MLA Position Statements and FAQs

Role of Health Sciences Librarians in Patient Safety Position Statement

MLA Position

Patient Safety: Why Librarians Must be Involved

Patient Safety Initiatives: Partnership Opportunities for Librarians

Patient Safety: Roles for Librarians

Conclusion

References

Authors

The Medical Library Association's Position

The Medical Library Association (MLA) maintains that the nation’s health sciences librarians must play an active role in furthering patient safety initiatives in their organizations. This position is supported throughout the literature, including journals in health sciences librarianship, patient safety, and nursing.

MLA believes that librarians are essential for the practice of evidence-based health care (EBHC), a documented component for providing quality patient care and for addressing patient safety issues [1]. Research has shown that libraries improve patient care and have an impact on health outcomes for patients and may lead to time savings for health care professionals [2]. The results of a 2004–2005 study demonstrated that case discussion at residents’ morning report, accompanied by a computerized literature search and librarian support, led to shortened length of stay and lower hospital charges [3].

MLA’s Code of Ethics calls for the health sciences librarian “to provide leadership and expertise in the design, development, and ethical management of knowledge-based information systems that meet the information needs and obligations of the institution” [4]. Thus, MLA believes that health sciences librarians are uniquely positioned, qualified, and challenged to support their institution’s goals to develop and implement effective patient safety programs.

Patient Safety: Why Librarians Must Be Involved

Like the physical and emotional harm caused by medical errors, the financial consequences
don’t stop at the hospital door. Eliminating medical errors and their after effects must continue
to be a top priority of our health care system. [5]

Following release of the 1999 Institute of Medicine (IOM) report, To Err Is Human, health care accreditation agencies and organizations began launching initiatives to address the problem of medical errors and strategies for promoting patient safety. The IOM report concluded that “Most medical errors do not result from individual recklessness but instead from basic flaws in the way the health system is organized [6].” The report raised awareness that for systems to change, health care executives and clinical leaders must accept responsibility and accountability to change and to create a safer health care delivery system.

2000-2001 MLA President J. Michael Homan, AHIP, FMLA, stated that “At the bottom line of the IOM report and virtually every recommendation made by professional societies, accrediting agencies, watchdog groups and other authorities was that systems must be knowledge- and evidence-based” and that “if at the end of the day, we do not bring knowledge-based resources to the problem of medical errors, the solutions we devise are not going to work” [7]. Homan pointed out that hospitals have information experts on staff—medical librarians—who possess the knowledge, skills, and expertise to further their organization’s patient safety initiatives [7].

Lorri Zipperer, managing cybrarian for the Agency for Health Research Quality (AHRQ) Patient Safety Network, and Linda Williams support Homan’s position, noting that access to information plays a key role in providing safe patient care. Nurse executives, nurse administrators, and frontline nursing personnel can ensure better access to information by seeking out the hospital librarian to strategize about patient safety improvements [1]. Key findings from a 2003 survey found that information professionals and librarians responding to the survey were aware of the importance of patient safety initiatives; that some information professionals were proactively becoming involved with safety initiatives, particularly promoting the role of evidence-based decision making; and that information professionals have opportunities to define their roles in and contributions to this vitally important area. Based on these other findings, Zipperer and Jan Sykes concluded, “Librarians and information professionals should have an integral role in patient safety efforts” [8].

Patient Safety Initiatives: Partnership Opportunities for Librarians

Standard 5 of MLA’s Standards for Hospital Libraries 2007 calls for the librarian’s role in performance improvement and patient safety through “active membership of the librarian on performance improvement and patient safety teams; frequent provision of information on which performance improvement and patient safety decisions are based; and documentation of regular routing to appropriate individuals of current literature relevant to the hospital’s quality indicators, top diagnoses, performance improvement projects, patient safety, and/or identified problem areas” [9].

Recent MLA initiatives further highlight the skills and expertise that health sciences librarians can contribute to patient safety within their organizations.

The American Nurses Credentialing Center’s (AANC’s) Forces of Magnetism Program requires Magnet Hospitals to provide evidence that nurses throughout the organization have access to the Internet, library, and/or other appropriate literature and data sources. MLA’s 2007 Magnet Recognition Program Collaboration Proposal to AANC identifies shared core objectives and ways that MLA as a professional association and health sciences librarians can support these common core objectives. The proposal recognizes that excellence in nursing care and patient outcomes begins and ends with the appropriate, relevant evidence-based information provided by librarians to guide health care decisions [10]. Further, results from a July 2007 Nursing and Allied Health Resources Section/MLA Magnet Coordinator Survey shows that 94% of the nurses in Magnet facilities have onsite access to a nursing or medical library, and 4% have access, but not onsite. The survey also found that 96% of facilities with a medical librarian perceived that this provided added value for the institution and its employees [11].

