Durable and Nondurable Medical Equipment, Devices, and Supplies

Learning Outcomes

• Describe durable & nondurable medical equipment

• Identify types of blood glucose meters & systems • Describe steps in measuring blood glucose • Describe nondurable medical supplies used in

– insulin delivery – blood glucose monitoring

• Explain insulin delivery – syringes – pumps – pens

Learning Outcomes

• Identify various types of blood pressure monitors & explain methods of measuring blood pressure

• Identify commonly used pedometers/heart rate monitors

• List advantages & disadvantages of home diagnostic products & identify commonly used products

• Identify orthopedic support products

• Describe purpose of ostomy products

Key Terms

• Aneroid blood pressure monitor • CLIA-waived • Colostomy • Continuous subcutaneous insulin infusion • Control solution • Durable medical equipment • Hemoglobin A1c • Insulin pen • Lancet

Key Terms

• Nondurable medical equipment • Orthotic • Orthopedic devices • Orthotic devices • Ostomy • Pedometer • Stoma • Test strip • Urostomy

DME Durable Medical Equipment

• Medicare defines DME as medical supplies that are

– able to withstand repeated use

– primarily used to serve medical purpose

– generally not useful to person without illness/injury

– appropriate for use in the home

• Nondurable medical equipment

– medical supplies that must be discarded after use

Role of Pharmacy Technician

• Assists pharmacist in

– maintaining adequate supplies & equipment

– billing insurance for these items

• Billing & Reimbursement

– must be accredited to bill Medicare Part B for DME

– Medicare Part B covers 80%

• patient must pay 20%,

CLIA • Clinical Laboratory Improvement Amendments

Act of 1988

• Devices may be classified as CLIA-waived products – some clinical tests waived from certain laboratory

requirements

• Certain home diagnostic tests using blood or urine samples can be used without maintaining requirements as strict as those for laboratory tests

Blood Glucose Meters

• Used to monitor blood glucose (blood sugar)

• Self-monitoring

• Maintaining blood glucose levels

• Diabetes complications

– increase risk of

• heart disease

• stroke

• blindness

• kidney failure

• nerve damage

• amputations

Meters and Supplies

• Blood glucose meters are DME

• Nondurable supplies

– test strips

– lancets

– control solution

• Blood glucose meters have similar features

• US glucose measurement in mg /dL

Glucometers

• Measure whole blood glucose

• Vary in features

– size of blood sample needed for testing

– calibration

– testing time

– memory of test results

– audible blood glucose meters

• Lancets

BG Monitoring Process

1. Gather materials used for test

2. Wash hands or clean finger/area of skin to be used

3. Place test strip in meter/obtain test strip from meter

4. Lance (stick) area of skin to obtain blood sample

5. Apply blood sample to test strip

6. Record blood glucose reading in log book

7. Discard lancet in hard, puncture-resistant container

Insulin Delivery

• Insulin is hormone produced in pancreas

– promotes utilization of glucose

– synthesis of protein

– formation & storage of lipids

• Different types of insulin vary in their

– onsets

– peaks

– durations of action

Name of insulin Type of Action

Insulin aspart (Novolog) Rapid-Acting

Insulin lispro (Humalog) Rapid-Acting

Insulin glulisine (Apidra) Rapid-Acting

Regular Human (Humulin R, Novolin R) Short-Acting

NPH (Humulin N, Novolin N) Intermediate-Acting

Insulin glargine (Lantus) Long-Acting

Insulin detemir (Levemir) Long-Acting

Insulin

• Injected with or before meals or administered once daily

• Concentration most commonly used 100 units/mL

• Available in 3-mL or 10-mL sizes

• Insulin injected subcutaneously (under skin)

• Traditionally, insulin administered using syringe

– can also be administered with insulin pens

– continuous infusion using pump

• Sites: abdomen, back of arm, outer thigh, hip/buttocks

Injection with Syringes

• Insulin syringes are available in

– 30-unit (3/10 mL)

– 50-unit (0.5 mL)

– 100-unit (1 mL)

• Use syringe size close to # of insulin units injected

– allows for more accurate dosing

• Needle can vary from 5/16 inch to 1/2 inch

• Gauge can range from 28 to 31

– higher gauge needles are thinner

Steps of Insulin Injection 1. Wash hands; gather materials

2. Clean site of injection with alcohol prep

3. Draw air into syringe-same volume as insulin units

4. Inject air into insulin vial

5. Invert vial, withdraw units, check for air bubbles while syringe needle remains in vial

Steps of Insulin Injection

6. If air bubbles are present, push insulin back into vial & withdraw insulin units again

7. Remove syringe from vial

8. Pinch fold of skin, inject at 45- or 90-degree angle

9. Keep needle in skin for few seconds; then release skin fold & remove needle from skin

Insulin Pens

• Portable, discreet, convenient

• Components: cartridge, dose indicator, dose knob

• Cartridges are available in 1.5-mL or 3-mL sizes for refill

• Some are disposable pens

– discard entire device –no refills

• Insulin pens continue to be updated with newer models

Disadvantages of Insulin Pens

• Typically more expensive

• Limited to commercially available products

• Each injection is limited to maximum number of units (varies per device)

