GO/NO GO: The Impact of a Digital Risk Assessment Tool and Training on Accurate Completion of Risk Assessment Process for Hyperbaric Prohibited Items

Introduction / Background
One of the cornerstones in hyperbaric safety is performing a ‘Go/No Go’ assessment prior to each treatment or new patient.1 Some facilities fail to evaluate products and document safety in a hyperbaric environment, per NFPA requirements. We measured the impact of a digital risk assessment tool (dRAT)* on completion and documentation of the risk assessment.

Materials and Methods
Two U.S. hospital-based hyperbaric centers participated in this prospective, one-group pretest-posttest study. Each safety officer (SO) received training on the dRAT and utilized it to perform and document the risk assessment process for 20 commonly seen prohibited items that were selected by the medical director (MD) at each facility. Outcomes were measured by external chart audits and surveys answered by the SOs before and after the intervention.

Results
Risk assessment was performed for 36 unique prohibited items. Material safety data sheet (MSDS) was not found for 23 items (63.9%). For the 13 items with MSDS (31.1%), 7 (53.8%) lacked flashpoint information.
For each facility, we analyzed 20 consecutive patient records immediately prior to and 8 after training (n=56). In total, 463 (48.3%) of 958 treatments prior to training, and 153 (67.4%) of the 227 treatments after training indicated the presence of a prohibited item in the chamber. Among these, our intervention resulted in a statistically significant improvement in the number of treatments with a completed ‘prohibited item’ form, exceptions log notation signed by both SO/MD, and documented risk assessment (Chi-square, p< 0.01 for all variables).
Surveyed SOs rated usability as 5/5 (easy), but still struggled to complete risk assessment for items that lacked complete MSDS information.

Summary / Conclusions
Utilization of the dRAT coupled with training on risk assessment and documentation significantly improved completion rate and documentation of the risk assessment process. Opportunities for continued improvement were identified. Processes were optimized and incorporated into each facility’s EMR.

Trademarked Items (if applicable): Trademarked Items
* Go/ No Go Tool, Wound Reference, Inc., San Francisco, CA

References (if applicable): 1. Technical Committee on Hyperbaric and Hypobaric Facilities (HEA-HYP). 14. Hyperbaric Facilities. In: (NFPA) National Fire Protection Association, editor. Nfpa 99: Health Care Facilities Code Handbook. 2012th ed. Quincy, MA: NFPA; 2012. p. 111–9.