Low health literacy is increasingly recognized as a barrier to quality patient care and is linked to under-use of preventive services, little knowledge and poor management of chronic diseases, medication error, and increased hospitalization and costs [12].

This parallels the Joint Commission’s findings that “the safety of patients cannot be assured without mitigating the negative effects of low health literacy and ineffective communication on patient care” [13]. MLA’s Health Information Literacy Curriculum identifies several ways that librarians can help improve patients’ health literacy by providing free access to the Internet, patient information packets, consumer health collections, native language resources, etc. [14].

The Joint Commission has addressed patient safety through several initiatives and publications. In 1996, it implemented the Sentinel Event Policy to help health care organizations identify sentinel events and take action to prevent their recurrence. In 2002, the Joint Commission approved its first set of National Patient Safety Goals with related specific requirements for improving the safety of patient care in health care organizations. In 2003, the Joint Commission’s Board of Commissioners approved the Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery, which drew upon, expanded, and integrated a series of requirements under the 2003 and 2004 National Patient Safety Goals. In 2002, the Joint Commission, together with the Centers for Medicare and Medicaid Services, launched, its Speak Up initiatives that urge patients to take a role in preventing health care errors by becoming active, involved, and informed participants on the health care team. The program features brochures, posters, and other materials on a variety of patient safety topics including infection prevention, medication mistakes, follow-up care, medical test mistakes, patient rights, and health literacy.

The librarian’s skills and expertise are crucial in the implementation of many Joint Commission initiatives and the standards related to information management and infection prevention and control. Libraries improve patient care, and research studies suggest that professionally led library services have an impact on health outcomes for patients [2]. The Joint Commission’s 2009 standards require accredited organizations to plan for the management of information and for knowledge-based information resources that are available, current, and authoritative (IM.01.01.01 and IM.03.01.01). They also require organizations to identify the risks for acquiring and transmitting infections and the evaluation of the effectiveness of its infection prevention and control plan (IC.01.01.01 and IC.03.01.01). Goal 7 of the Joint Commission’s 2009 National Patient Safety Goals seeks to reduce the risk of health care–associated infections by implementing evidence-based practices to prevent health care–associated infections due to multidrug-resistant organisms in acute care hospitals. Beginning January 1, 2010, hospitals will be required to educate patients, and their families, as needed, who are infected or colonized with a multidrug-resistant organism about health care–associated infection strategies. Williams and Zipperer have pointed out that “EBM cannot be practiced without library resources and libraries—expertise in refining the search question and then producing and evaluating relevant results rests with the medical librarian” [1].

Patient Safety: Roles for Librarians

An estimated 98,000 hospital deaths occur annually from medical errors…while there have
been many piecemeal approaches to patient safety, a total solution has remained elusive…
“The healthcare industry has been waiting for a perfect system, we can no longer wait.” [15]

Patient safety programs will continue to emerge and develop as the health care system continues to grapple with the challenge of reducing medical errors. While librarians may not be actively sought out to play a partnership role in these initiatives, opportunities do exist for librarians to become involved in these efforts. Following are some recommendations that have been addressed in the literature in recent years.

Ensure that your health professionals use the library and your services for access to high-quality, accurate, timely, and relevant evidence-based information for clinical care. As highlighted in MLA’s Myths and Truths about Library Services <http://www.mlanet.org/resources/vital/>, research has shown that libraries improve patient care and that professionally led library services have an impact on patient outcomes for patients and may lead to time savings for health care professionals [2].
Develop relationships with staff responsible for patient safety. Results of Zipperer and Sykes’s 2003 exploratory survey on the roles of librarians in patient safety indicated that an innovative and proactive relationship between librarians and those responsible for patient safety should be nurtured. This enables health professionals to most effectively identify, acquire, and disseminate information to support system improvements, learning organization behaviors, and clinical decisions so that the information dimensions of patient safety are fully integrated and leveraged [8].
Volunteer to serve on a patient safety or quality assurance committee. Homan pointed out that librarians bring to the committee the skills to research and identify available patient safety research, identify what works and what does not, and tap into the knowledge of other industries and health care organizations [7]. Jeannine Cyr Gluck AHIP, also recommends that librarians can become an integral part of the patient safety team by:

becoming familiar with the basic resources in this area, especially those provided by the National Patient Safety Foundation, the Institute for Safe Medication Practices, the Joint Commission Resources on Patient Safety, and IOM publications
assessing the patient safety of your organization and responding to those needs
recognizing members of the patient safety team outside of committee members (e.g., nursing staff, quality assurance, risk management, pharmacy, etc.)
reading articles relevant to patient safety in your professional literature [16]

