Section 10: Supplies/DME Updated: 8/24/12 Section Author(s): cspaziani & hscullin Field Guide Section 10: Supplies/DME 1
Section 10: Supplies & DME 2 Section 10: Supplies/DME Field Guide
Section Contents Medical Supplies...5 Supply Room Information...5 Supply Requests...5 Courier...6 Specialty Orders...6 Supplies for Kaiser Patients...6 Aromatherapy...7 DME Supplies...9 Delivery Process...9 Admissions Nurses/After Hours Nurses...9 Primary Care Nurses...9 Equipment not included in Per Diem...9 After Hour Services...9 Pick Ups... 10 FORM: Premier Order Intake Log... 11 Drain & Tube Reference... 13 Oxygen Safety... 17 Fire Hazard... 17 Concentrator Safety... 17 Handling and Storage of Tanks... 17 Liquid Oxygen Safety... 18 Oxygen System Selection, Concentrator vs. Liquid... 19 Oxygen Concentrator Clinical Indicators... 19 Liquid Oxygen Clinical Indicators... 19 Liquid Oxygen Flow Charts... 20 Helios Portable Flow Chart... 21 Cylinder Flow Chart... 22 Oxygen Delivery Devices... 23 Liquid Oxygen Fill Instructions... 24 Liquid Oxygen Flow/Duration... 25 How to Read Your Contents Gauge... 26 Oxygen System Selection Algorithm... 27 Specialty Mattress Selection Algorithm... 28 Field Guide Section 10: Supplies/DME 3
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Supply Coordinator Office: 303-398-6296 BB: 720-413-4900 supplyrequest@denverhospice.org Medical Supplies Supply Room Information The Denver Hospice is under a bar-coded system with our supply vendor. Each Employee is issued their own barcode, which is to be scanned when supplies are requested. When supplies are taken from the ICC, a supply request form is to be filled out in its entirety. Including first and last name, date, and the exact amount of supplies taken, for Inventory purposes. This will be used to re-stock afterhours/admissions supplies. Our supply room inventory is stocked by an auto generated computer ordering system. If our Inventory is off, our order will not automatically generate, which will result in TDH not having the sufficient amount of supplies that are set in our software. The supply room at the 501 South Cherry Office is open from 7am -5pm; Monday to Friday. Afterhours, Weekend, and Admissions have a small supply room in the admissions area at the ICC. This small supply is not for re-stocking cars; its purpose is for an unexpected need. All field staff are responsible for having their cars stocked at all times; a car supply list will be provided to you. See Car List for Field Nurses on page Error! Bookmark not defined. It is vital that all employees comply with TDH procedure in order for our process to run effectively. Supply Requests Supply email requests can be made to supplyrequest@denverhospice.org. Field Staff: Option 1: You can come into the office during office hours and the supply coordinator can assist you in getting supplies and answering any supply questions, specialty orders, or supply concerns you may have. Option 2: You can email or call supply requests to 303-398-6296 or 720-413-4900. Your requests must include: the name/type of supplies needed; the quantity/amount needed; sizing. For afterhours and weekend staff, you can email or call supply requests (indicate the amount and quantity needed) and your order will be prepared and either couriered to the ICC or can be left in the supply request pick-up area. Field Guide Section 10: Supplies/DME 5
Courier The ideal method for patients to get supplies is delivery from clinicians with their visit. When an unexpected need arises, we have a courier that can deliver a product to the patients home. This is for emergency and unexpected needs only. Email supplyrequest@denverhospice.org with the need for courier delivery, specifics of the order and if the need is same day or next day. The courier does 2 runs a day at 9 am and 1 pm. Specialty Orders If you need a product that we do not stock you can email supply request with the specifics of the need and details about the size and quantity of the item. The supply coordinator will research the need with our supplier and discuss the product and cost with a Resource Nurse and Manager. Special orders can take a week or more to arrive. You will be informed as soon as the order is placed and the details of the delivery. Supplies for Kaiser Patients See Section: Kaiser 6 Section 10: Supplies/DME Field Guide
