Description of Event or Problem · 1
AFTER PATIENT COMPLETED HYPERBARIC OXYGEN TREATMENT, THE GURNEY WAS ATTACHED TO THE HBO CHAMBER AND THEN THE STRETCHER WITH PATIENT WAS REMOVED AND LOCKED ONTO GURNEY. THE ENTIRE UNIT WAS MOVED TO THE PATIENT CHANGING AREA IN THE HBO TREATMENT ROOM. WHEELS WERE THEN LOCKED AND UNIT ELEVATED TO ALLOW IT TO BE LOWERED FOR PATIENT TO TRANSFER OFF. THE STRETCHER WAS LOWERED TO ALLOW PATIENT TO TRANSFER OFF. HBO TECHNICIAN MOVED TO SIDE TO LOWER SIDERAIL. THE PATIENT BEGAN TO SIT UP AND MOVE TOWARD THE FOOT OF THE UNIT. THE STRETCHER PORTION TILTED DOWN TOWARDS THE FOOT END AND SLED UNTIL THE FOOT END OF THE STRETCHER HIT THE FLOOR. THE PATIENT SLID TOWARD THE FOOT OF THE UNIT BUT DID NOT FALL TO THE FLOOR. INITIALLY, PATIENT REPORTED NO DISCOMFORT OR INJURY.======================MANUFACTURER RESPONSE FOR HBO MONOPLACE CHAMBER STRETCHER, SECHRIST (PER SITE REPORTER).======================RESPONDED AND ATTEMPTED TO DETERMINE IF A PRODUCT MALFUNCTION OCCURRED.