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An Introduction to Hyperbaric Oxygen Therapy
Hyperbaric Oxygen Therapy Introduction and Indications for Treatment
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HBO Initial Patient Evaluation
Overview of an initial patient evaluation for Hyperbaric Oxygen Therapy
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Medications In The Hyperbaric Environment
When administered in concentrations greater than those found under ambient room air conditions, oxygen can put forth clinical effects having a therapeutic profile not unlike other pharmaceutical agents. As a drug, oxygen is most notable in the setting of hyperbaric oxygen therapy where the partial pressure (dosage) of oxygen prescribed is significantly higher than that which is typically encountered in routine clinical practice.
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Hyperbaric Chamber History and Consent
Hyperbaric Oxygen Patient History and Consent
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Visual Acuity and HBOT
Notification of Instructions Due To: A Change in Visual AcuityAs discussed during your hyperbaric patient education, vision changes are possible after receiving several (>20) hyperbaric treatments. This is usually a temporary change that will resolve within 3 to 4 months after your last hyperbaric treatment.You are receiving this notification because during your last eye exam in the Hyper
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Documentation: HBO Risks and Benefits
Risk and Benefit Assessment for Hyperbaric Oxygen Therapy
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Documentation: HBO Consultation History and Physical
Consultation Template for Hyperbaric Oxygen Therapy
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Risks and Benefits Documentation
Hyperbaric Oxygen Risk and Benefit Documentation Template
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Hyperbaric Oxygen Therapy and Visual Acuity
HBOT documentation templates for weekly visual acuity exam throughout the course of HBOT
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Diabetic Foot Ulcer - Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy (HBOT) protocol for patients with diabetes with lower extremity ulcers
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Transcutaneous Oximetry
Application of transcutaneous oximetry in hyperbaric medicine with practical algorithm.
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Utilization Review
An overview of the utilization review process for hyperbaric oxygen therapy.
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Soft Tissue Radiation Necrosis
Hyperbaric oxygen therapy (HBOT) protocol for soft tissue radiation injury, with evidence, sample documentation statements, checklists
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Chronic Refractory Osteomyelitis
Hyperbaric oxygen therapy (HBOT) protocol for chronic refractory osteomyelitis, with evidence, sample documentation statements, checklists
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Compromised Skin Grafts and Flaps
Hyperbaric oxygen therapy for treatment of compromised flaps and skin grafts (including mutilated limb injuries), with evidence, sample documentation statements, checklists.
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Acute Traumatic Ischemia, Crush Injury and Compartment Syndrome
Hyperbaric oxygen therapy (HBOT) protocol for acute traumatic peripheral ischemia, crush injury and compartment syndrome with GRADE recommendations, review of recent evidence, checklist, sample documentation statements
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Idiopathic Sudden Sensorineural Hearing Loss
Hyperbaric oxygen therapy (HBOT) protocol for Idiopathic Sudden Sensorineural Hearing Loss, with evidence-based graded recommendations, sample documentation statements, physician order template, checklists.
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Acute Exceptional Blood Loss Anemia
Hyperbaric oxygen therapy (HBOT) protocol for Acute Exceptional Blood Loss Anemia, documentation template and GRADE assessment of current evidence
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Acute Peripheral Arterial Insufficiency
Hyperbaric oxygen therapy (HBOT) protocol for Acute Peripheral Arterial Insufficiency
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Central Retinal Artery Occlusion
Hyperbaric oxygen therapy (HBOT) protocol for Central Retinal Artery Occlusion
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Pyogenic and Invasive Fungal Intracranial Abscesses
Hyperbaric oxygen therapy for treatment of pyogenic and invasive fungal intracranial abscesses, evidence-based protocol, sample physician order template
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HBO Treatment Indications With Protocols
Hyperbaric Oxygen Therapy Treatment Protocol Guidelines and Indications
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Medical Director Guidelines
Hyperbaric Oxygen Therapy Medical Director Guidelines and Responsibilities
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Medical Director Job Description
Hyperbaric Medical Director Job Summary
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Physician Credentialing Guidelines
Physicians engaged in the practice of hyperbaric medicine range across the entire spectrum of clinical specialties. This practical topic describes the Undersea and Hyperbaric Medical Society (UHMS)' position on eligibility, training, credentialing and continuing medical education for physicians who engage in the practice of hyperbaric medicine
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Physician Credentialing Privilege List
This form lists physician credentialing privileges in hyperbaric medicine and can be used as an evaluation form
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Physician Training Guidelines
Guidelines for physician training in hyperbaric medicine
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Role of the Medical Director in Hyperbaric Safety
This topic illustrates how the medical director can take an active role in conjunction with the hyperbaric safety officer in promoting safety in hyperbaric facilities
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The Role of the Medical Director in Hyperbaric Safety - A Brief Overview
The medical director, rather than simply being a figurehead, must take an active role in conjunction with that of the safety officer. This blog post provides a brief overview on the Role of the Medical Director in Hyperbaric Safety
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Patient Education - Hyperbaric Oxygen Therapy for Diabetic Foot Ulcer
Topic for patients and caregivers. This topic on hyperbaric oxygen therapy for diabetic foot ulcers can be shared by email, or its PDF (attached to the topic) can be printed as a patient handout and handed directly to patients at the point-of-care.
