INTRODUCTION

Staffing of the hyperbaric medicine department is the responsibility of the Hyperbaric Nurse Manager and/ or Program Manager, Medical Director with collaboration from the Safety Director to ensure compliance with the Safety Program Guidelines.  The hyperbaric medicine team is a multidisciplinary group of healthcare professionals, institutionally credentialed with training and qualification(s) in the safe provision of hyperbaric oxygen therapy. It is necessary to identify the roles and responsibilities of the physician(s), nurses and allied health professionals that staff the program. 

For additional staffing guidance specific to wound care centers, see topic "Staffing Guidance for Wound Care Centers". 

STAFFING GUIDELINES  

Roles and responsibilities

• The Medical Director will be responsible for the scheduling of hyperbaric physician coverage, ensuring supervision of all hyperbaric oxygen treatments. 
• The Nurse Manager and/ or Program Manager will be responsible for the scheduling of qualified staff to be present during all patient treatments. 
• The  Hyperbaric Safety Director is responsible for providing insight and support to the Medical Director and Nurse Manager regarding the changing dynamics of patient acuity and patient volume that will impact staffing ratios.   
• The hyperbaric medicine unit is staffed with a Physician Medical Director, staff physicians, Non-Physician Practitioners (NPP), nurse manager, nurses and technologist.  All of the hyperbaric medicine team members will be institutionally credentialed, trained in hyperbaric medicine and qualified to provide care according to their respective licensure scope.  Upon eligibility, all qualified NPP, nurses and allied health professionals should obtain hyperbaric certification from the National Board of Diving and Hyperbaric Medical Technology (NBDHMT). 

In certain circumstances (e.g. new program) the hyperbaric medicine team may not be experienced or have completed the NBDHMT certification eligibility requirements.  In this case all personnel (physician, NPP, nurse, allied health) providing care and participating in the delivery of hyperbaric oxygen therapy will be required to have completed the minimum training guidelines for their respective discipline. 

Staffing Ratios

The hyperbaric medicine unit staffing ratios will be determined by patient volume(s), which can range from one to two patients at one time receiving care. One-to-two clinical staff works in the department during scheduled weekday treatments. 

• A hyperbaric physician will provide direct supervision for all hyperbaric treatments
• A hyperbaric nurse or technologist will be present for all hyperbaric treatments
• The nurse or technologist will maintain visual contact with the patient throughout the entire treatment.
• The minimum staff to patient ratio should be 1:2 (staff:patient). Additional qualified staff should be immediately available in the event of unforeseen complication or difficulty.

STAFFING CONSIDERATIONS

The above guidelines are to be adhered to, however there are variables that can impact staffing and scheduling, such as the ones listed below:  

• Facility location – availability of additional personnel in the event of complication or emergency.
• Type of chamber
• Monoplace or multiplace
• Hyperbaric staff qualification and experience
• Patient mix
• Patient acuity – factors that require 1:1 staff:patient ratio
• The patient’s inability to follow commands
• The patient’s inability to equalize tympanic membrane
• History of seizures
• History of confinement anxiety
• Hemodynamically unstable
• Critical care patients

Patient transition time(s) - Factors to be considered

• Post-treatment physician/NPP evaluation of complication (e.g. ear pain)
• Post-treatment blood glucose check
• Patient mobility
• Dressing change required
• Cleaning of the chamber between patients… include required disinfectant kill time.
• Documentation – completion patient medical