The North Wales The North Wales Clinical Librarian Clinical Librarian

ProjectProjectJean RyanJean Ryan

OverviewOverview

BackgroundBackground RoleRole Day-to-day Day-to-day

featuresfeatures MarketingMarketing Progress to dateProgress to date

EvaluationEvaluation SuccessesSuccesses Barriers / Barriers /

dilemmasdilemmas Future Future

developmentdevelopment

BackgroundBackground What is a Clinical Librarian?What is a Clinical Librarian?

Originally conceived by Dr. Gertrude Lamb in Originally conceived by Dr. Gertrude Lamb in 1971 at the University of Missouri, Kansas City1971 at the University of Missouri, Kansas City

““to provide information quickly to physicians and to provide information quickly to physicians and other members of the healthcare teams; to other members of the healthcare teams; to influence the information seeking behaviour of influence the information seeking behaviour of clinicians and to improve their library skills; and clinicians and to improve their library skills; and to establish the medical librarian’s role as a valid to establish the medical librarian’s role as a valid member of the health care team”member of the health care team”

Cimpl, K. Clinical medical librarianship – a review of the Cimpl, K. Clinical medical librarianship – a review of the literature.literature.

Bulletin of the Medical Library Association Bulletin of the Medical Library Association 1985, 1985, 7373, 21-28, 21-28

Defining the RoleDefining the Role

Intermediary – takes the library to the Intermediary – takes the library to the useruser

EducatorEducator DisseminatorDisseminator Bridge the literature – practice gapBridge the literature – practice gap The evidence-based medicine process The evidence-based medicine process

parallels the clinical librarianship parallels the clinical librarianship process and offers opportunities for the process and offers opportunities for the CL to empower and educate usersCL to empower and educate users

Steps in EBM processSteps in EBM process

1.1. Formulate an answerable questionFormulate an answerable question

2.2. Track down the best evidence Track down the best evidence

3.3. Critically appraise the evidenceCritically appraise the evidence

4.4. Integrate with clinical expertise and patient Integrate with clinical expertise and patient valuesvalues

AdvantagesAdvantages Is part of the Library team & has access to all Is part of the Library team & has access to all

library resourceslibrary resources Has database and searching expertiseHas database and searching expertise Gets to know about users’ own clinical areas Gets to know about users’ own clinical areas

& specialties& specialties Tailored to specific needs of your teams/usersTailored to specific needs of your teams/users Can ensure questions arising at meetings are Can ensure questions arising at meetings are

answered on the basis of evidence from answered on the basis of evidence from published literaturepublished literature

Reduce information overload by providing Reduce information overload by providing the most clinically relevant materialthe most clinically relevant material

How It All StartedHow It All Started Long, long ago…………Long, long ago…………

Idea to pilot a CL serviceIdea to pilot a CL service Feb. 2003 Feb. 2003 Funding obtained Funding obtained Sept. 2003 CL starts in postSept. 2003 CL starts in post

Evaluation Partner Evaluation Partner Chosen Chosen Teams selectedTeams selected

Nov. 2003Nov. 2003 CL Project CL Project “operational” “operational”

June 2004June 2004 All baseline information All baseline information complete complete

Feb. 2005Feb. 2005 Final ReportFinal Report

TeamsTeams

The clinical The clinical librarian is librarian is working with:working with:

Conwy and Conwy and Denbighshire Denbighshire NHS TrustNHS Trust

NorthNorth West West Wales NHS TrustWales NHS Trust

North East Wales North East Wales NHS TrustNHS Trust

TeamsTeamsConwy & Conwy &

DenbighshirDenbighshiree

North West North West WalesWales

North East North East WalesWales

ICUICU Information Information Skills Training Skills Training

to Entire to Entire Community Community DirectorateDirectorate

Psychiatry Psychiatry Journal ClubJournal Club

Urology MDTUrology MDT OT Journal ClubOT Journal Club Psychiatry Psychiatry Evidence-Based Evidence-Based Practice GroupsPractice Groups

Lung MDTLung MDT

Nutrition Nutrition Support TeamSupport Team

CAP TeamCAP Team

Services On OfferServices On Offer Information skills Information skills

training / User training / User EducationEducation

Current awareness Current awareness updates updates

Expert literature search Expert literature search serviceservice

Develop resource lists Develop resource lists on requested topicson requested topics

Provide evidence for Provide evidence for development of new development of new guidelines / pathwaysguidelines / pathways

Day-to-Day JobDay-to-Day Job Variety is keyVariety is key Different Models - Different Models -

adopt to different usersadopt to different users Juggling act - Juggling act -

schedules, teams, schedules, teams, priorities, locations priorities, locations etc….etc….

