MLA Position Statements and FAQs
Role of Health Sciences Librarians in Patient Safety Position Statement
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 . 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 . 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 .
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” . 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.
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 .” 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” . 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 .
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 . 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” .
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” .
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 . 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 .
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 .
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” . 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. .
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 . 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” .
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.
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.
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>.
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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].
National Network of Libraries of Medicine. Patient safety resource seminar: librarians on the front lines [Internet]. The Network [cited 17 Nov 2008].
National Network of Libraries of Medicine. Patient safety: librarian as advocate [Internet]. The Network[cited 17 Nov 2008].
Zipperer L. Select publications [Internet]. [cited 17 Nov 2008].
Prepared March 2009 by
For more information, contact Mary Langman, 312.419.9094 x27.
Medical Library Association
Last Updated: 2009 June 03