Get to know: Sarah Carnes, MLIS, AHIP

Clinical Librarian, Acting Emergency Manager

Bedford Veterans Administration Medical Center, Mass.
linkedin.com/in/sarahcarnes/

“44+ of our Veterans are recovered!”

As the COVID-19 pandemic challenges healthcare systems worldwide, some hospital librarians find themselves being labeled “essential”, having to shift their key priorities, and taking on new responsibilities—often unrelated to the library.

On May 17, 2020, Sarah gave us a peek inside the Bedford Veterans Administration Medical Center in Massachusetts.

Q&A

Please describe the type of transformation you have witnessed at the medical center during the past few months.
Early in February, our medical center—like others throughout the Veterans Health Administration—began conducting planning and exercises in anticipation of SARS-CoV2 affecting our patients and staff. We also started restricting access to the facility by limiting visitors and reducing outpatient appointments.

In early March, I was asked to become the acting Emergency Manager due to my background in that field. I still do perform some of my Clinical Librarian roles as well, but if I am too busy, I turn to my colleagues in our consolidated service within our region.

Since early March, we have further restricted access to our facility by temporarily delaying non-emergency outpatient services, tightening control on facility access by reducing entry points and initiating screening, controlling access in our inpatient areas and adding secondary screening. We are also restricting library deliveries that normally were provided at least weekly, and activating our Incident Command. These were done to mitigate the risks of exposure.

We spent a lot of time ensuring that our procedures followed the current guidance from the CDC, VA, and other reputable and reliable sources. As I am the Clinical Librarian, I was able to put my librarian skills to use for both our medical center and our regional staff to help us keep up with the continually changing evidence and guidelines. Most notable has been the increased understanding of asymptomatic spread and the need for face coverings and masks for all staff and patients.

Our patients are particularly vulnerable: we have the largest number of assisted living patients who live at Bedford full time. In addition, we have residential programs for Veterans who have experienced homelessness, addiction, and severe mental illness. Veterans experience health disparities and chronic illnesses at a very high rate, and our Veterans all have at least one high risk factor for COVID-19.

We began planning for the possibility of having COVID+ patients at Bedford by creating cohorted units with negative air machines and surge capacity. Those plans were well underway when we learned of some extreme circumstances at the nursing homes and soldiers’ homes in our community. These are not run by the Veterans Health Administration, but we are committed to our fourth mission of assisting our communities.

In early April, we received multiple COVID+ patients from the Chelsea Soldier’s Home and so we expedited the transformation of one of our assisted living areas into a COVID+ unit to provide the most protective and responsive care to these patients.

Later, we did diagnose patients and staff with COVID+, so we have cohorted those patients and created additional COVID+ and quarantine units. Over the last three weeks, we were thrilled to create our Recovery units where multiple Veterans who are recovering from COVID-19 can convalesce and receive the essential restorative services so they can regain their strength.

We are extremely lucky to have an array of interdisciplinary mental health experts to support both our Veterans and our staff. The illness and loss due to COVID-19 has affected all of us, and our frontline staff have experienced this very acutely. Through multiple courses of action, we have focused on providing resources to support our Veterans and staff. Our fellow staff members, our Veterans’ families, and our community have sent in letters and signs and we had a beautiful salute to service from responders from throughout the Boston metro area. Our staff assistance team has expanded to include a Stress Management Response Team, or SMaRT team. They conduct deliveries of snacks and beverages to staff supporting our patients. They have also created and gathered incredible content that staff members can use to help them relax and build their resilience.

The pandemic has resulted in many professionals working outside of their specialty area or discipline to treat COVID-19 patients. How have you and/or your library adjusted?
Without question, that has been exactly my situation. Due to my background in emergency management, I have been working as the Emergency Manager. My Clinical Librarian experience definitely informs my actions, though. My physical library is closed, and my volunteers are not conducting their deliveries and visits with inpatients. Recently, my volunteers and I started to modify our support to our inpatients that complies with our infection control requirements while still fulfilling our Veterans information and entertainment interests to include books, audiobooks, magazines, and DVDs.

How have the priorities of your library changed? Are you taking on activities that are not typical for a librarian?
We’ve always had the Veteran at the center of all we do, but our modes of fulfilling that are changing. Next week, we will be initiating a “Library Network” via Skype so that we can provide the military history programs and book reading that we used to do in person.

As a Clinical Librarian, has your interaction with clinicians increased or decreased during this time? Are you able to go on rounds?
My in person interaction with clinicians has decreased as I cannot go on rounds, but I work closely with our Chief of Staff, Nurse Executive, Deputy Nurse Executive, physicians, nurse practitioners, and nurses to provide them information and assist with developing our procedures and operational plans.

There is a continuous influx of COVID-19 medical literature being published. How are you helping hospital staff navigate through the clutter to find quality content?
I have been conducting literature alerts for the VA Library Network (VALNET) for a few years. These included hypertension, pressure wounds, homebased care, geriatric psychiatry, and the opioid epidemic.

When SARS-CoV2 emerged, I asked the director of VALNET, Nancy Clark, if I could conduct a literature alert for VALNET as I had started one for my own medical center. She agreed and since then I have been providing the latest research and resources to the VA. We have a distribution list, but I also forward it to a number of staff members who I know are interested. I’ve also shared it with colleagues in the Medical Library Association through several distribution lists after asking if there might be interest.