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Patient Education - Hyperbaric Oxygen Therapy for Chronic Refractory Osteomyelitis
Topic for patients and caregivers. This topic on hyperbaric oxygen therapy for chronic refractory osteomyelitis can be shared by email, or its PDF (attached to the topic) can be printed as a patient handout and handed directly to patients at the point-of-care.
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Patient Education - Hyperbaric Oxygen Therapy for Soft Tissue Radiation Injury
Topic for patients and caregivers. This topic on hyperbaric oxygen therapy for soft tissue radiation injury can be shared by email, or its PDF (attached to the topic) can be printed as a patient handout and handed directly to patients at the point-of-care.
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Patient Education - Hyperbaric Oxygen Therapy for Osteoradionecrosis
Topic for patients and caregivers. This topic on hyperbaric oxygen therapy for osteoradionecrosis can be shared by email, or its PDF (attached to the topic) can be printed as a patient handout and handed directly to patients at the point-of-care.
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Case: New-onset cutaneous vasculitis
Wound care clinicians often face challenging ulcers that have been previously treated with little or no success by other healthcare providers. Some of these ulcers are related to cutaneous vasculitis. This topic describes how an atypical lower extremity ulcer was diagnosed as new-onset cutaneous vasculitis at a wound care clinic.
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Cutaneous Vasculitis
INTRODUCTIONBackgroundDefinition:Vasculitis of the skin (cutaneous vasculitis) includes several inflammatory disorders that compromise blood vessels and specifically the cutaneous vascular system (i.e. arterioles, capillaries, postcapillary venules), and lead to cutaneous changes. (Papi and Papi 2016) According to the 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides (CHCC2012), cutaneous vasculitis can present in 3
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Patient Education - Hyperbaric Oxygen Therapy for Compromised Grafts and Flaps
Topic for patients and caregivers. This topic on hyperbaric oxygen therapy for compromised grafts and flaps can be shared by email, or its PDF (attached to the topic) can be printed as a patient handout and handed directly to patients at the point-of-care.
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Documentation: Hyperbaric Treatment Notes by the CHRN and CHT
To ensure audit-readiness and smooth reimbursement, facility and physician charges related to wound care and hyperbaric oxygen services must be validated with documentation from both physician AND non-physician providers (i.e.,Certified Hyperbaric Registered Nurses and Certified Hyperbaric Technologists). The CHRN or CHT note is proof and validation that a treatment was provided and billed by the facility (G0277). This topic provides a template for hyperbaric treatment records documented by non-physician providers.
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Designation of Hyperbaric Safety Director
This topic elaborates on the role of a Hyperbaric Safety Director, including aspects related to designation, training/education and a sample policy and procedure. Authors also explain the rationale behind having a formally designated and specifically trained Safety Director in each hyperbaric medicine facility. Designation of the Safety Director in writing and an appropriate job description for the role are paramount to hyperbaric facility safety.
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Staff Minimum Qualifications and Training for HBOT
Regardless of the the purpose and scope of the hyperbaric facility, inadequate knowledge of applicable gas laws, chamber fire safety, potential risks, side effects, and contraindications of hyperbaric medicine, may result in dangerous situations that risk patients' and personnel's well-being. This topic elaborates on the minimum qualifications and training/education for hyperbaric staff, and provides policies that can be adjusted and adopted by hyperbaric programs.
