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Two of your five-a-day: The role of the Librarian in Clinical Audit
Niamh Lucey & Anne Madden St Vincent’s University Hospital Dublin, Ireland
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Clinical Audit
What role do Librarians play?
How this benefits us
How this might benefit you
Librarians as Auditors
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St Vincent’s University Hospital
• Acute adult services – tertiary referral centre – national specialties
• Accredited by JCI
• Academic teaching hospital affiliated to University College Dublin (UCD)
• 2,500+ staff (500+ beds)
• Serving population of 365,000
• St Vincent’s Healthcare Group (SVHG)
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SVUH Library
• Est. 1980
• 2.12 WTE staff (0.001% of SVUH WTE)
• Services to all SVHG hospitals
• SMH branch
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Report on Status of Health Librarianship and Libraries in Ireland (SHELLI) 2011
Perception: Clinical staff appreciate what their librarians do but senior management do not
Recommendation: Librarians should promote their unique skills to key stakeholders with in their organisation
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Doom and Gloom….
• Ireland has been in major recession since 2008
• Health budgets slashed
• Health staff reduced by 10%
• Health librarian numbers down by 34%
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The times they are a-changin’…
Value of Library
Value of Librarian
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Where do we - or how can we - show our value to the key decision makers within our organisation?
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Clinical Audit
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Clinical audit…
…is a systematic review and evaluation of current practice with reference to research based standards with a view to improving patient care
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Clinical audit…
…is a systematic review and evaluation of current practice with reference to research based standards with a view to improving patient care
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Strategic Goals and Objectives of SVUH
5 To ensure that the Board, management and staff are accountable for their actions, that effective clinical governance and audit mechanisms are in place, and that there is transparency in all resource use, both within the Healthcare Group and its interaction with its external environment.
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Clinical Audit v Evidence Based Practice
1. Select a topic to audit
2. Select criteria or standards to measure
3. Observe performance or data collection
4. Compare performance with standards
5. Implement changes & re-audit
1. Ask a clinically focused question
2. Search for evidence
3. Evaluate results
4. Apply changes
5. Evaluate changes
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Clinical Audit & SVHG
• Feb 2005: Clinical Audit Taskforce
• Sept 2005: Appointment of Clinical Audit Co-Ordinator
• 2006 - : Clinical Audit Committee – Approve submissions for audit
– Review reports, risk rating, recommendations for quality improvement
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Clinical Audit Submissions SVH
30 35
73
103
149
131
158
181
0
20
40
60
80
100
120
140
160
180
200
2006 2007 2008 2009 2010 2011 2012 2013
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What role do Librarians play?
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We sit on the Clinical Audit Committee
Review all submissions to audit
Review all reports of completed audits
Apply risk rating to all completed audits
Multidisciplinary team – CEO, COO, Director of Nursing, Clinical Services Manager, Chief Pharmacist, Director of Quality, Consultants, NCHDs…
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Select a topic to audit
Select standards to measure
Observe performance/collect data
Compare performance with standards
Implement changes & re-audit
= 2 of your 5-a-day!
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We present at Clinical Audit Masterclass
• Open to all health staff nationwide
• Promote our services
• Anatomy of a Search
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Librarians as Auditors
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Audit: the library users’ view
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Audit of the impact and value of the Library service
• Joint SMH/SVUH audit of the 3 sites
• Split into 4 cohorts: Med/Surg, Nursing, Allied Health Professionals and Non-Clinical
• Key to understanding the audit process
• Paper on process and findings published in Medical Research Services Quarterly: Bennett,
Breda and Madden, Anne(2011) 'Hospital Libraries: Stand Up and Be Counted!', Medical Reference Services Quarterly, 30: 2, 178 — 188
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Findings highlight role in patient care
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Completing the audit cycle
UK(a) Christine Urquhart & Alison Weightman (2008): Assessing the impact of a health library service: best practice guidance. Downloaded from: http://cadair.aber.ac.uk/dspace/handle/2160/648
UK(b) Christine Urquhart, Rhian Thomas, Jason Ovens, Wendy Lucking & Jane Villa (2010): Planning changes to health library services on the basis of impact assessment. Health Information and Libraries Journal, 27: 277-85.
