INTRODUCTION

In selecting appropriate patients for HBOT, it is important to screen patients for conditions that can pose relative risks for treatment. the importance of obtaining a thorough history and physical during the initial consultation cannot be overstated. All medical treatments and procedures inherently include a benefit-risk analysis. The more accurate and complete the data are from the patient's medical history, the more reliable the benefit-risk analysis can be.[1]  The following information is a guideline for physicians and qualified health practitioners (QHP's) when performing and documenting a hyperbaric specific benefit-risk assessment. 

DOCUMENTATION TEMPLATE 

Risks and Benefits for Hyperbaric Oxygen Therapy

"At the time of initial consultation, the risks and benefits of hyperbaric oxygen therapy were discussed with the patient. The benefits include raising the tissue oxygen levels in order to enhance healing of difficult wounds or to reverse toxic effects of chemicals and inhaled gases. Potential risks include ear, sinus, tooth, or pulmonary barotraumas. This can result in pain and discomfort in the ears, sinuses, or teeth, and rarely to pneumothorax of the lung. There are several potential eye changes, most commonly slight worsening of far vision with improvement of near vision. This is reversible without intervention in most cases. Rarely, certain types of cataracts may mature more quickly than in patients not treated with hyperbaric oxygen. There is a remote risk of fire. We have discussed the list of prohibited items that will not be allowed into the chamber at any time. This list of items reduces the risk of catastrophic fire. Finally, we discussed the risk of oxygen toxicity that can be manifest as a seizure or lung changes. The risks and benefits were explained in detail.

The patient verbalized understanding of this discussion and was given opportunity to ask questions and have them answered satisfactorily. Additional education is provided to each patient by the nursing and technical staff of the hyperbaric chamber. There is ample opportunity for the patient to ask questions at any time. Verbal acknowledgement of this understanding and consent for treatment was obtained prior to treating the patient in the hyperbaric chamber."

Risks and Benefits for Advanced Wound Care

"At the time of initial consultation, the risks and benefits of advanced wound care were discussed with the patient. The benefits include enhancing wound/ulcer healing and improving the patient’s quality of life. The potential risks include mild to moderate pain with mechanical or enzymatic debridement, a risk of infection to the wound/ulcer, and the potential that the wound/ulcer could deteriorate. The patient does understand that wounds/ulcers sometimes herald significant changes in the extremity and may necessitate surgery or amputation in the course of treatment.

The need for periodic debridement, obtaining wound cultures or biopsies, and the need for serial digital photography in order to document progress of the wound/ulcer was also discussed. The patient expressed an understanding of this discussion and was given opportunity to have questions answered. Verbal acknowledgement of this understanding and consent prior to treatment was obtained."