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Julie, I would say that recognizing our limitations is also part of our training/competency, and the fact that you did so, and also knew what the next step should be - contacting your Compliance people - is an indication that you are doing a splendid job in connecting people to the right information sources.  If I were in your shoes, I might email the requestor letting them know that you are/were going to bring Compliance onboard to ensure that the information you provide is as complete as possible. Then the requestor won't be surprised by the contact from Compliance.  Sometimes I guess I may try to be too politically correct, but I wouldn't want the requestor to feel that I was "tattling" on him/her.  Of course they shouldn't feel that way, but one can never completely anticipate reactions, nor know all the working relationships, good and bad, that exist within a group dynamic.


Ardis Weiss, MLS, BA
Medical Librarian
My job is to provide the information that you need to excel at your job.
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1798 N. Garey Ave., Pomona, CA 91767
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-----Original Message-----
From: Medical Libraries Discussion List [mailto:[log in to unmask]] On Behalf Of Estabrook, Alexia
Sent: Thursday, October 30, 2014 8:25 AM
To: [log in to unmask]
Subject: Re: HELP: drawing a line on my competency...

That is a tough one because.  Any search we do for a clinician has the potential to go south.  We are the experts in finding and vetting information but not necessarily experts in interpreting it.  We do a search with the assumption that the clinician will "do the right thing" with the information.  You can give the physician what you find and suggest he or she also checks with your compliance people but you can't force him to do so and just have to hope he does.

So, as for what the line is... I think that is partially up to you and I think the scenario in question has crossed your line.

Alexia D. Estabrook-Isely, MSLS
Consultant, Medical Library

Providence Hospital | Helen L. DeRoy Medical Library Main Phone: 248-849-3294 | Fax: 248-849-3201 | Email: [log in to unmask]<mailto:[log in to unmask]> Library Home Page: http://www.intra.providence-hospital.org/MedicalLibrary/

Whatever knowledge we find for you leaves you more time for your patients.  Thank you for allowing us to assist you.

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________________________________________
From: Medical Libraries Discussion List [[log in to unmask]] on behalf of Julie Stielstra [[log in to unmask]]
Sent: Thursday, October 30, 2014 11:08 AM
To: [log in to unmask]
Subject: HELP: drawing a line on my competency...

Some weeks ago, our Anesthesia chair asked me to find the federal, state, Jt Commission, and CMS rules/regs/standards regarding the requirement for history&physical exams prior to anesthesia, specifically if the anesthesia was for a NON-surgical procedure.  They specifically wanted to know if they HAD to do them, if it wasn't for surgery.  Our state regs are explicit: if there's anesthesia involved, you MUST do an H&P, surgery or not, and I strongly recommended they contact our compliance / legal team for further advice. Now they want the same kind of info regarding obstetric / labor epidurals.  They regard these as analgesia, not anesthesia, and therefore the rules shouldn't apply.  At this point, I'm thinking - whoa.  This is way above my pay grade: this is a legal compliance issue and a patient safety issue.  Do I want them to skip an H&P because the librarian found (or couldn't find) info saying it was (or wasn't) okay?  Am I supposed to comb through CMS manuals to find that detail?  Or is this more properly the job of our compliance / legal experts?  At what point do we say: no, this is not something I am competent to answer?  I went ahead and got in touch with our regulatory compliance person, who agreed this was a complicated situation and she will pursue.  My gut tells me this question needs to be addressed by others with proper expertise here, not me.  What do your guts say?  My ego wants me to be The Answer Wonder Woman Who Can Find Anything, but at some point that's just stupid...and asking for trouble.  Where's the line??

--
Julie Stielstra, MLS
Manager, Libraries of Cadence Health
Central DuPage Hospital
25 N Winfield Rd
Winfield, IL 60190
phone 630-933-4536
fax     630-933-4530
email jstielstra [ at ]  gmail.com

"Never...be mean in anything; never be false; never be cruel. Avoid those three vices...and I can always be hopeful of you."  -- Betsy Trotwood to David Copperfield (Charles Dickens)

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