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Business Applications

Business Applications. Chapter 18: 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

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Business Applications

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  1. Business Applications Chapter 18: Durable and Nondurable Medical Equipment, Devices, and Supplies

  2. 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

  3. 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

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

  5. Key Terms • Nondurable medical equipment • Orthotic • Orthopedic devices • Orthotic devices • Ostomy • Pedometer • Stoma • Test strip • Urostomy

  6. 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

  7. 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%,

  8. 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

  9. 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

  10. 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

  11. 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

  12. BG Monitoring Process • Gather materials used for test • Wash hands or clean finger/area of skin to be used • Place test strip in meter/obtain test strip from meter • Lance (stick) area of skin to obtain blood sample • Apply blood sample to test strip • Record blood glucose reading in log book • Discard lancet in hard, puncture-resistant container

  13. 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

  14. 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

  15. 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

  16. Steps of Insulin Injection • Wash hands; gather materials • Clean site of injection with alcohol prep • Draw air into syringe-same volume as insulin units • Inject air into insulin vial • Invert vial, withdraw units, check for air bubbles while syringe needle remains in vial

  17. Steps of Insulin Injection • If air bubbles are present, push insulin back into vial & withdraw insulin units again • Remove syringe from vial • Pinch fold of skin, inject at 45- or 90-degree angle • Keep needle in skin for few seconds; then release skin fold & remove needle from skin

  18. 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

  19. 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

  20. 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

  21. 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

  22. 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

  23. 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

  24. 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

  25. Blood Pressure Monitoring • Hypertension (high blood pressure) major risk factor for: • heart disease • stroke • congestive heart failure • kidney disease • Hypertension management • monitoring blood pressure

  26. 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

  27. 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

  28. 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

  29. Monitoring Process • Avoid food, caffeine, tobacco, alcohol for 30 minutes • Sit quietly for 3–5 minutes in comfortable position • Rest your arm, at level of your heart, on table • Place arm cuff over brachial artery • Measure blood pressure by following directions • Remain quiet while taking your blood pressure • Write measurements down in your own log • Take repeat reading 2–3 minutes after 1st one to check accuracy

  30. 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

  31. 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

  32. 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

  33. 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

  34. 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

  35. 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

  36. 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

  37. 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

  38. 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

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