Rainier Medical Spa & Infusion Center
Rainier Medical Spa & Infusion Center
Standing Orders: Hyperbaric Oxygen Therapy
1. Licensed nurse to obtain signed clinician orders for first HBOT treatment:
2. Receptionist to verify REQUEST AND CONSENT FOR HYPERBARIC OXYGEN THERAPY – PRIVATE PAY form is signed and scanned/placed in the patients chart. Licensed nurse to ensure the patient has given informed consent.
3. Operator to inquire of each patient and keep licensed nurse informed regarding improvements noted since last treatment, complications encountered during treatment or changes in health status since last date of service. Licensed nurse to assess and record pertinent patient information in chart and notify clinician of any significant changes. Licensed nurse to ensure any updated clinician orders are executed.
4. Licensed nurse to be present during pressurizing and depressurizing portion of 1st treatment and periodically thereafter. Consider the patient’s handicaps and risk factors and ensure the patient is positioned appropriately and flaccid limbs protected. Consider all medications and supplements, past history of seizure disorder, claustrophobia, ear symptoms, and chronic/acute sinus congestion. Use of PO or topical decongestants requires clinician order. Operator is to check patient instructions for changes.
5. Operator to inspect for and ask about oil-based skin, hair and cosmetic products. Have the patient remove cosmetics in the lavatory if necessary. Remove all jewelry (put tape completely around ring if cannot be removed), watch, dental bridges, contacts, hearing aid(s), hairpieces, etc. Emphasize that no personal items will be allowed into the chamber. A cotton cloth or padding is to be used in place of synthetic incontinence aids or feminine sanitary napkins. Advise patients that tampons are not permitted.
6. Operator to ensure patient is wearing only the cotton garments provided.
7. Licensed nurse to assess tympanic membrane if ear symptoms occur or persist. Notify clinician of any abnormalities. After obtaining an order, irrigate the ear canals PRN. Operator is to instruct in Valsalva maneuver and ask about any problems equalizing ear pressure.
8. For diabetic patients, operator is to ensure that a meal was not missed, especially if on insulin or taking oral hypoglycemic medications. Operator to perform a blood glucose check and inform licensed nurse of results on all diabetic patients prior to starting treatment. If the licensed nurse determines that the patient is at risk for a hypoglycemic reaction during HBOT, give the patient 120ml of juice before the treatment.
9. Licensed nurse to determine whether the patient has a history of seizure disorder. If anti-convulsant medication is used, ensure that doses have not been missed (Dilantin, Phenobarbital, etc.). Operator to verbally confirm, prior to each treatment, that patient with history of seizure disorder has taken Prime Nutrients (or vitamin or equal quality), minimally, as scheduled (reduces seizure risk).
10. Operator to encourage patient to empty bladder before start of treatment, if indicated. Assist patient PRN.
11. Operator to reassure patient, “I will not leave you” “I don’t expect any problems, but if you experience anything different, let me know” etc. Answer questions and allay fears. Inform licensed nurse if patient shows signs of claustrophobia or excessive anxiety. Licensed nurse is to administer Xanax (or generic equivalent) for claustrophobia or excessive Anxiety, if prescribed, and to assess patient response. If a tranquilizer is to be used by patient, operator to ensure patient will not be driving while under the effects of the medication. The patient must arrange for someone to drive them home. Safe transport arrangements to be noted in patient chart per occurrence.
Rainier Medical Spa & Infusion Center
Standing Orders: Hyperbaric Oxygen Therapy Continued…
12. If patient complains of being too hot within the chamber, the operator may increase the flow rate from 250 L/min to 350-400 L/min for 15 minutes (or so) duration. This is also for the occasional patient who perspires profusely in the chamber, causing moisture to fog the inside. Ensure the flow rate is set back to 250 L/min before completion of any treatment during which it is increased.
13. If a patient experiences nausea/vomiting, urinary/bowel incontinence, or other, while within the chamber or in HBOT deliver area, operator to ensure the chamber/delivery area is sanitary prior to next use. Patients/parents are required to remove soiled diapers from the clinic premises. Operator to supply plastic bag PRN.