Carefully manage Carefully manage workload & balance workload & balance time spent on each teamtime spent on each team

Value of Library Teams’ Value of Library Teams’ SupportSupport

Sell! Sell! Sell!Sell! Sell! Sell!

Marketing – key to successMarketing – key to success Need to have championsNeed to have champions Tailor publicity to specific teamsTailor publicity to specific teams Overcome ambivalence / resistanceOvercome ambivalence / resistance Promotion as key to successPromotion as key to success Warning: Warning: You will get very tired of hearing You will get very tired of hearing

your own voice!your own voice!

If it works it also increases the Library’s If it works it also increases the Library’s visibility & should raise profile visibility & should raise profile

Progress to Date:Progress to Date:

Six-monthly report, April 2004 – Six-monthly report, April 2004 – overview of Project to date and overview of Project to date and indication of service usageindication of service usage

Survey of UK Clinical Survey of UK Clinical LibrarianshipLibrarianship

University Hospitals of LeicesterUniversity Hospitals of Leicester Record of work practices for the Record of work practices for the

month of February 2004month of February 2004

Working Time Activities Working Time Activities February 2004February 2004

Working Time activities February 2004:Working Time activities February 2004:

Administrative ActivitiesAdministrative Activities 20%20% Attending Clinical MeetingsAttending Clinical Meetings 16.8%16.8% Other Meetings with health professionals (outside Other Meetings with health professionals (outside

Library)Library) 0.8%0.8% Literature SearchingLiterature Searching 25.6%25.6% Teaching information skillsTeaching information skills 17.2%17.2% Teaching critical appraisalTeaching critical appraisal 5.6%5.6% Preparing / Editing PresentationsPreparing / Editing Presentations 2.4%2.4% Meetings with other LibrariansMeetings with other Librarians 1.6%1.6% Ethics Committee & Evaluation Project Ethics Committee & Evaluation Project 8.4%8.4%

Working Activities Feb. Working Activities Feb. 20042004

20%17%

1%

26%

17% 6%

2%

2%

9%

Admin. Activities

Clinical Meetings

Other Meetings with HealthProfessionalsLit. Searching

Teaching Information Skills

Teaching Critical Appraisal

Preparing Presentations

Meetings with Librarians

Ethics Committee &Evaluation

Training in North West Training in North West WalesWales

109 people trained in Community to 109 people trained in Community to datedate

Two training sessions for GPsTwo training sessions for GPs One training session for General One training session for General

Practice staff & LHB staff Practice staff & LHB staff Internet searching, database Internet searching, database

searching, critical appraisal skills searching, critical appraisal skills are most in demandare most in demand

EvaluationEvaluation Evaluated by a team led by Dr. Christine Urquhart from the Evaluated by a team led by Dr. Christine Urquhart from the

Department of Information Studies, University of Wales, Department of Information Studies, University of Wales, AberystwythAberystwyth

Final report in March 2005 will recommendFinal report in March 2005 will recommendwhether service should continue and how it shouldwhether service should continue and how it shouldevolveevolve

Evaluation GoalsEvaluation Goals

Indicate whether the service has been Indicate whether the service has been successful and if it should continuesuccessful and if it should continue

How the service has affected clinical How the service has affected clinical practicepractice

Success factors and problem areasSuccess factors and problem areas Comparisons between the sites and Comparisons between the sites and

teamsteams Recommendations for future Recommendations for future

developmentdevelopment

ResearchResearch

Research into clinical librarianship Research into clinical librarianship has been lacking in the pasthas been lacking in the past

Opportunity to produce a seminal Opportunity to produce a seminal piece of work to guide the further piece of work to guide the further development of these servicesdevelopment of these services

See article by Kay Cimpl Wagner – See article by Kay Cimpl Wagner – Evaluating the Evaluating the effectiveness of clinical medical librarian programs : a effectiveness of clinical medical librarian programs : a systematic review of the literaturesystematic review of the literature; J Med Libr Assoc ; J Med Libr Assoc 92 (1) January 200492 (1) January 2004

FOR MORE INFO...

