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

Objectives of this presentation

• Examine the reasons for starting these programs• Describe the implementation process• Discuss the outcomes

Two different user populations

• NursesEmployed by RWJUH

• Pediatric ResidentsEmployed by Rutgers RWJ

Medical School

Nursing Rounds

Robert Wood Johnson University Hospital

Background

• Changes in health care

• Resources• Time• Intranet resources• Empirical Outcomes

• Medical Librarian – EBP committees– Research Steering– Onsite– Nursing Research Day

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

Implementation

• Pilot• Comfort level• Communication with

the staff• Multidisciplinary team

Examples

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

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

CINAHL

HealthSTAR

Challenges

• UMDNJ/Rutgers University merger• Implications for staff nurses• Resources• Getting people to ask questions

Outcomes

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

Pediatric Morning Report

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

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.asp

(Accreditation Council for Graduate Medical Education)

Definition of house staff

• House staff: Any physician in an accredited graduate medical education program, including interns, residents, and fellows

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

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

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?

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

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

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

DynaMed

DynaMed

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

Cochrane Library

PubMed Clinical Queries

• Makes it easier to find articles that report applied clinical research

• Divided into 3 sections

- Clinical Studies

- Systematic Reviews

- Medical Genetics

PubMed Clinical Queries

PubMed Queries Filter

Outcomes

• Feedback has been positive• After first session, the librarian was booked through the rest of

the academic year

Questions?

hargwood@ca.rutgers.edu