The following article is written by Abbigail Oswalt, CHT, HC-S.

Abbigail is a UHMS member, Hyperbaric Safety Director in a hospital setting, and Chair of the System's Outpatient Wound Care Integration Council. For more on her bio go to the Hyperbaric Certification Commission's Graduates page: 

Lessons Learned:

Calling Upon All Hyperbaric Safety Directors to Act Now

With the preliminary hearing concluded and the evidence now on record, it appears to me that several critical issues stand out that every hyperbaric safety director may wish to examine within their own program. I encourage all safety directors to listen to the hearings firsthand to form their own assessment. That said, in my opinion and based on my review, the following key issues have emerged and, in my view, merit careful consideration:

Grounding Straps

If you are working in a monoplace facility, your patients, providers, and staff should be thoroughly informed about the reason grounding straps are used and why they are considered essential rather than optional. In addition to always wearing the grounding straps, I would strongly recommend that staff verify that the patient is grounded prior to the start of every treatment without exception.

Does your program implement annual competencies for all staff, and are they verifying patient grounding on the list of competencies?

Static

As we all know, static is all around us. I know for myself, when I was a brand-new chamber operator with little knowledge and minimal direction, when I observed one of my patients' hair standing up while they were in the chamber, I was—for lack of a better word—alarmed. I stopped the treatment and removed the patient from the chamber and reverified all the grounding checks that I had just completed only an hour before, and everything was within normal limits. I found myself frustrated and confused.

With no one immediately available to me for direction, I revisited every credible resource that I had available. Eventually, I found my answers and came to understand why it happened. Years since then, I have had chamber operators—new and experienced—call me about the same issue.

To me, this illustrates why ongoing education and training are vitally important. I have learned that education is not always about new information; it is often about revisiting knowledge that you already have.

Checklists

When was the last time you reviewed your checklists? Do your staff walk through and complete the checklist items line by line, or do they sit at the desk and just place a check mark in each box because "I do this every day; I know that it gets done"?

In my experience, it is easy to assume that things are the same every day—until you have a near miss or an incident report.

Pre-Treatment Safety STOP I would encourage you to do the following:

  • Revisit your safety stop procedure.
  • Observe how each staff member completes the safety stop and ensure they understand its importance.
  • Educate your patients on the importance and the reasoning behind the procedure.


Informed Consent

Read your patient consent forms in their entirety. At a minimum, you may want to make sure they include the following:

…a description of the procedure

…the reasons for the procedure

…the benefits

…all of the risks, including fire

…all potential side effects/complications

…what the alternatives are

…the risks of refusal

…a voluntary consent statement

…a confidentiality statement

…dates/time and signatures from the patient, physician, and witness

When obtaining consent are patients verbally told all the things listed within the consent form? Do these patients fully understand what they are signing?

Pillows

Are you using pillows purchased from the chamber manufacturer, or are you using regular bed pillows with cotton covers over them? This is a practice that I have seen used in other clinics and I consider to be potentially unsafe.

In my professional opinion, the safest option is to purchase directly from the manufacturer. The cost may be more, but I would ask whether the lower cost of a pillow that could contribute to a fire is truly worth the potential risk to someone else's—or your own—life.

Documentation

In nursing school, they drill it into your brain to never document something that you have not done. Perhaps at some point in our careers we may have been tempted to do otherwise. At the time, it can feel easy to justify because you know you are going to be really busy and trying to document in between tasks may slow you down. You may feel you have extra time now, and you know you are going to complete the task later—so why not document it now to save time?

Don't do it.

Make sure your staff are not doing it either and are teaching others not to do it. Medical records and logbooks are legal documents, and regardless of your title (nurse, EMT, unlicensed chamber operator), you may be subject to the same legal consequences when you pre-document something that you did not actually do. None of us can predict the future, even if you believe the task is unavoidable and must be done to complete the treatment.

My recommendation is simple: do not document something that you have not already done.

Evaluation

Audit your program from top to bottom; review everything, observe staff, talk to patients, reeducate staff and providers, and verify staff competencies. Revisit every element of your program and compare it with current industry safety standards. Include your staff, encourage them to ask questions and share their thoughts. Are there areas they feel need improvement?

In my view, collaboration drives innovation, which I believe is crucial when instilling a safety mindset within your program.

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