1. Out of the Library…On to the Floors: Participating in Patient Rounds and Morning Report Pamela Hargwood, MLIS AHIP Rutgers University Robert Wood Johnson Library of the Health Sciences

2. Objectives of this presentation Examine the reasons for starting these programs Describe the implementation process Discuss the outcomes

3. Two different user populations Nurses Employed by RWJUH Pediatric Residents Employed by Rutgers RWJ Medical School

4. Nursing Rounds Robert Wood Johnson University Hospital

5. Background Changes in health care Resources Time Intranet resources Empirical Outcomes Medical Librarian –EBP committees –Research Steering –Onsite –Nursing Research Day

6. Purpose Staff questions related to patient care Defining best practices Identifying and locating the most current evidence Navigating the library resources Real time Magnet accreditation

7. Implementation Pilot Comfort level Communication with the staff Multidisciplinary team

8. Examples RVAD: new patient population CAUTI Depression following CABG Chest Tube management Patient satisfaction Length of stay Benefits of interdisciplinary rounds

9. Databases CINAHL: (Cumulative Index to Nursing & Allied Health Literature) is the authoritative resource for nursing and allied health professionals, students, educators and researchers HealthSTAR: Contains citations and abstracts to the published literature on health services, technology, administration, and research. Information is derived from MEDLINE, the Hospital Literature Index, and selected journals PubMed: PubMed comprises more than 23 million citations for biomedical literature from MEDLINE, life science journals, and online books

10. CINAHL

11. HealthSTAR

12. Challenges UMDNJ/Rutgers University merger Implications for staff nurses Resources Getting people to ask questions

13. Outcomes Questions about Nurse Sensitive Indicators Best practice Culture of inquiry Promoting the library Other user groups now interested

14. Pediatric Morning Report

15. Background Director of the Pediatric Residency Program consulted the Library Director Wanted to make morning report more evidence based “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” ( Sackett DL et al, 1996) Felt the inclusion of a librarian would be beneficial

16. What is Graduate Medical Education “The period of didactic and clinical education in a medical specialty (2-6 years) which follows the completion of a recognized undergraduate medical education and which prepares physicians for the independent practice of medicine in that specialty, also referred to as residency education.” From: ACGME Glossary: http://www.acgme.org/acWebsite/home/home.asphttp://www.acgme.org/acWebsite/home/home.asp (Accreditation Council for Graduate Medical Education)

17. Definition of house staff House staff: Any physician in an accredited graduate medical education program, including interns, residents, and fellows

18. Purpose Identify unanswered questions that arise during the care of patients Librarian helps the residents who are presenting at report formulate a question “PICO” acronym: summarizes the 4 basic elements of well-built clinical questions Patient or problem Intervention (ie. treatment) Comparison intervention (if necessary) Outcome Librarian is available at report to determine best databases to answer the PICO questions

19. Implementation Began the program October 2013 Librarian attends morning report once per month Librarian is given the topics that will be discussed at report ahead of time Meet in conference room with internet capability and projection screen Resident presents case and formulates question Librarian shows the databases and search terms used to answer question

20. Examples In adolescent females, does exposure to the Gardasil vaccine lead to sexual disinhibition? What is the sensitivity and specificity of rapid strep tests in school aged children presenting with typical signs and symptoms of strep pharyngitis? Does pacifier use in the newborn period reduce breast feeding?

21. Databases Pre-Appraised (EBM) Literature Pre-appraised literature comes in may forms and fit under three basic categories: –Systematic Reviews (meta analysis) –Surveillance tools –Clinical Summaries

22. Start by searching a summary resource Summary (pre-appraised) resources include the full range of evidence concerning the management options for a given health problem Summary resources should include: 1) Details of the retrieval process used to find the best evidence 2) The appraisal process for rating the quality of evidence 3) Key references for all care recommendations 4) Date of most recent update

23. DynaMed Updated daily Monitors over 500 journals & systematic review databases Articles evaluated for clinical relevance and validity New evidence is integrated with existing content Overall conclusions changed as appropriate

24. DynaMed

26. Cochrane Library The Cochrane Library contains high-quality, independent evidence to inform healthcare decision-making. It includes reliable evidence from Cochrane and other systematic reviews, clinical trials, and more. Cochrane reviews bring the combined results of the world's best medical research studies, and are recognized as the gold standard in evidence- based health care

27. Cochrane Library

28. PubMed Clinical Queries Makes it easier to find articles that report applied clinical research Divided into 3 sections - Clinical Studies - Systematic Reviews - Medical Genetics

29. PubMed Clinical Queries

31. PubMed Queries Filter

32. Outcomes Feedback has been positive After first session, the librarian was booked through the rest of the academic year

33. Questions? hargwood@ca.rutgers.edu