Multiplace Delivery System
Monthly Hyperbaric Safety Notice: February 2006
Answering the Call of Nature:
Offering Privacy While Maintaining Safety
In this notice, discussed will be several operational techniques used by multiplace chamber personnel to safely provide patient and personal privacy during treatments.
Background
Finding a moment of privacy inside a crowded multiplace chamber can be quite
challenging. Everyday all over the world, clinical multiplace chambers take groups
of up to 18 people to a pressure usually no greater than 3 ATA. Normal treatment
periods typically last no more than two hours, a short ride for most of
us. However, it is guaranteed that at some point the multiplace chamber operator
will hear over their headset, the words, “Gotta go [to the bathroom].” Whether
those words pertain to a patient or to an inside observer, the chamber operator
must ensure privacy while maintaining safety. In the clinical environment, an
event such as this is commonly known as “code brown in the chamber.”
Safety Issue
Digestive bodily functions can be expected while occupants spend time at pressure
inside a multiplace chamber. When a patient inside the chamber asks the inevitable
question of what to do, should they need to use the bathroom, skilled inside
observers are able to reply with the demeanor of a politician, promising, “Don’t
worry, we have ways to take care of that, and of course, we ensure your right
to privacy throughout each and every treatment.”
Patients who present to the unit on a gurney probably have the most privacy. When a patient is lying on a stretcher where urinals and bedpans can be used, relief is usually achieved while the patient is covered. If there is not enough material to cover everything, the inside tender may decide to drape a sheet around the patient. If a patient has an existing catheter and/or colostomy bag, their need for privacy is a moot issue.
While privacy is the main concern, a remaining secondary concern is any effect that a patient’s, ummm “movements” may have on the other occupants inside the chamber. If an “off-gassing” odor begins to overwhelm the chamber’s atmosphere, the chamber operator and the inside observer must work together to reduce any dissatisfaction that may be felt among the other patients. The chamber operator may need to increase the ventilation rate in order to exhaust the noxious smell. If the “fumes” are really bad, the tender can request that all patients be allowed to breathe from the built-in-breathing-system (if not already). Ensuring patient satisfaction with treatments is part of everyone’s goal. Patients who are dissatisfied may not comply with their full course of scheduled therapy. Just as well, a patient who feels humiliated could go AWOL and their name soon erased from the daily treatment roster.
It is common for hyperbaric facilities to schedule the first treatment of the day to start around eight o-clock in the morning. When early treatments are scheduled, drinking a “last” cup of morning coffee or tea is a risk sometimes taken by the hyperbaric staff member going inside the chamber with the patients. Now we all know where this is going…and yes, at times, it is the inside tender that feels the urgent “call of nature”. Most multiplace chambers are not equipped with a system for waste removal. When a patient asks an inside observer, “What do you do if you have to use the bathroom”, the tender may say they hope that will never happen. Perhaps a more correct response would be to simply recite the policy for such situations.
Unless you are the person inside the chamber that is actually experiencing the immediate need for a toilet, the actions taken are not usually considered as an “emergency” procedure. However, to be safe and ensure procedural continuity, a written policy should exist. If the inside observer is committed to a decompression table, the chamber operator may be forced to make adjustments to the table. Some hyperbaric facilities change chamber operators each day. Don’t forget their need to be familiar with all procedures related to chamber operations. It is imperative that every person involved in the hyperbaric treatment know how to safely decompress the chamber and its occupants. It is the responsibility of the hyperbaric safety director to ensure compliance with this NFPA standard. A written policy for all to know and practice will help.
One of the chief responsibilities of a chamber operator during treatments is to maintain constant audible or visual contact with the chamber console. Skilled operators keep close watch of the console throughout every treatment. Seemingly by instinct, they automatically act as an extra set of eyes for the inside observer. A safe operator is always aware of the chamber console and any activity inside the chamber.
When a tender inside a multiplace chamber feels an undeniable “urge to purge”, that person’s main concern is to find some privacy. However, because cameras are running, sometimes even documenting, privacy may not be easy to find. Privacy while maintaining patient safety may be even harder to find. The chamber operator must be ready to quickly follow procedures that ensure both.
If answering the call of nature can’t wait, an inside observer’s options depend primarily on the medical status of the other occupants inside the chamber. Patients on a ventilator or in critical care require constant monitoring and should never be left unattended. In this situation, another “nitrogen-clean” qualified staff member could be sent to pressure in the outer lock. When at pressure, the second tender transfers into the main lock to take over monitoring the patient(s). The original inside tender may then either use the outer lock to achieve relief, or be brought to ambient pressure to use the unit’s regular facilities.
The situation may be further complicated if the inside observer is breathing oxygen as part of a decompression commitment. Any interruption in the breathing schedule must be factored into the equation used for determining decompression stops and times.
When all patients inside the chamber are stable, do not have an I.V., and are alert and in otherwise good shape, then there may be no need to send another staff member into the chamber. If this is the case, the outer lock (OL) again could be pressurized. Once the OL reaches “bottom”, the inside tender can cross over into the OL to quickly do their “business”. When finished, the tender resumes their duties in the main treatment compartment while the outer lock is depressurized with “the goods”.
If the outer lock is momentarily used as a bathroom, the procedure should take place during an air break, not while patients are breathing oxygen. Even if “occupied”, the inside observer remains responsible for the patients inside the chamber. Stopping "mid-stream" to respond without delay should a patient require immediate attention, demands skill and maybe even a little practice. If the inside tender has to use the outer lock, visual contact of the patients must be kept by outside personnel. Even so, modesty has to be set aside. NFPA 99 requires constant audible or visual contact be maintained between the chamber operator and the inside observer. This means headsets stay on, unless of course the inside tender doesn’t mind being observed by those on the outside.
Bottom Line
Answering the call of nature during a treatment can be a risky task. When the
call is heard from a patient inside the chamber, their safety, their self esteem,
and their satisfaction must all be provided. If the chamber operator needs to
do the same, there should always be another staff member who is qualified to
take over the controls. However, when the call comes from the inside observer,
the best answer often comes to those who can wait.
Reading Assignment
- NFPA 99 Standard for Health Care Facilities, Chapter 20, National Fire Protection Association, Quincy, MA , 2005 edition.
- Patient Privacy Act. HIPPA.
- Hyperbaric Nursing, Section III. Baromedical Nurses Association. Best Publishing 2002.
- USN Diving Manual, Decompression procedures.
Contributing Author: Barry D. Baker
Barry
is vice-president of Market Development with Pan-America Hyperbarics. Barry’s
introduction to the field came by way of his recreational diving interests. He
worked in the Caribbean during the 1980’s as an instructor and occasional
commercial diver. He founded Innerspace Technology in 1980, through which he
designed and installed mixed gas diving systems. Barry served as safety and hyperbaric
technologist at Carraway Medical Center multiplace hyperbaric medicine program,
in Birmingham, Alabama, for some eight years. He then assumed a consultant role
for hyperbaric facility start-ups, before joining Pan-America Hyperbarics, in
2003. He is a contributing chapter editor for the “Hyperbaric Nursing” textbook,
and survey team member for the Undersea and Hyperbaric Medicine Society Facility
Accreditation Program.
Full Panel of Safety and Technical Correspondents
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