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Hyperbaric Oxygen Therapy And Congestive Heart Failure
Background
There are a number of known risks and side effects of hyperbaric oxygen treatments most of which are either rare or of minimal consequence. One such complication is an exacerbation of congestive heart failure. When pulmonary edema occurs, it is typically noted in the latter half of a 90-minute treatment and, though rare, this complication can be significant. Patients may do well with simple decompression. Some may require a diuresis while others may require hospitalization
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Termination of Relationship: Patient-Provider And/Or Patient-Wound Care And Hyperbaric Service
Providers should use caution when terminating a patient-provider relationship and ensure it does not constitute abandonment. Healthcare providers also have the right to terminate relationships with patients for a variety of reasons. This topic lists these reasons, provides legal/ risk management considerations, documentation and operational guidance for a standardized approach. Includes sample patient dismissal letter.
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Safety and Hyperbaric Oxygen Therapy
Creating and maintaining an environment of safety in the hyperbaric facility is achieved through proactive planning and attention to detail. Lack of proper safety protocols and procedures causes accidents, and, unfortunately, loss of life. While we never want to have a disaster, we learn from safety analysis of them.
This topic provides a summarized update on Safety in the Hyperbaric Facility. The topic also provides guidance and resources that will help you build an excellent hyperbaric safety program. Resources include safety guidelines, job descriptions, go-no-go lists, go-no-go risk assessment tool, and emergency procedures.
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Patient Education in Wound Care and Hyperbaric Oxygen Therapy
Patient and caregiver education is central to patient-centered, value-based care. It can be a differentiating factor for wound care and hyperbaric oxygen therapy (HBOT) services looking to offer the highest standards of clinical practice. This topic provides an update on the importance and benefits of patient education in wound care and HBOT, current gaps, commonly used methods, and resources to develop patient education programs in wound care and HBOT. It lists 5 tools that can be implemented today to streamline patient education at the point-of-care, and provides a downloadable framework with best practices on patient education in wound care and HBOT.
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Patient Education - Hyperbaric Oxygen Therapy for Chronic Refractory Osteomyelitis (Spanish)
For patients and caregivers, in SPANISH. This topic on hyperbaric oxygen therapy for chronic refractory osteomyelitis can be shared by email, or its PDF (attached to the topic) can be printed as a patient handout and handed directly to patients at the point-of-care.
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Patient Education - Hyperbaric Oxygen Therapy for Compromised Grafts and Flaps (Spanish)
For patients and caregivers, in SPANISH. This topic on hyperbaric oxygen therapy for compromised skin grafts and flaps can be shared by email, or its PDF (attached to the topic) can be printed as a patient handout and handed directly to patients at the point-of-care.
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Patient Education - Hyperbaric Oxygen Therapy for Diabetic Foot Ulcer (Spanish)
For patients and caregivers, in SPANISH. This topic on hyperbaric oxygen therapy for diabetic foot ulcers can be shared by email, or its PDF (attached to the topic) can be printed as a patient handout and handed directly to patients at the point-of-care.
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Investigational HBOT Indications
We would like to start this blog series by emphasizing that we are not recommending HBOT for off-label indications. However, the use of HBOT for certain conditions may be supported by some evidence, as described by case reports, case series or small randomized controlled trials (RCTs). In this blog series we will provide an overview of off-label indications for HBOT, and review existing evidence for selected conditions...We will start from the basics…What is an off-label HBOT?
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Global Surgical Transfer of Care to the Wound Clinic
Wound physicians must be aware of the surgical global packaging rules as they relate to the transfer of care from one provider to another. Documentation and proper billing methods are essential to meet CMS compliance standards and to ensure the rules are followed. Failure to do so could make the wound care provider a target for audit and denials. This topic provides guidance and a protocol for global surgical transfer of care.
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Investigational HBOT Indications - Infertility
This blog post reviews current evidence on use of adjunctive HBOT for female infertility
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Patient Education - Hyperbaric Oxygen Therapy for Osteoradionecrosis (Spanish)
For patients and caregivers, in SPANISH. This topic on hyperbaric oxygen therapy for osteoradionecrosis of the mandible can be shared by email, or its PDF (attached to the topic) can be printed as a patient handout and handed directly to patients at the point-of-care.