Develop and/or contribute to the organization’s patient safety web page. Homan highlighted the value of the librarian to acquire and evaluate data that can provide knowledge-based resources needed by patient safety teams and to create an in-house patient safety web page where others in the institution can access all the best resources [7]. Ensure that health professionals, patients, and their caregivers have access to information about national patient safety initiatives and publications such as the Stand Up for Patient Safety Program established by the National Patient Safety Foundation; the Safest Hospital Alliance; the Joint Commission’s report, “What Did the Doctor Say?: Improving Health Literacy to Protect Patient Safety”: and Ask Me 3 from the Partnership for Clear Health Communication.
Develop knowledge maps for patient safety. Zipperer and Gluck maintain that librarians are ideally positioned to create resource maps of internal and external, explicit and tacit sources of knowledge. Using sentinel events as the topic for a model knowledge map, they explore the concept, history, organizational activities, and recent developments in patient safety and reduction of medical errors. The hospital librarian’s contribution to the “safety culture” in an institution includes compiling tools that blend together both practitioner and administrator knowledge of the elements that help institutions effectively manage and respond to adverse incidents. Their sample incident knowledge map is an adaptable resource list for any institution [17].
Involve patients in the safety of their care as a strategy for reducing medical errors. As reported by Zipperer, Mark Berendsen, and Linda Walton, The Partnering for Patient Empowerment through Community Awareness program was launched in 2005 to improve communication among the consumer, health care professional, and librarian regarding patient safety awareness and health care information and to improve consumer awareness about patient safety and resources so that as patients or lay caregivers, they understand the importance of information and feel empowered to accept an active role as partners in ensuring optimal care. Components of the effort include:

presenting consumer-oriented patient safety awareness programs in public libraries
compiling a tool kit and facilitator’s guide that can be used by libraries and hospitals to help build patient safety partnerships to present awareness programming in their communities
developing and maintaining a project website on patient safety [18]

Seek roles in safe medication information delivery. Alan Vaida and Zipperer suggest that librarians can be included in the medical information process in the following ways:

reviewing evidence for off-label use of drugs
developing systemized drug formularies
overseeing up-to-date information in drug libraries, databases, and published resources
acting as expert members of the clinical team [19]

Position yourself as an advocate for information and knowledge exchange and present yourself as a key member of the health care team. Key roles could include:

informing patients about their right to ask questions
listening to consumers and referring their comments to physicians, nurses, and pharmacists
uncovering health literacy and general literacy weaknesses
documenting information searches and results in the patient chart
participating in awareness training on the consumer’s role in patient safety [19]

Play a key role in health literacy programs in your organization by:

helping patients find information on the Internet, including the “Top 10” Most Useful Consumer Health Websites
developing patient information packets
assisting in the special needs of individual patients
ensuring that patients have access to accurate and reliable health information
developing a consumer health collection that includes native languages resources
becoming involved in patient education and health professional training activities
using Information Rx to refer patients to reliable health information and to the library for help [14]

Participate in continuing medical education and other in-service education. Assist educators in amassing the information they need to develop knowledge-based curricula in all areas of health care [7].
Read the literature. Maintain a reading list of literature on librarians and libraries in patient safety. Zipperer and the National Network of Libraries of Medicine, Greater Midwest Region, maintain comprehensive bibliographies. Links to these are provided at the end of the reference section.

Conclusion

As patient safety programs continue to dominate the health care landscape in the coming years, health sciences librarians are challenged to find opportunities to bring their education, training, unique skills, and expertise to the patient safety teams in their organizations and communities.

References

1. Williams L, Zipperer L. Patient safety. improving access to information: librarians and nurses team up for patient safety. Nurs Econ. 2003 Jul–Aug;21(4):199–201.

2. Weightman AL, Williamson J. The value and impact of information provided through library services for patient care: a systematic review. Health Inf Libr J. 2005;22(1):4—25.

3. Banks DE, Shi R, Timm DF, Christopher KA, Duggar DC, Comegys M, McLarty J. Decreased hospital length of stay associated with presentation of cases at morning report with librarian support. J Med Libr Assoc. 2007 Oct;95(4):381–7.

