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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
Jeff is a Principal Partner with Midwest Hyperbaric LLC and is the Co-founder and Chief Clinical Officer for Wound Reference. Jeff is a Registered Respiratory Therapist, a Certified Hyperbaric Technologist (CHT) by the National Board of Diving and Hyperbaric Medical Technology, a Certified Wound Care Associate (CWCA) by the American Academy of Wound Management. After receiving primary hyperbaric training from National Baromedical Services he trained as a UHMS Safety Director and is a UHMS Facility Accreditation Surveyor. He is the 2010 recipient of the Gurnee Award and the 2013 recipient of the Paul C. Baker Award for Hyperbaric Oxygen Safety Excellence. He has also served on the UHMS Board of Directors (2010-2015) In 2020, Jeff received "The Associates Distinguished Service award (UHMSADS). "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.”
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
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