Clinical Librarian in a University Medical Library

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Clinical Librarians and knowledge management a
next step

• Sarah Sutton, Clinical Librarian,
• University Hospitals Leicester

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Introduction

• Clinical Librarian project
• Extending the service
• Implementation
• Lessons learnt
• Evaluation

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At UHL the CL supports the whole Clinical Team

• We answer questions for
• Doctors
• Nurses
• Allied Health Professionals
• Each CL linked to a group of clinical areas

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Why a Clinical Librarian

• Because a Clinical Librarian
• Provides answers to Clinical Questions full
  text too!
• Comes to the clinical team
• Is also part of Library Team with excellent
  access to all services
• Has access to IT
• Has database knowledge
• Gets to know about own Clinical areas
• Knows about searching techniques and critical
  appraisal

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CHI Report

• What, if anything, did CHI find that the rest of
  the NHS can learn from?
• Clinical librarians are attached to each
  directorate and attend ward rounds, clinical
  meetings and audit meetings so that evidence is
  more readily available.

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The Problem
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Happy Customer
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What about the others

• Scharr report said
• The major shortfall of the Project has been the
  delay in launching an online version of the
  clinical questions database
• BOOTH, A, SUTTON, A and FALZON, L. (2002)
  Evaluation of the clinical librarian project
  University Hospitals Leicester NHS Trust.
  Sheffield, School of Health and Related Research
  University of Sheffield.

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How to share knowledge?

• Write up some searches
• Use criteria to decide which ones
• Use similar system to Attract best evidence
  from a brief search, not a SR
• Make it available electronically
• Replace old summaries with new, do not update

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Criteria

• FAQs
• Questions with clear, high level evidence.
• Questions important locally, even if only low
  level evidence

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Example of a summary on intranasal diamorphine
for pain relief in children

• A multi centre randomized controlled trial by
  Kendall (1) from 2001 on nasal diamorphine for
  analgesia in children and teenagers with clinical
  fractures. This study of 404 patients found that
  nasal diamorphine produced faster onset of pain
  relief than intramuscular diamorphine. Pain
  scores were lower at 5, 10 and 20 minutes after
  treatment. It recommended the use of intranasal
  diamorphine over other methods of pain relief for
  this age group.
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• A Best Bets critically appraised topic from 2001
  by Davies (2), who found that intranasal
  diamorphine is a safe and effective analgesia for
  acute musculoskeletal pain. Davies appraises
  Kendalls and Wilsons randomized controlled
  trials for this article.
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• Wilson (3) from 1997 with a prospective
  randomized controlled trial of 58 children that
  showed that intranasal diamorphine is an
  effective, safe and acceptable method of
  analgesia for children receiving opiates in the
  emergency department.
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• Maurice (4) from 2002 on emergency analgesia for
  the paediatric population this review refers to
  Wilsons paper but not to Kendall the
  literature search was probably completed before
  Kendalls paper was published. The review
  recommends intranasal diamorphine as a pain
  relief option for this age group.
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• North Bristol NHS Trust Medicines Information and
  Training (5) on intranasal diamorphine for
  paediatric analgesia from 2000 a protocol for
  its use in the AE department of the North
  Bristol NHS trust.

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First Attempts

• Worked with IMT
• Have our own database
• Link from Intranet
• Staff member leaves

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Make use of DMS System

• DMS on Insite available to all UHL staff
• Shares location with Clinical Guidelines, PILs
  and lots of other good stuff
• Averaging 122 hits per month only live for 7
  months

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DMS on INsite
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Problems

• Making time for writing the summaries
• Not enough Knowledge Management in the Knowledge
  Management, yet

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Evaluation and future developments

• Do audit of use of Evidence Summaries use
• Evidence Summaries to be available on NHS Net
• Consider making them available for single search
  engine
• Work with Knowledge Management on introduction of
  thesaurus

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