Safety Stop
Clinicians providing hyperbaric oxygen therapy go to great lengths to ensure patient safety with every treatment. We utilize processes and systems that have been developed within the field, in some cases through “near misses” and from standards set forth by The Joint Commission (TJC) and the Undersea and Hyperbaric Medical Society (UHMS).
In June of 2014, the UHMS Safety Committee released a position statement recommending the utilization of a safety “Stop” prior to the start of every hyperbaric treatment. The position statement is available on the UHMS website:
“The Safety Committee of the Undersea and Hyperbaric Medical Society recommends that a Safety Time Out/Pause (STOP) be performed prior to the start of every hyperbaric treatment. A STOP should be completed regardless of multiplace or monoplace operations. A STOP will be performed in order to be compliant with safety goals, to combat complacency, and document completion of our unique safety practices. We recommend that the STOP be modeled after the timeouts performed before surgical procedures."
STOP Checklist
The Practice of Hyperbaric medicine is a procedure-oriented specialty. Each patient should have two identifiers verified and the patient should agree to the procedure. For the safety of patients and staff, we strongly encourage documentation of a Safety Time Out/Pause (STOP) protocol verifying the “Right Patient, Right Treatment and Right Safety.” The STOP checklist should include:
- Signature and date on the completed STOP checklist (signed or initialed by two staff members prior to closing the door of the chamber)
- Treatment profile and staffing plan
- Out of the chamber - confirmation that prohibited items were removed from the chamber (both monoplace and multiplace)
- Patient ground check (monoplace)
The UHMS recommends that each hyperbaric facility and institution develop and implement a STOP protocol with these basic elements. A basic template can be found here. A more detailed protocol may be in order depending on the specific needs of the facility.
The UHMS Safety Committee position statement provides a structured approach to pre-treatment procedures. This statement is long overdue and should be taken one step further to include pre-hyperbaric treatment checklists. Pre-treatment checklists have been employed for many years and include inspection and confirmation that Prohibited Items have been removed from the patient’s possession prior to initiation of the treatment. Elements of the Safety STOP should be included in all pre-treatment checklists.
In an article published on the NEJM Catalyst website, “Smartlists for Patients: The Next Frontier for Engagement?” Latif et al. identify that checklists work by providing information about who needs to act, what actions need to be taken, and how, where, and when each action should occur. As such, customized patient-centered checklists have a wide range of applications, with the potential to improve patient education, pre-procedure planning, discharge instructions, care coordination, chronic care management, and plans for staying well.
The question becomes, at what point is the inspection and verification of Prohibited Items documented? Are you inspecting the patient, verifying, initiating treatment (descent) and then documenting? If so, then utilizing a “STOP” prior to the initiation of descent should be implemented and utilized to ensure all pre-treatment safety checks are appropriately completed.
Resources
The WoundReference Hyperbaric Oxygen Therapy Knowledge Base features guidelines to promote high standards of patient care and operational safety within the hyperbaric program and other important tools. The WoundReference Curbside Consult gives you actionable, specific answers from our multidisciplinary clinical and reimbursement advisory panel in a timely manner.
For customized safety programs and other wound care and hyperbaric medicine consultation services, visit MidWest Hyperbaric.
Acknowledgements
We thank Julie Rhee ScM, for style editing
References
- The UHMS Safety Committee UHMS Blog, accessed 10-26-2018: http://uhmsblog.wordpress.com/2014/07/31
- The Joint Commission, Standards, National Patient Safety Goal, Universal Protocol, accessed 10-26-2018 http://www.jointcommission.org/standards_information/up.aspx
- NEJM Catalyst, Smartlists for Patients: The Next Frontier for Engagement, accessed 10-26-18: https://catalyst.nejm.org/patient-centered-checklists-next-frontier
About the Authors
Jeff Mize, RRT, CHT, UHMSADS
With over four decades of healthcare experience, Jeff currently holds the position of Principal Partner at Midwest Hyperbaric LLC and the Co-founder and Chief Clinical Officer of Wound Reference.
Jeff has excelled in critical care throughout his career, devoting almost a decade as a Flight Respiratory Therapist/Paramedic for the Spirit of Kansas City Life Flight. In 1993, Jeff transitioned into the field of Hyperbaric Medicine and Wound Care, where he committed 21 years of his career to serving as the Program Director for a 24/7 Level 1 UHMS Accredited facility with Distinction. In this role, he continued to provide patient care while overseeing all administrative, clinical, and daily operations within the Wound Care and Hyperbaric Facility.
Jeff is a Registered Respiratory Therapist and a Certified Hyperbaric Technologist (CHT). He has also undergone training as a UHMS Safety Director and a UHMS Facility Accreditation Surveyor.
Jeff currently serves as a member of the UHMS Accreditation Council, the UHMS Accreditation Forum Expert Panel, and the UHMS Safety Committee. Additionally, he is an esteemed member of the NFPA 99 Hyperbaric and Hypobaric Facilities Technical Standards Committee.
Jeff's dedication to the field has earned him numerous prestigious awards. In 2010, he received the Gurnee Award, which honored his outstanding contributions to undersea and hyperbaric medicine. Three years later, in 2013, he was awarded the Paul C. Baker Award for his commitment to Hyperbaric Oxygen Safety Excellence. Most recently, in 2020, Jeff was honored with "The Associates Distinguished Service Award (UHMSADS)," a recognition reserved for exceptional Associate members of the Society who have demonstrated exceptional professionalism and contributions deserving of the highest accolades.
Tiffany Hamm, BSN, RN, CWS, ACHRN, UHMSADS
An Advanced Certified Hyperbaric Registered Nurse and Certified Wound Specialist with expertise in billing, coding and reimbursement specific to hyperbaric medicine and wound care services. UHMS Accreditation Surveyor and Safety Director. Principal partner of Midwest Hyperbaric LLC, a hyperbaric and wound consultative service. Tiffany received her primary and advanced hyperbaric training through National Baromedical Services in Columbia South Carolina. In 2021, Tiffany received the UHMS Associate Distinguished Service Award. "This award is presented to individual Associate member of the Society whose professional activities and standing are deemed to be exceptional and deserving of the highest recognition we can bestow upon them . . . who have demonstrated devotion and significant time and effort to the administrative, clinical, mechanical, physiological, safety, technical practice, and/or advancement of the hyperbaric community while achieving the highest level of expertise in their respective field. . . demonstrating the professionalism and ethical standards embodied in this recognition and in the UHMS mission.”