• Must not be used for multiple patients

Sharps Disposal

• Insulin syringes/pen needles should be used once

• Discarded into puncture-resistant container

• Products available for sharps disposal

– BD Home Sharps Container

– BD Safe-Clip

– Clip & Stor Insulin Needle Safety System

– UltiCare

– UltiGuard

– Voyager.24-26

Continuous SQ Insulin Infusion

• Provided via catheter

– attached to insulin reservoir within insulin pump

• Infusion administers insulin for 24 hours

• Rapid-acting insulin used in insulin pumps

• Insulin pump allows for flexibility of meals & physical activity

• Frequent blood glucose monitoring required

Advantages of Insulin Pump

• Elimination of individual insulin injections

• More accurate insulin delivery than injections

• Improvement of hemoglobin A1c level

• Fewer variations in blood glucose levels/reduction in episodes of low blood sugar

• Ability to administer additional insulin based upon carbohydrate intake & blood glucose levels

• Flexibility in mealtimes & physical activity

Disadvantages of Insulin Pump

• Weight gain

• Diabetic ketoacidosis (DKA)

• Expense

• Device attached to body at all times

• Extensive education required

• Infection resulting from improper care

Pump Features

• Basal rates, battery life, degree of water resistance

• Pump provides both basal & bolus delivery

• Daily dose:

– 40–50% for basal

– 50–60% for bolus insulin

• Education about nutrition, frequent BS monitoring

Blood Pressure Monitoring

• Hypertension (high blood pressure) major risk factor for:

– heart disease

– stroke

– congestive heart failure

– kidney disease

• Hypertension management

– monitoring blood pressure

Blood Pressure

• Home blood pressure monitoring

• Adjustments in lifestyle and/or medication therapy

• Blood pressure measured in millimeters of mercury (mmHg)

• Normal blood pressure is considered to be <120/80 mmHg.

• High blood pressure for adults is defined as

– systolic blood pressure of 140 mmHg or higher or

– diastolic blood pressure of 90 mmHg or higher

Blood Pressure Monitors

• Aneroid blood pressure monitors

– built-in stethoscope

– gauge with dial where numbers are read

– cuff manually inflated

– less expensive than digital monitors

– require adequate hearing, sight, dexterity

Blood Pressure Monitors

• Digital blood pressure monitors are

– easy to read

– manually or automatically inflated

– expensive

• extra features, such as printout of blood pressure readings

– accuracy affected by body movements/irregular heart rates

– accuracy affected by the size of cuff used

Monitoring Process

1. Avoid food, caffeine, tobacco, alcohol for 30 minutes

2. Sit quietly for 3–5 minutes in comfortable position

3. Rest your arm, at level of your heart, on table

4. Place arm cuff over brachial artery

5. Measure blood pressure by following directions

6. Remain quiet while taking your blood pressure

7. Write measurements down in your own log

8. Take repeat reading 2–3 minutes after 1st one to check accuracy

Heart Rate Monitoring

• Measure heart rate in real time while physically active

• Normal heart rate ranges for adults, 60–100 beats per min

• Heart beat detected radio signal transmitted

• Regular physical activity can

– improve blood glucose control

– reduce cardiovascular risk factors

– contribute to weight loss

– improve well-being

Pedometers

• Records each step-detects motion of the hips

• Recommended number of steps per day- 10,000

• Microelectromechanical system (MEMS)

– inertial sensors & sophisticated software

• Pedometer should be worn on belt

• Simplest pedometers-only count steps

• Complex pedometers

– calorie estimates, clocks, timers, stopwatches, speed estimators, 7-day memory, heart rate

Measuring Cholesterol

• High cholesterol-modifiable risk factor for heart disease

• 60% of all adults have high cholesterol (>200mg/dL)

• > 1 of every 5 adults have > 240 mg/dL

• Home testing of cholesterol

– determine health risk status for heart disease

• Cholesterol kits use blood sample from fingerstick

• Results within 10–15 minutes

Measuring Hemoglobin A1c • Average blood glucose control for past 2–3

months

• Patients may want to monitor their hemoglobin A1c levels between physician visits

• Blood sample obtained from fingertip using lancet

• Samples must be mailed to reference laboratory

• Results are sent back to the patient by mail, by fax, or electronically

HIV Testing

• Rate of HIV in US rapidly increasing

• 21% undiagnosed & unaware of their HIV status

• Body forms antibodies to virus between 6 weeks & 3 months after infection with HIV virus

• HIV test in privacy of home

– concern for maintaining confidentiality

– results are retrieved by calling toll-free number

– kit is considered to be 99.9% accurate

Pregnancy/Ovulation Testing • Home pregnancy test

– use drop of urine on test strip

– detects human chorionic gonadotropin (hCG)

– positive result-color change or symbol appears

– false-negative results if tests very early in pregnancy

• Ovulation testing-used in family planning

– determines when woman is most fertile

– ovulation predictor tests detect monthly luteinizing hormone (LH) surge

Orthopedic Devices

• Orthopedic devices are DME

– used by patients of all ages

– braces, supports, splints

– used for rehabilitation & pain management

• Orthotic devices

– prevent or correct physical deformity or malfunction

• Some braces & supports require custom-fitting with assistance of certified orthotist

Ostomy Products

• Ostomy is a surgically created opening in body

• Sigmoid or descending colostomy

– most common type of ostomy surgery

– certain types of cancer of bowel or anus

• Stoma

– passage through abdominal wall

• Patients must learn how to care for stoma & to keep area clean

Other -ostomies

• Ileostomy

– involves small intestine

– ileoanal reservoir (also known as J-Pouch)

• most common alternative to conventional ileostomy

• Urostomy

– diverts urine from bladder

– reservoir or pouch in abdomen

– pouch systems include

• skin barrier & collection pouch