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Patient Education - Hyperbaric Oxygen Therapy for Soft Tissue Radiation Injury (Spanish)
For patients and caregivers, in SPANISH. This topic on hyperbaric oxygen therapy for soft tissue radiation injury can be shared by email, or its PDF (attached to the topic) can be printed as a patient handout and handed directly to patients at the point-of-care.
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Investigational HBOT Indications - Preconditioning for Cardiac Surgery
This blog article discusses the use of HBOT for patients who have an ischemic/reperfusion injury to the myocardium. While HBOT has been studied after Acute MI (AMI) in conjunction with stunting/angioplasty and/or TPI administration, it focuses primarily on patients who have a coronary artery bypass grafting (CABG) surgery.
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Investigational HBOT Indications - Inflammatory Bowel Disease
Well, time for the third installment of diseases that are considered “off-label” for hyperbaric oxygen ... yet, these diseases have some (sometimes a lot) evidence of effectivity and a plausible pathophysiology. This blog will deal with
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Offloading Devices
This topic provides a review and updates on offloading devices for diabetic foot ulcers (DFUs), from the clinical, coverage and reimbursement perspectives.
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How to Select Offloading Devices
This topic provides guidance on selection of Offloading Devices with an interactive framework
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To treat or not treat a patient with C. Diff: That is the Question
Decision support on how to manage HBOT patients with Clostridium difficile
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HBOT and COVID - 19
Here what we know and what we don't know about HBOT and COVID-19Synopsis: UHMS Hyperbaric Oxygen Therapy Committee Meeting on COVID-19 and HBO2. This is a synopsis of a conference call between invited members of the Hyperbaric Oxygen Therapy committee, the American College of Emergency Physicians’ Section on Unders
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Case: Surgical offloading of a lesser toe DFU with flexor tenotomy
This case demonstrates a classic presentation of a lesser toe diabetic foot ulcer which resolved quickly with percutaneous surgical release of the hammertoe deformity. Includes video depicting the procedure.
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HBOT for Diabetic Foot Ulcer - An Overview
This topic is part of a series for clinicians who are considering referring patients to a hyperbaric oxygen therapy (HBOT) center for treatment consideration. It provides an overview on adjunctive HBOT for diabetic foot ulcers. A printable PDF that can be customized with the facility contact information is included.
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HBOT for Chronic Refractory Osteomyelitis - An Overview
This topic is part of a series for clinicians who are considering referring patients to a hyperbaric oxygen therapy (HBOT) center for treatment consideration. It provides an overview on adjunctive HBOT for chronic refractory osteomyelitis. A printable PDF that can be customized with the facility contact information is included.
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HBOT for Soft Tissue Radiation Necrosis - An Overview
his topic is part of a series for clinicians who are considering referring patients to a hyperbaric oxygen therapy (HBOT) center for treatment consideration. It provides an overview on adjunctive HBOT for soft tissue radiation necrosis. A printable PDF that can be customized with the facility contact information is included
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HBOT for Compromised Flaps and Grafts - An Overview
What is Hyperbaric Oxygen Therapy?
The Undersea and Hyperbaric Medical Society defines hyperbaric oxygen therapy as an intervention in which an individual breathes 100% oxygen intermittently while inside a hyperbaric chamber that is pressurized to greater than sea level pressure (1 atmosphere absolute, or ATA). For clinical purposes, the pressure must equal or exceed 1.4 ATA while breathing near 100% oxygen.
How Hyperbaric Oxygen Therapy Works
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HBOT for Osteoradionecrosis of the Mandible - An Overview
What is Hyperbaric Oxygen Therapy?
The Undersea and Hyperbaric Medical Society defines hyperbaric oxygen therapy as an intervention in which an individual breathes 100% oxygen intermittently while inside a hyperbaric chamber that is pressurized to greater than sea level pressure (1 atmosphere absolute, or ATA). For clinical purposes, the pressure must equal or exceed 1.4 ATA while breathing near 100% oxygen.