4. Medical Library Association. Code of ethics for health sciences librarianship [Internet]. Chicago, IL: The Association [cited 17 Nov 2008].

5. Clancy CM. Patient Saf Health Inf Technol E-Newsl [Internet]. Washington, DC: Agency for Healthcare Research and Quality; 2008 Aug 20:47 [cited 17 Nov 2008].

6. Institute of Medicine. To err is human: building a safer health system, report brief [Internet]. The Institute; Nov 1999 [cited 17 Nov 2008].

7. Homan JM. Reducing medical errors: medical evidence and knowledge-based resources in reducing medical errors: the role of the medical librarian [Internet]. Chicago, IL: Medical Library Association [cited 17 Nov 2008].

8. Zipperer L, Sykes J. The role of librarians in patient safety: gaps and strengths in the current culture. J Med Libr Assoc. 2004 Oct;92(4):498—500. [cited 17 Nov 2008].)

9. Hospital Libraries Section Standards Committee, Bandy M, Doyle JD, Fladger A, Frumento KS, Girouard L, Hayes S, Rourke D. Standards for hospital libraries 2007 [special report]. J Med Libr Assoc. 2008 Apr;96(2):162–9. [cited 8 Oct 2008].)

10. Allison M, Bandy M. Magnet Recognition Program® collaboration proposal, American Nurses Credentialing Center and the Medical Library Association white paper [Internet]. Chicago, IL: Medical Library Association; 25 Jun 2007 [cited 8 Oct 2008]. <http://www.mlanet.org/pdf/resources/mla_magnet_whitepaper.pdf>.

11. Sherwill-Navarro P, Allen M. Final report: NAHRS/MLA magnet coordinator survey, July 2007 [Internet]. Chicago, IL: Medical Library Association [2008 Apr; cited 8 Oct 2008].

12. Agency for Healthcare Research and Quality, US Department of Health and Human Services. Literacy and health outcomes: evidence report [Internet]. Rockville, MD: The Agency; 2004 [cited 17 Nov 2008]..

13. The Joint Commission. What did the doctor say?: improving health literacy to protect patient safety [Internet]. The Joint Commission; 2007 [cited 18 Nov 2008].

14. Medical Library Association. Putting information into health literacy: the health information literacy curriculum [Internet]. Chicago, IL: The Association [cited 17 Nov 2008].

15. Safest Hospital.org. Safest hospital initiative to save lives, cut costs [Internet]. Pharmahorizons; May 2007 [cited 18 Nov 2008].

16. Gluck J. Librarians as members of the patient safety team. Natl Netw [Internet]. 2005 Apr;29(4):17–8 [cited 17 Nov 2008].

17. Zipperer L, Gluck J, Anderson S. Knowledge maps for patient safety. J Hosp Libr. 2002;2(4):17–35.

18. Zipperer L, Berendsen M, Walton L. Empowering patients at the public library. Patient Saf Qual Healthc [Internet]. 2006 Mar/Apr;3(2) [cited 18 Nov 2008].

19. Vaida AJ, Zipperer L. Safe medication information delivery: the role of the medical librarian. Patient Saf Qual Healthc [Internet]. 2006 Nov/Dec;3 [cited 18 Nov 2008].

Additional Resources

National Network of Libraries of Medicine. Patient safety resource seminar: librarians on the front lines [Internet]. The Network [cited 17 Nov 2008].

This interactive seminar focuses on ways both public and medical librarians can become more involved in patient safety processes and activities—both in their institutions and organizations and in provision of patient safety resources for health professionals, administration and staff, and patients and families. The site provides course and reading materials.

National Network of Libraries of Medicine. Patient safety: librarian as advocate [Internet]. The Network[cited 17 Nov 2008].

These materials are geared for libraries wanting to take a more active role in patient safety in their institutions. Includes a ten-minute PowerPoint presentation and librarians and libraries in patient safety bibliography.

Zipperer L. Select publications [Internet]. [cited 17 Nov 2008].

Authors

Prepared March 2009 by
Margaret Bandy, AHIP, Exempla St. Joseph Hospital Medical Library, Denver, CO
Katherine R. Stemmer Frumento, AHIP, Greenwich Hospital, Richard & Jonathan Sackler Medical Library, Greenwich, CT 06830
Mary M. Langman, Coordinator, Information Isssues and Policy, Medical Library Association.

For more information, contact Mary Langman, 312.419.9094 x27.