the prevailing challenges to finding and accessing the available information, lack of time (66%) and findings that are difficult to appraise and analyze (45%) were clearly the prominent answers. 1 –While three in ten (31%) nurses indicated a high level of familiarity with EBP, almost one in four (24%) rated their familiarity low. Advanced practice nurses were more likely to indicate a higher level of familiarity.

4. Most clinical medical librarian (CML) programs have been targeted at physicians. In a literature review, only six articles were located that specifically discussed CML services for nurses, with four of them being published between the years of 1983-1985.

5. Librarian collaboration with Dr. Linda Roussel, a College of Nursing faculty member, on teaching evidence based practice to students in both regular and online courses led to participation on a hospital committee charged with revising a protocol on deep vein thrombosis.

6. Upon the suggestion of integrating clinical librarians into other hospital committees, the Medical Centers Clinical Practice committee requested a CME on clinical librarianship. Response was very enthusiastic and a 6-month pilot project for a CML was adopted. Eight committees between the two university hospitals were identified for CML participation.

7. Critical Care Committee Medication Use Committee Multi-disciplinary Patient Care Committee Pressure Ulcer Prevention Committee Performance Improvement Council Clinical Practice Committee Medical Center Hospital Policy and Procedure Committee Children & Womens Hospital Policy and Procedure Committee

8. Clinical Medical Librarian Pilot Project 6 month CML pilot project, start date Aug. 1 2 librarians at 8 hrs/week each –Clista Clanton: Experience as a clinical librarian working with multidisciplinary healthcare teams developing clinical protocols/pathways. –Ellen Sayed: Experience with clinical librarianship rounding with multidisciplinary teams on the Internal Medicine and Pediatric wards. Formal evaluation at end of 6 months

9. Sculpture garden at the Childrens & Womens Hospital, Mobile, AL

10. Committee or Person Requesting Search # of Questions Received from August 2006 – April 11, 2007 Children & Womens Hospital Policy and Procedure Committee 11 Medical Center Policy and Procedure Committee 1 Pressure Ulcer Committee4 Medication Use Committee/Pharmacy9 Critical Care Committee2 Children & Womens PICU/Attending Physician 3 Performance Improvement Council3 Clinical Practice Committee2 Patient Care Committee2 Total Questions:37

11. The majority of questions were received from nurses. However, since the committees are multidisciplinary, questions were also received from physicians, pharmacists, and the hospital administrator for the Medical Center.

12. The majority of questions were received during committee meetings. However, now that a clinical librarian has been identified as a resource, questions are received by phone and email as well.

13. Observations: In observing dialogue between clinical staff during meetings, questions that could be answered by literature searches are discussed but probably would not be referred to the library if a librarian was not present at the meeting. Furthermore, some questions are raised in meetings that would benefit from a literature search but are not posed to the librarian present. Asking would you like me to research this is usually meet with an enthusiastic yes. Clinicians do not always accurately identify information needs that could be addressed by a librarian. Taking this active role further integrates the librarian into the committee and enhances their role as a team member as opposed to a guest. Regular attendance of the meetings by the librarian is important and leads to further opportunities for collaboration with clinical staff that would be otherwise missed.

14. Conclusions: The CML pilot program was evaluated by the Clinical Practice committee after 4 months with the decision to continue the service indefinitely. The time spent by the librarians on the CML program has thus far been well within the 8 hours/week allocated by each librarian. Searches pertaining to hospital policy and protocol development, as opposed to individual patient care questions, are predominant. Integration into the committees has been smooth and librarian involvement welcomed. Nurses are integral in developing hospital policy, procedures, and protocols. They recognize both their time and expertise limitations in searching the literature and are appreciative of CML services. Librarian involvement in hospital committees has helped to better inform the librarys educational programs for medical, nursing, and allied health students.

15. 1. Sigma Theta Tau Internationals Position Statement on Evidence-Based Nursing. Available at http://www.nursingsociety.org/research/main.html#ebp. Accessed 6/17/06.http://www.nursingsociety.org/research/main.html#ebp