Aromatherapy Field Guide Section 10: Supplies/DME 7
Author: jyarbro Date: 04/25/2012 8 Section 10: Supplies/DME Field Guide
DME Supplies Premier Medical Corporation Hours of Operation: Monday-Saturday, 8am-5pm Delivery Process In most cases, deliveries for DME will be next day, except for hospital discharges and patients who need oxygen when no oxygen is in the home. Admissions Nurses/After Hours Nurses Admissions RN will fax over a completed order form requesting equipment for a newly admitted patient. (See following order form). If the Admissions RN is unable to fax form for any reason it is permissible to call Premier directly and request equipment. Then send an email to COAs listing the equipment called into Premier so they can add to the patient s equipment profile in Home Works. For admissions from the hospice and for new oxygen deliveries during normal business hours, Premier will deliver within 4 hours of receipt of the order. (Please triage oxygen need if there is oxygen already in the home, a four hour deliver is not necessary.) Primary Care Nurses During The Denver Hospice normal business hours, any request for DME must be either emailed to clinicalopsasst@denverhospice.org or called in to the Clinical Operations Assistants (COA) at 303-398-6279. (Please include any necessary details regarding the patient ex: liter flow, height, weight, urgent or non-urgent delivery.) Equipment not included in Per Diem All items ordered with a purchase price of $150.00 must be approved by manager prior to ordering. (Purchase items will be delivered within 7-10 business days depending on availability.) All items ordered with a rental price of $5.00/day or more must be approved by manager prior to ordering. (Specialty rental items will be delivered within 1-10 business days depending on availability.) The approval process starts with an inquiry to the COAs from the RN. They will contact the Premier purchasing agent, who will provide price and availability to the requested item(s). The COA will then provide the RN and clinical manager with that information. COAs will hold the order until they receive an approval or denial from the clinical manager. After Hour Services Premier has on-call drivers who are available evenings and weekends to make emergency only deliveries. This service is mainly for new admissions and those patients with oxygen and suction machine needs. Other needs may be delivered if Premier drivers have time to make additional nonurgent deliveries. **Premier s Respiratory Therapists are available for emergency consults 24x7. Field Guide Section 10: Supplies/DME 9
Pick Ups The COA s will fax the death and discharge list to premier every morning for the day before, indicating that DME needs to be picked up. Premier will then call the family around 4pm that day to coordinate a pick up time. If a patient no longer needs a piece of equipment and is still on our service, email the COA s to have it picked up. You may also email Premier at customerorders@premiermedicalcorp.com. 10 Section 10: Supplies/DME Field Guide
FORM: Premier Order Intake Log Field Guide Section 10: Supplies/DME 11
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Drain & Tube Reference Field Guide Section 10: Supplies/DME 13
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Oxygen Safety Fire Hazard Oxygen supports combustion. This means that some things will burn hotter and faster when oxygen is present. Oxygen is not flammable in itself. But remember that oxygen will accumulate around the user and immediate area, so flammable material should not be present. Do not operate devise in a confined area You should never use petroleum-based products in and around your nose (ie., Vaseline, A&D Ointment, etc.). Use of these products with oxygen can cause burns. Avoid open flames, matches, stoves, BBQ grills, space heaters, and any other similar products No smoking within five (5) feet of the patient and /or equipment Caution should be used with electrical devices or toys that produce sparks. Concentrator Safety Concentrator machines should be plugged into a properly grounded outlet. Do not use extension cords Do not use multiple plugs Do