Value of information found SVHG UK(a) UK(b)
Relevant 91% 84% 93%
Accurate 80% 59% 72%
Current 79% 67% 76%
Refreshed your memory of details/facts 59% 47% 37%
Of little/no clinical value 16% 5% 5%
Of clinical value 43%
Provided new knowledge 72% 56% 56%
Substantiated prior knowledge/belief 57% 45% 39%
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Audit of compliance with Data Protection
• Topical – arising from recent newspaper reports
• Generated considerable discussion at the audit meeting
• Action plan implemented immediately
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Level of evidence, specificity, relevance and usefulness of Reference Service
Image: http://www.tenontours.com CC
Overall, very positive response but highlighted a need for clarity and/or context in requests sent in writing.
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The other 3 of your 5-a-day
• Observe practice/data collection
– Address problems with objectivity/bias
• Compare performance with criteria and standards
– Questionnaires: how they are applied and interpreted
• Implement changes
– Resources/support available to make changes?
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How this benefits us
How this might benefit you
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We are more VISIBLE • Committee is group
wide, multidisciplinary, senior management heavy
• Equal voice/opinion sought and valued
• New relationships
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We are much BUSIER
• More work, no extra resources
• Recognised for our expert searching – NCCP Pancreatic Tumour Group
• Insight into clinical audit/quality improvement priorities for our organisation
• Evidence Bulletin – bi monthly
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We sit on a LOT of Committees
• Library & Information Services Committee
• Postgraduate Education Committee
• Education Committee
• Clinical Audit Committee
• Nursing Research & Innovation Committee
• Clinical Documentation Standards Working Group
• Q-Pulse Steering Committee
• Performance Information Team
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An Uncertain Future….
2013 - new hospital groups announced
2015 – Dublin East : 11 hospitals incl. SVUH
Q – what does this mean for health libraries and librarians? Threat or Opportunity?
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Getting involved in core clinical functions in a healthcare organisation is critical to our survival
Take home message….
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References Harrison J, Creaser C, Greenwood H. Irish health libraries: new directions. Report on the status of health librarianship and libraries in Ireland (SHELLI). Dublin: Library Association of Ireland Health Sciences Libraries Group; 2011. Lawton A, Murphy A. Emerging from SHeLLI – one year on. In: Visible evidence: the role of health science libraries in Ireland. HSLG Conference; 2013 Apr 11-12; Dublin, Ireland. Available at http://www.slideshare.net/hslgcommittee. Sollenberger JF, Holloway Jr, RG. The evolving role and value of libraries and librarians in health care. JAMA. 2013 Sept 25; 310(12):1231-2. Marshall JG, Sollenberger J, Easterby-Gannett S, Morgan LK, Klem ML, Cavanaugh SK et al. The value of library and information services in patient care: results of a multisite study. J Med Lib Assoc. 2013 Jan; 101(1):38-46. National Institute for Clinical Excellence. Principals for best practice in clinical audit. Abingdon: Radcliffe Medical Press; 2002. Weightman A, Urquhart C, Spink S, Thomas R. The value and impact of information provided through libraries for patient care: developing guidance for best practice. Health Info Libr J. 2009 March; 26(1):63-71. Bennett B, Madden A. Hospital libraries: stand up and be counted! Med Ref Serv Q. 2011; 30(2):178-88. O’Connor P, McDonald D. An evaluation of the TOOL (Toowoomba Online Literature Search) protocol for improving literature searches in a hospital setting. In: Positioning the profession: the Tenth International Congress on Medical Librarianship; 2009 Aug 31-Sept 4; Brisbane, Australia. Available from: http://espace.library.uq.edu.au/view/UQ:179996
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Thank You!
Niamh Lucey & Anne Madden Library & Information Services
St Vincent’s University Hospital
Elm Park, Dublin 4, Ireland.
www.stvincents.ie