How the Intervention Works
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Arterial Ulcer - Introduction and Assessment
Evidence-based review on arterial ulcer. Framework for assessment of patients with arterial ulcers. Includes concise abstract and comprehensive resources on the condition (e.g. epidemiology, risk factors, etiology, pathophysiology, history, physical examination, diagnosis, differential diagnoses, documentation and ICD-10 coding)
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Provider Supervision of HBOT
Do physicians need to directly supervise hyperbaric oxygen therapy services (HBOT)? It is helpful to first review the definitions of the different types of level of supervision (CFR Title 42, Chapter IV, Part 410) (i) General supervision means the procedure is furnished under the physician's overall direction and control, but the physician's pre
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2021 Office/Outpatient E/M Services Updates for Wound Care and HBOT
As of January 1, 2021, evaluation and management (E/M) CPT® codes 99202-99215 can be selected on the basis of the complexity of the medical decision making (MDM) or on the basis of the total time on the date of the encounter. This topic provides a summary of the main updates, along with a printable point-of-care tool that includes sample verbiage for support documentation of MDM in wound care and hyperbaric and oxygen therapy (HBOT).
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Prohibited Item Risk Assessment
Introduction
Why should each hyperbaric unit have a prohibited items assessment/checklist? The unit safety program is the foundation of every hyperbaric medicine service. The safety program provides guidance in order to ensure that the risks and hazards associated with hyperbaric oxygen therapy are identified and eliminated. In certain circumstances, the risk can not be eliminated (e.g., removing a wound care product), and mitigating measures must be taken to reduce the risk potentia
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How to Assess HBOT Prohibited Items: The Go/No-Go Risk Assessment Tool And The Burman Scoring System
The NFPA recommends that hyperbaric facilities utilize the NFPA Risk Assessment Algorithm for assessment of dressings and items that have not been evaluated or deemed safe for use in the hyperbaric chamber. However, several challenges (as described above) prevent widespread use of the NFPA Risk Assessment Algorithm. The Go No-Go Risk Assessment Tool combines the NFPA Risk Assessment Algorithm and the Burman Risk Scoring System. This combination of the two approaches and a user friendly digital interface provide the hyperbaric facility with a robust go/ no-go documentation and risk mitigation tool. This topic provides step-by-step instructions on how to conduct this risk assessment process.
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Applying the Balanced Scorecard in Wound Management and Hyperbaric Medicine
Guidance on strategic planning and performance improvement tailored to wound care and hyperbaric oxygen therapy (HBOT) programs is still scarce. This topic provides an Editable Balanced Scorecard Tool with sample metrics for wound care and HBOT programs. Institutions can make a copy of the tool, and use it to select and monitor their own objectives and metrics, according to their own vision and mission.
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Building a Limb Preservation Program: Traditional and Nontraditional Models
The literature shows that the vast majority of non-traumatic amputations are preventable. The ultimate goal of limb preservation programs is to restore pulsatile blood flow to an at-risk extremity and prevent major lower extremity amputation. This topic provides resources for starting or further developing a limb preservation program.
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Osteoradionecrosis - Mandibular
Hyperbaric oxygen therapy (HBOT) protocol for osteoradionecrosis (mandibular), with evidence, sample documentation statements, checklists
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Necrotizing Soft Tissue Infections And Fournier's Gangrene
Hyperbaric oxygen therapy for treatment of necrotizing soft tissue infections and Fournier's gangrene, protocol with evidence, sample physician order template and documentation guidance/template
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Decompression Illness and Arterial Gas Embolism
Hyperbaric oxygen therapy for treatment of decompression illness and arterial gas embolism, evidence-based protocol, sample physician orders, documentation statements, evidence-based GRADE recommendations. Category A Continuing Education Credit
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Acute Carbon Monoxide Poisoning
Hyperbaric oxygen therapy (HBOT) protocol for acute carbon monoxide with GRADE recommendation, review of recent evidence, checklist, sample documentation statements. Approved for 1 Category A Continuing Education Credit by the NBDHMT
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Clostridial Myonecrosis (Gas Gangrene)
Hyperbaric oxygen therapy for treatment of clostridial myonecrosis. Evidence-based protocol, sample physician order template and documentation templates to support HBO indication. Operational considerations and nursing interventions