not use electrical devises that create heat or sparks Power sources should meet or exceed electrical/amperage requirements of the equipment Handling and Storage of Tanks Oxygen is usually stored in heavy containers, care should be taken to avoid tipping over the tank The oxygen should always be kept in the stand or the cart to avoid tipping. You should only move tanks as instructed by your representative Do not store tanks in confined or unventilated areas Do not store tanks near flammable substances or heat or ignition sources Do not store or leave tanks in the trunk or your car Always secure tanks in a moving vehicle to keep the tank from falling or tipping over. Compiled from In-service & handouts provided by Premier Medical Field Guide Section 10: Supplies/DME 17
Liquid Oxygen Safety No smoking! Do not allow residents, visitors or staff members with portable oxygen equipment near smoking areas, or near any source of spark or open flame. Liquid oxygen portable units may only be filled in the 02 room, do not fill them in resident rooms. This is a state regulation. Make sure liquid oxygen portables are stored in an upright position. Liquid oxygen inside the portable will leak out if the portable tips over! Do not use oil or petroleum based products on oxygen equipment or on residents who are on oxygen. Liquid oxygen is a pale blue liquid that is stored at -300 degrees Fahrenheit. Skin exposed to liquid oxygen will suffer a frostbite thermal injury that is almost identical to a burn. if skin is exposed to liquid oxygen, the appropriate first aid treatment is to flush the area with tepid (not hot) water, and seek immediate medical attention Liquid oxygen portables are designed to be safely filled according to manufacturer and FDA guidelines without the need for personal protective equipment (PPE). Some facility policies or fire department regulations require the useof PPE anyway. Always use PPE when filling liquid oxygen portables if required: eye protection (face shield or goggles) hand protection (leather gloves) hearing protection splash protection (leather apron) The liquid oxygen portable may freeze to the liquid oxygen stationary tank during the filling process. If this occurs, DO NOT FORCE THEM APART. Allow the equipment to gradually warm up and it will thaw and disconnect easily. To prevent most incidents of liquid oxygen portables freezing you must wipe any moisture from the fill connection on both the portable and the large stationary tank with a clean dry cloth. Condensation of the moisture in the air onto the filling connections occurs every time a portable is filled. Any residual moisture will cause the equipment to freeze together the next time it is filled unless it is wiped clean. On rare occasions a valve may freeze open during the filling process, and liquid oxygen may drip or even spray out of the oxygen equipment. If this occurs, do not attempt to fix the leak! Back away from the equipment, leave the room and warn staff members to not enter the room until the leak stops. Call Premier Medical to check the equipment for any malfunctions. Please make sure when you fill the liquid portables that you give the correct portable back to each resident. If this does not occur it creates an infection control issue and cross contamination. Compiled from In-service & handouts provided by Premier Medical 18 Section 10: Supplies/DME Field Guide
Oxygen System Selection, Concentrator vs. Liquid Oxygen Concentrator Clinical Indicators Low flow oxygen needs 1-5 liters per minute Best for non-ambulatory or moderately ambulatory patients High flow concentrator can accommodate flow rates of 6-9 liters per minute Patient has available power outlet with adequate amperage capacity Patient home layout accommodated by 50ft long extension tubing Patient/caregiver can change E-tank regulators successfully Home situation does not accommodate liquid oxygen deliveries: stairs, remote location, unavailable for weekly deliveries Usually better for people rarely going out Liquid Oxygen Clinical Indicators High flow oxygen needs, greater than 8 liters per minute Best for ambulatory patients at any liter flow High flow rates via multiple tanks can accommodate any flow rate needs Patient has no available power outlet with adequate amperage capacity, or on fixed income and concentrator electric bills are not affordable or frequent power outages Patient home layout not accommodated by 50ft long extenstion tubing, patient uses liquid portable around the house Patient/caregiver unable to change E-tank regulators successfully Patient satisfaction some patients who have been on liquid oxygen will not consider using any other system Don t store by heat/flammable items Compiled from In-service & handouts provided by Premier Medical Field Guide Section 10: Supplies/DME 19
