In a new element: medical librarians making patient education rounds

BACKGROUND

Englewood Hospital and Medical Center is a medium-sized community hospital with a daily census of approximately 250 beds. We are a teaching hospital with 675 medical staff, 40 internal medicine residents, and 90 B.S.N. nursing students in affiliation with the University of Medicine and Dentistry of New Jersey and Ramapo College of New Jersey. In addition, we have an affiliation with Mt. Sinai Medical Center in New York, with surgical residents and medical students who complete rotations at our hospital.

Two librarians, the director and nursing librarian, along with four volunteers, are responsible for the operation of the Health Sciences Library. For over twenty years the library staff has provided consumer/patient information to the public and patients, usually via call-in requests. Educational and informational packages are mailed out, delivered to patients' rooms, or picked up.

During the last three years the Health Sciences Library has collaborated with the Meland Foundation—Network for Medical and Health Information.* Its founder, Robert Nelson, established an office for the foundation on the second floor of the library. The mission of the foundation is to provide information and inspirational literature to patients and families. Because of the availability of the Meland staff, a secretary and five volunteers, some of whom are trained in searching for patient education information, we were able to develop a performance-improvement project for 2002. The project included making patient education rounds to increase the number of patient education requests coming from the nurses. The Meland Foundation and staff have supported the library staff by doing some of the research for the patient education questions.

VISITING PROGRAM

During January 2002, only five nurses called the library for patient education information. In April 2002, the two librarians at Englewood Hospital and Medical Center implemented the performance-improvement project and began making patient education rounds on twelve inpatient nursing floors in order to identify patient education questions and provide materials. As they made rounds on the hospital floors, they often heard comments from physicians such as, “What are you doing up here?” or “Ah-ha! You're out of your element!” One day, the response to this by the librarian was, “No, I'm in a new element. We make patient education rounds now and we're handling about 65 requests a month—from our patients!”

Sometimes nurses will have patient education questions and educational packages will be delivered directly to them; they review the materials and distribute the information to their patients. Sometimes nurses will ask the librarians to visit specific patients. We do not meet patients directly in their rooms unless there is a specific request to visit from the nurse. Presently, time limitations prohibit us from visiting families in waiting rooms. Information about the Meland Foundation and the library is posted in the waiting rooms and other areas of the hospital inviting patients to visit or call.

The following is an example of a typical day as the two librarians made their rounds. Lia Sabbagh, nursing librarian, visited the cardiac floor. The head nurse asked her to provide information on a variety of topics that could be set up in folders for use on the floor as part of the nurses' patient education program. Subjects included arrhythmias, congestive heart failure, pacemakers, atrial fibrillation, cardiac catheterization, lowering cholesterol, cholesterol and exercise, insulin, and diabetic diet. This type of project takes several days to complete.

Kathy Lindner's visit that day was to a medical-surgical unit on the fifth floor. She made a list of each nurse's assigned patient room numbers. As each nurse was located, the following sentence would open the dialog: “Hi, I'm Kathy from the library and I'm making my patient education rounds today. Do you have any patients who need patient education information?”

One nurse asked Kathy to visit her patients. One young woman asked for information on colon cancer surgery. Another patient and her son asked for information on a fracture of the proximal humerus. The fracture was the result of a bad fall. The librarian offered to deliver information on preventing falls as well.

If the questions are discussed with the patient, the librarian will end the discussion by saying, “I would like to share your questions with your nurse so, if necessary, you can ask him or her more questions. Would that be O.K.?” Usually the patient agrees and in this way we are protecting their right of confidentiality. We only share the patients' questions with the nurse if they agree.

On one occasion, a man in the intensive care unit asked for information on the craniotomy he had just had. He also wanted information on infertility for himself and his wife. When the librarian asked if it was O.K. to share this information with his nurse, he said it was O.K. to share the information on the first question (on craniotomy) but not on the second (the subject of infertility). His wishes were respected.

If the nurse is to be informed, there is a form on the library's letterhead that is addressed to the nurse. The form, which is always dated, is shown in Figure 1. The form is signed by the library director and includes a note at the bottom: “For privacy reasons you may tear up this sheet after you read it and document the patient education request in the chart.”

Figure 1.

Patient information request form

When information is delivered to a patient, a disclaimer also accompanies it (Figure 2). Similar letters are used for public patrons and employees in the hospital.

Figure 2.

Disclaimer

STATISTICS

Table 1 displays the pattern in the number of requests that were made by nurses for their patients since we began patient education rounds in April 2002. Before that time we rarely had any requests from any nurses.

Table 1 Number of requests from nurses for patient education materials

We have no firm explanation for the fluctuation in the number of questions, but we are satisfied that the number of requests is at least five times higher per month than when we started.

The total number of patient education information questions for 2002 was 1,182. Through March 2002, we recorded only the total number of patient education questions. Beginning in April 2002, we kept specific statistics on the number of questions coming from the public, the nurses, and the patients. The total includes 323 requests from nurses, 52 requests directly from patients, and 807 requests from the public.

The patient education rounds to the nursing floors have been an extension of the philosophy begun by the library staff in 1992 and expressed in the slogan “Encouraging Information Therapy” [1]. A literature review failed to uncover any other health sciences librarians who make rounds to nurses or patients. Bolton and Brittain suggested in 1994, “If patients are unable to visit the library, then the information staff in liason with the medical staff concerned, could visit the patients with the information required” [2]. Shearer reported that approximately two hundred hospitals have instituted clinical librarianship programs, but these are set up for the clinical staff, not patients [3].

The “informationist role” described by Davidoff includes the idea of creating new information retrieval systems and “finding out more about when and how clinicians, patients, and families need information, what information they need most, and in what forms it is most useful to them” [4]. Although this informationist role is still being debated and defined, it is noteworthy that the original idea included services to patients as well as clinicians.

Calabretta, in her review of consumer-driven, patient-centered health care, describes the librarian's activities in the area of patient education information at Cooper Health System in Camden, New Jersey. She points out that JCAHO requires that patient education be delivered as part of inpatient care and documented in the patients' charts. Clinicians at Cooper place orders for patient education information on the Clinical Information System; librarians receive the requests; two copies of the informational materials are sent to the floors via “runners” who are employed by the nursing department. One copy goes to the patient and one copy is placed in the patient's chart [5].

We feel the Cooper Health System program is exemplary, but we also feel that our visiting program of making rounds and forming relationships with the nurses promotes an increase in awareness that our patient education materials are available and can be requested.

At this point in time, because of the “downsizing” of our library assistant position, which occurred in March 2003, and other increasing pressures in the library, the librarians are in the process of training volunteers to make rounds on the floors to fill patient education requests. Figure 3 shows the guidelines we have developed for training the volunteers.

Figure 3.

Volunteer training guidelines

Our future plans include finding more volunteers to help us and developing an evaluation tool to determine the effectiveness of our program. We are also in the process of seeking a grant, which would include funds for salaries of part-time staff to make patient education rounds. We are also continuing to develop our Website.† Our Website provides easy access for consumers and patients to find health information on their own.

Carla J. Funk, CAE, executive director of MLA, in 1998 called on librarians, “to redefine their position in the world of information” [6]. We have tried to meet that challenge.