MethodologyMethodology

Variety of Evaluation methods to be Variety of Evaluation methods to be usedused

Qualitative:Qualitative: Questionnaires, Interviews, Feedback Questionnaires, Interviews, Feedback

Forms, Reflective Practice DiaryForms, Reflective Practice Diary QuantitativeQuantitative

Statistical data based on ILL requests Statistical data based on ILL requests and time spent on searches will provide and time spent on searches will provide an economic analysis of the servicean economic analysis of the service

ScheduleSchedule

Three questionnaires will be given to Three questionnaires will be given to participants at beginning, middle participants at beginning, middle and end of project. Interviews will and end of project. Interviews will also be held over the three phases of also be held over the three phases of the projectthe project

Jan Feb Mar Apr May Jun July Sep Oct Nov Dec

Phase 1Phase 1

Phase 2Phase 2

Phase 3Phase 3

Issues to be ExaminedIssues to be Examined

How CL fits into How CL fits into clinical teamclinical team

Contribution made Contribution made to clinical work of to clinical work of teamteam

How CL supports How CL supports clinical governanceclinical governance

Changes in users’ Changes in users’ information information seeking behaviourseeking behaviour

Cost-benefit analysis Cost-benefit analysis – time spent – time spent searchingsearching

Users’ awareness of Users’ awareness of evidence-based evidence-based resourcesresources

Information skills – Information skills – improved searching improved searching etc…etc…

Is CL service Is CL service empowering empowering enabling for users?enabling for users?

WARNING!WARNING!

Ethics Committees – a lot of Ethics Committees – a lot of Red TapeRed Tape Plan in advancePlan in advance This takes a lot of timeThis takes a lot of time Can hold up researchCan hold up research

SuccessesSuccesses

OT Journal ClubOT Journal Club Information Outreach TrainingInformation Outreach Training Nutrition TeamNutrition Team CAP Team CAP Team Psychiatry especially the Nurses’ Psychiatry especially the Nurses’

EBP groupsEBP groups ICU ???? ICU ????

ImpactImpact New ICU critical care protocol was developed New ICU critical care protocol was developed

on use of steroids in sepsison use of steroids in sepsis Provided evidence to develop protocol for Provided evidence to develop protocol for

rapid tranquilisation in psychiatric patientsrapid tranquilisation in psychiatric patients Evidence used to develop leaflet & Evidence used to develop leaflet &

questionnaire for Benzodiazepine Servicequestionnaire for Benzodiazepine Service Literature to support development of audit Literature to support development of audit

tool for breathlessness in lung cancertool for breathlessness in lung cancer Data to support update of TPN regimes for Data to support update of TPN regimes for

PharmacyPharmacy Evidence to support choice of cognitive Evidence to support choice of cognitive

screening tool in OTscreening tool in OT Have identified research gap for OT in CAP Have identified research gap for OT in CAP

teamteam

Dilemmas / ProblemsDilemmas / Problems

Resistance Resistance Lack of time vs. Lack of time vs.

Lack of priorityLack of priority Lack of feedbackLack of feedback Scheduling – Scheduling –

ICUICU Rapid rotation of Rapid rotation of

staffstaff

Future PlansFuture Plans

““Library Clinics” for communityLibrary Clinics” for community Database of questions and use of Database of questions and use of

CATmaker software at Psychiatry CATmaker software at Psychiatry Journal ClubJournal Club

Overhaul of ICU and Psychiatry Overhaul of ICU and Psychiatry Journal Clubs Journal Clubs

Psychiatry Nurses EBP Group – Psychiatry Nurses EBP Group – training training

EvaluationEvaluation

Key Characteristics of a Key Characteristics of a CLCL

FlexibleFlexible PatientPatient OptimisticOptimistic MotivatedMotivated Good CommunicatorGood Communicator Teaching SkillsTeaching Skills PatientPatient ProactiveProactive Long Arms!Long Arms!

No standard.No standard.

Innovation is keyInnovation is key..

Should We All Be Doing Should We All Be Doing It?It?

Over to you!Over to you!

Jean RyanJean Ryan

Clinical LibrarianClinical Librarian

Glan Clwyd Hospital LibraryGlan Clwyd Hospital Library

Ph: (01745) 534729Ph: (01745) 534729

Email: Jean.Ryan@cd-tr.wales.nhs.ukEmail: Jean.Ryan@cd-tr.wales.nhs.uk