Liquid Oxygen Flow Charts Time is approximate-individual usage times may vary LPM Stationary Approximate time in days PB41 1 23 2 11.5 3 7.5 4 5.5 5 4.5 6 3.9 Portable Approximate time in hours LPM PB100 (Hours).025 44.5 27.75 19.6 1 15.5 1.5 11.4 2 8.5 2.5 6.7 3 5.8 3.5 5 4 4.3 5 3.4 6 2.6 8 2.1 10 1.7 15 1.1 Compiled from In-service & handouts provided by Premier Medical 20 Section 10: Supplies/DME Field Guide
Helios Portable Flow Chart Only when they breath in (Approximate use time of a full portable. Individual usage may vary.) Flow Control Knob Setting Approximate Use Time.12 LPM 15 hours.25 LPM 15 hours.5 LPM 10 hours.75 starts not LPM 6.5 hours 1 13 hours 1.5 12 hours 2 10 hours 2.5 8.5 hours 3 6.5 hours 3.5 6 hours 4 5 hours Compiled from In-service & handouts provided by Premier Medical Field Guide Section 10: Supplies/DME 21
Cylinder Flow Chart (Time is approximate-individual usage times may vary.) LPM M-6 C D E (E Cylinder) H 1 / 32 LPM 72 hrs 98 hrs 162 hrs 252 hrs 118 days 1 / 16 LPM 36 hrs 48 hrs 80 hrs 126 hrs 59 days 1 / 8 LPM 18 hrs 24 hrs 40 hrs 63 hrs 29 days ¼ LPM 9 hrs 12 hrs 20 hrs 32 hrs 14 days ½ LPM 4 hrs 6 hrs 10 hrs 16 hrs 7 days 1 LPM 2 hrs 3 hrs 5 hrs 8 hrs 3.5 days 2 LPM 1 hr 1.5 hrs 2.5 hrs 4 hrs 44 hrs 3 LPM.75 hr 1 hr 1.75 hrs 2.5 hrs 29 hrs 4 LPM.5 hrs.75 hrs 1.5 hrs 1.75 hrs 25 hrs 5 LPM N/A.5 hrs 1 hr 1.5 hrs 17 hrs 6 LPM N/A N/A.75 hrs 1.25 hrs 14 hrs Compiled from In-service & handouts provided by Premier Medical 22 Section 10: Supplies/DME Field Guide
Delivery Device Oxygen Delivery Devices Minimum to Maximum Liter Flow Range (Adults) Approximate 0 2 % Delivered Notes RT assistance recommended for liter flows of 5 liters/minute or more Nasal Cannula 1-6 liters/minute 25-50% * Humidifier (black top) recommended for all flow rates >4 liters/minute High Flow Nasal Cannula Oxymizer Cannual Mustache & Pendant Styles Low Flow Mask 1-15 liters/minute 25-50% * High Flow humidifier required (tan top) for all flow rates of 5 liters/minute or more 1-15 liters/minute Varies Do Not Use with humidifiers. Replace every 3 weeks. 1-15 liters/minute 30-50% * Humidifier not required Includes bi-flow mask Simple Mask 6-10 liters/minute 40-50% * Humidifier not required Non Rebreather Mask 10-15 liters/minute 60-80% * Humidifier not required Liter flow must be sufficient to keep reservoir bag partially inflated during inspiration Hi-Ox Mask 8-15 liters/minute 100% * Humidifier not required Liter flow must be sufficient to keep reservoir bag partially inflated during inspiration Transtracheal oxygen catheter 1-15 liters/minute Varies RT assistance recommended Trach collars, face tents 1-30 liters/minute Varies RT assistance recommended * 0 2 % Delivered varies by flow rate (liters/minute), respiratory rate, tidal volume, mask fit, etc. Compiled from In-service & handouts provided by Premier Medical Field Guide Section 10: Supplies/DME 23
Liquid Oxygen Fill Instructions 24 Section 10: Supplies/DME Field Guide
Liquid Oxygen Flow/Duration FLOW RATE PORTABLE RATE (FULL) STATIONARY (FULL).25 44.0 hours 58 days.50 27.0 hours 47 days.75 19.6 hours 31 days 1.0 15.5 hours 23 days 1.5 11.4 hours 15.5 days 2.0 8.5 hours 11.7 days 2.5 6.7 hours 9.4 days 3.0 5.8 hours 7.8 days 3.5 5.0 hours 6.7 days 4.0 4.3 hours 5.8 days 5.0 3.4 hours 4.7 days 6.0 2.6 hours 3.9 days 8.0 2.1 hours 2.9 days 10.0 1.7 hours 2.3 days 15.0 1.1 hours N/A Compiled from handouts received from Premier Medical Field Guide Section 10: Supplies/DME 25
How to Read Your Contents Gauge 26 Section 10: Supplies/DME Field Guide
Oxygen System Selection Algorithm Field Guide Section 10: Supplies/DME 27
Specialty Mattress Selection Algorithm 28 Section 10: Supplies/DME Field Guide