I’m thrilled to provide this service as there is an unmanageable amount of literature and resources. I try to balance sensitivity and specificity, and I assess the alerts and suggestions I receive to provide a curated list. Even so, the alert is massive. At least 2,300 new articles related to COVID-19 are added to PubMed each week. Like I do with my opioid epidemic alert, I put a smaller list of the most recent research and resources that I determine could be of particular use at the top of the alert, followed by the comprehensive list of the most recent articles.

I’ve received very good feedback, so that is really rewarding.

Have clinician content needs changed? If so, how has your library adapted to support this need?
Content needs have changed. Several clinical operations are temporarily suspended, so there are fewer units that need information. However, their information needs have grown exponentially, especially as new research is emerging.

We are still providing care to non-COVID patients, but my information requests have been mostly related to COVID-19. They have concerned not only research but also the latest guidance from the CDC and VA. We’ve also developed our own local standard operating procedures, so I help disseminate that information as well. Of particular interest has been information related to therapeutics, environmental mitigation like negative air and antechambers, COVID-19 testing for diagnosis and for presence of antibodies, PPE needs, return to work procedures for staff, and infection control procedures.

Have you experienced any access or technology bandwidth challenges?
I have not experienced any access challenges. I’m on campus every day and frequently access our intranet from home as well in the evenings and on weekends. When we increased the use of telework, some staff had trouble connecting or calling in on meetings, but those issues seemed short lived.

Have you needed to educate or provide resource/materials to external groups, such as patients, patient family members, or the media?
Through our weekly calls, I provide updates to family members and staff members. I also work with the PAO to respond to requests from the media and elected officials. When we receive complex questions from someone, I employ my clinical librarian skills to conduct research and package the information. Then I share that through the most appropriate channel, whether it is our PAO or staff members who work with the families, such as our social workers.

A good deal of the content regarding COVID-19 is not credible, or substantial. Have you needed to educate anyone internally or externally on information literacy?
Absolutely. As always, a staff member or elected official or family member will read something—like information about NSAIDs or antibody testing—and I help provide them better evidence in a format that is useful and understandable. In addition, I help others explain some of the complex answers in a way that is appropriate for the audience.

Which communication channels have you found to be the most reliable to quickly disseminate COVID-19 content and updates?
Official updates, reports, briefings, meetings, and phone calls have been very effective. Most of these are scheduled and recurring.

Every morning, our Incident Command has a daily briefing for our Director and for each other to provide us information about the activities of the last 24 hours and to focus our priorities for the next day. Several sections within the Incident Command provide us data daily so that we can monitor our patient status, logistics levels, and other data points. I consolidate these for a report to our region, and also disseminate this report to our Incident Command team members and other members of our staff who need this for situational awareness.

Daily at 11, our Director has a meeting with our VA region’s leaders, which I attend to contribute and gather information. I have my own meeting with the region’s emergency managers daily at 1 pm to receive and provide updates that are related to our emergency management channels. Later in the day, I have a daily phone call with the Town of Bedford’s Chief of the Fire Department to exchange information and to ensure that our modified procedures dovetail with their plans to provide us emergency response support.

We conduct daily operational updates to staff through our Public Affairs Officer (PAO) to keep them informed about new guidance and our current status. We also provide this update to regional stakeholders and the media.

On Tuesdays, members of our Incident Command meet with our state congressional representative via conference call to update them about our status and to address their questions.

On Wednesdays, we have a Town Hall with our staff where the Incident Command provides updates and answers questions. We also do this on Thursday with our patients’ family members. Our PAO and social workers also have a newsletter for the families that is sent in hard copy and electronically, and we have a hotline and email address for them to contact staff.

On Thursday afternoons, I have a phone call with the State Department of Public Health and frequently have conversations with the Town of Bedford’s manager and public health leader.

Staff regularly reach out to me and Incident Command with questions and suggestions. That works very well—especially since it allows for a synchronous communication since so many people are very busy and we cannot easily meet in person. When we do meet, Skype meetings with limited in person works very well.

The increased anxiety and workload throughout the hospital must be palpable. How are you managing to navigate this challenging time, and do you have any tips for your librarian colleagues?
I meditate at least once a day, I try to connect with some of my friends on staff to commiserate and bolster each other, and I have wonderful conversations with my daughter and parents where I don’t talk much about work. I also have a routine to ensure self-care, to include healthy eating and sleeping. I don’t get enough physical exercise due to my hours, but I have been improving on that. I also keep my focus on the reason for why I do what I do—to support the efforts of our staff to provide the best care to our Veterans.

What upcoming challenges do you foresee your hospital library facing?
While it is challenging to not be able to visit our Veterans directly and regularly or to conduct clinical rounding, I believe that we have multiple options for continuing our support in a modified fashion. I’m very optimistic that with our staff and volunteers, we will find ways to ensure the continuum of care that we all want to provide to our Veterans, their families, and our staff.

Tell me something good!
We are so excited that 44+ of our Veterans are recovered from COVID-19!

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