Background

Qualified Healthcare Professionals engaged in the practice of hyperbaric medicine range across the entire spectrum of clinical specialties.  The practice of hyperbaric medicine involves the delivery of 100% oxygen at pressures above normal atmospheric conditions. This is achieved by the use of a pressurized (hyperbaric) chamber. Chambers are designed to accommodate a single patient (monoplace) or several patients simultaneously (multiplace).

Hyperbaric Oxygen therapy results in several therapeutic effects including hyper-oxygenation of poorly perfused or hypoxic tissues, selected antimicrobial activity, neovascularization, reduction/elimination of gaseous emboli, vasoconstriction without component hypoxia and antagonism of ischemia-reperfusion injury. 

Exposure pressure, duration, frequency and course (dose) will vary depending upon each patient’s referral condition. Carbon monoxide poisoning, for example, usually requires no more than three treatments. Radiation damaged tissue may require as many as forty treatments. 

Undersea and The Hyperbaric Medical Society

The Undersea and Hyperbaric Medical Society serves as the principal medical and scientific body for this discipline.  It is international in its scope and sets standards regarding the appropriate clinical application of hyperbaric oxygen therapy. The Society also seeks to improve the scientific basis of hyperbaric oxygen therapy, promote evidence-based treatment protocols and best practice standards, and provide continuing education (CME) accreditation. The UHMS supports the supervision of hyperbaric oxygen therapy by the QHP in accordance with federal, state and institutional guidelines.[1]

Qualified Health Care Provider

The Qualified Healthcare Provider is an individual who is qualified by education, training, licensure/regulation, and institutional privileging who performs a professional service within his/her scope of practice and independently reports that professional service.

The Qualified Healthcare Provider (QHP) acting within their scope of practice, will provide care for the presenting patient from initial history taking, clinical assessment, diagnosis, treatment and evaluation of their care.  

QHPs are distinct from clinical staff. QHPs - depending on state scope of practice, licensing, and the Centers for Medicare & Medicaid Services’ (CMS), or other payers’, are: 

• Advanced Practice Registered Nurses
• Physician Assistants

Baromedical Nurses Association Certification

Certification is an added qualification for the registered nurse clinician. Certified Hyperbaric Registered Nurse Clinician® (CHRNC®) It is not an entry level pathway for hyperbaric nursing. The candidate must have met the following requirements:

• Master’s or Doctorate Degree from an accredited academic program in Nursing or health related area. 
• Minimum of 5 years’ experience in the field of hyperbaric oxygen therapy, currently working (10 hour/week or 40 hour/month) for a minimum of 480 hours/year in the clinical and/or administrative areas of hyperbaric nursing. 
• Written documentation of three of the following:
• Responsible for administrative and nursing care activities of the Hyperbaric Department.
• Speaker at regional/national hyperbaric conferences and workshops.
• Contributes to hyperbaric materials for regional/national distribution, (i.e. journal articles, manuals, videos, books, etc).
• Active participation in the Baromedical Nurses Association (BNA), Baromedical Nurses Association Certification Board (BNACB), Undersea and Hyperbaric Medial Society (UHMS), UHMS Chapters, and/or UHMS Associates as an officer or committee member.
• Principal investigator or co-investigator in a published hyperbaric or related study. 

Joint Commission on Accreditation of Healthcare Organizations

The Joint Commission (TJC) has no formal position on delineation of privileges in hyperbaric medicine. However, this organization states that the professional criteria specified in medical staff bylaws must be informally applied to all applicants. Further, the TJC states that such criteria constitute the basis for granting initial or continuing medical staff membership and for granting initial, renewed or revised clinical privileges. In addition, UHMS is recognized by TJC as a complementary accrediting organization, through a cooperative agreement initiative.[2] UHMS has published guidelines on Credentialing, Privileging and Supervision of Hyperbaric Oxygen Therapy in the U.S.A.[3]

Hyperbaric Medicine Initial Credentialing Criteria

• The Qualified Healthcare Provider (QHP) - Must be board certified as a Nurse Practitioner, Clinical Nurse Specialist or Physician Assistant by an approved certifying body.
• Documented satisfactory completion of an Undersea and Hyperbaric Medical Society approved introductory training program in hyperbaric medicine, within three years of the application for credentialing, unless presently practicing hyperbaric medicine elsewhere.
• Must have a current DEA license in the state of practice.
• Must hold current (BLS).
• Must hold current (ACLS).
• A working knowledge of the following:
• Management of critically ill patients, including those requiring ventilator support.
• Recognition and management of potential side effects and complications of hyperbaric oxygen therapy.
• UHMS approved, and common investigational, indications for hyperbaric oxygen therapy. 
• Hyperbaric chamber operation sand emergency procedures.
• Should have an interest in learning, practicing, and maintaining competency in the field of hyperbaric medicine.
• Have a working understanding of the codes and regulations that govern the operation of a hyperbaric medicine facility.
• Qualified Healthcare will provide consultation, evaluation/ management and direct supervision of hyperbaric treatments, consistent with prevailing compliance criteria. 
• Qualified Healthcare Providers will utilize the hyperbaric medicine program’s treatment protocol guidelines as representative of best practice guidelines; and review these guidelines annually. 
• Qualified Healthcare Providers will undergo peer preceptorship of their first six hyperbaric (consultation/case management) cases.  
• Should complete a minimum of 12 credit hours of Category 1 AMA/AOA PRA CME in hyperbaric-related topics for each (12) months of hyperbaric medicine practice or (24) credit hours in (2) years. If local requirements or the requirements of certification agencies exceed these standards, the CME requirements of the QHP’s certification and privileging agencies should be followed.  

Core Privileges

Core privileges in hyperbaric medicine will include but are not limited to the following referral indications:

• Decompression sickness
• Cerebral arterial gas embolism
• Carbon monoxide intoxication
• Gas Gangrene
• Crush Injury
• Enhancement of healing in selected problem wounds
• Necrotizing soft tissue infections
• Osteomyelitis
• Late radiation tissue injury
• Compromised skin grafts and skip flaps
• Thermal burns
• Intracranial abscess
• Acute exceptional blood loss anemia
• Diabetic foot ulcer

Reappointment

• Reappointment as a hyperbaric medicine QHP will be based on unbiased objective results of care according to the institution’s existing quality assurance mechanisms.  
• Specifically privileged to practice clinical wound care and hyperbaric medicine in the sponsoring medical institution(s) under the process delineated by the institution’s medical staff or credentialing committee.
• Complete a period of preceptorship in which they demonstrate consistent competence in hyperbaric medicine case management, treatment procedures and safety before working unsupervised.
• Applicants must be able to demonstrate that they have maintained competence by showing evidence that they have provided inpatient and/or outpatient hyperbaric consultative and case management services for the minimum number of patients, as established by that institution.
• For reappointment, hyperbaric medicine QHPs must complete a minimum of 12 credit hours of Category 1 AMA/AOA PRA CME in hyperbaric-related topics for each (12) months of hyperbaric practice or (24) credit hours in (2) years. If local requirements or the requirements of certification agencies exceed these standards, the CME requirements of the physician’s certification and privileging agencies should be followed.