9.3 Medical and Home Health Supplies and Equipment

Community pharmacies also sell the everyday first-aid and health supplies needed by customers. General health supplies and equipment include the usual bandages, tape, wound dressings, thermometers, heating pads, splints, braces, vaporizers, bathroom accessories, and adult/child diapers. These are all elements that do not need a prescription, and technicians can help patients find these stocked items.

Parents will often come into the pharmacy worried about a child with a high fever, looking for the right thermometer. Technicians need to become acquainted with the range available. Different types have different features, and it is helpful for a technician to be able to explain the differences to concerned parents. There are electronic/digital, infrared, and mercury thermometers for use in the mouth, armpit, rectum, ear, forehead, and vein areas. (Mercury thermometers are being phased out.) Oral thermometers are for those who can hold them under the tongue, which is often difficult for children or seniors. Rectal thermometers are generally used for infants. If customers have specific questions about the best type for detecting a specific illness or for a patient who is difficult to care for, the pharmacist should help them.

Pharmacies also have specialized supplies suited for aging patients and specific chronic conditions, such as heart disease, respiratory diseases, and diabetes. Disposable medical supplies include such items as test kits, needles, and sterilizing wipes. Durable medical equipment (DME) and supplies are reusable and long-lasting for ongoing needs. DME includes canes, wheelchairs, walkers, crutches, blood pressure monitors, blood sugar monitors, nebulizers, and oxygen equipment, among other typical items. These are often prescribed by physicians.

It is helpful to be familiar with some of the key medical supplies and equipment sold in a community pharmacy.

Test Kits

People often want to diagnose and treat themselves, so they buy test kits to help them discern their conditions. Some of the most common test kits requested by patients include the following:

OraQuick is a screening test for those who fear that they may have contracted HIV.

• pregnancy

• ovulation cycle

• bladder infection

• high cholesterol

• illegal drug use

• human immunodeficiency virus (HIV) infection

Occasionally, the pharmacy may need to special order a less-requested test kit for a customer. The pharmacy technician can help customers select a test kit and understand the test instructions and outcomes. Patients will want to confirm the test finding with a doctor. Letting patients know where community clinics are in the area can be helpful.

IN THE REAL WORLD

Blood Pressure Monitors

Patients with high blood pressure often seek home monitors. They may want (or be urged by a prescriber) to purchase a type of sphygmomanometer for home use. A sphygmomanometer is a blood pressure gauge and cuff similar to that used in a physician’s office. Many patients prefer to purchase a digital blood pressure cuff for their wrist as it is easier to use by oneself. Its results can be recorded and brought to the physician’s office on the next visit.

A digital blood pressure unit with a wrist cuff is easier to use for home use than an arm cuff.

This is an example of a peak flow meter, which measures one’s lung/breath capacity to monitor respiratory diseases such as asthma.

Respiratory Management Supplies—Inhalers and Nebulizers

Many children and adults suffer from asthma and other diseases that cause breathing issues, and they take prescribed medications through a metered-dose inhaler (MDI). It is a small, pressurized canister of a prescribed medication that is pumped out in specific doses for inhaling. Some patients need a plastic spacer device, or extension tube, to deliver the medication more effectively. Spacers are particularly beneficial for the very young as well as elderly patients who may have difficulty with coordinating the movement needed for deep inhalation into the lungs. Spacers come in small, medium, and large sizes. If written as a prescription, the spacer will be covered on some drug insurance plans. Prescribers may also recommend that some respirator patients purchase an adjustable plastic peak flow meter to measure their breathing expirations to assess the severity of their asthma symptoms or the therapy benefits.

Occasionally, prescribers order medications in nebulizer form for patients with the acute wheezing or shortness of breath that accompanies chronic obstructive pulmonary disease (COPD). A nebulizer is a battery- or electric-powered machine that turns the asthma medicine into a fine mist that can be inhaled deep into the lungs to ease breathing difficulties. The pharmacy technician completes the processing for billing an insurance plan for the home nebulizers and medications. These both require prescriptions with diagnosis codes (ICD-10) for insurance coverage.

Diabetic Management Supplies

Nearly 10% of US citizens are affected by diabetes, and the percentage is growing. Community pharmacies offer a wide range of products to serve these patients. Even special therapeutic footwear for patients with diabetes, which helps prevent injury, may be prescribed or recommended by physicians and carried by some community pharmacies. Many pharmacists acquire specialty training and certifications in serving patients with diabetes and matching them with the particular drugs and supplies they need.

Pharmacy technicians can complete a special diabetes training, pass an examination, and become certified in patient education for patients with diabetes. Such skills are considered valuable within the pharmacy and may enhance hourly pay. Even without this specialty training, technicians in a community pharmacy are often called upon to assist patients in locating or selecting diabetes supplies, such as a glucometer, insulin syringes, pen needles, test strips, lancets, and alcohol wipes for skin cleansing.

Technicians are also key to helping patients work with the insurance companies to pay for their diabetes supplies and durable medical equipment. Insurance covers many of these items. Below is a sample of some of the varied diabetic supplies pharmacies carry.

Glucometers

To determine the level of glucose in one’s body, and therefore how much insulin is needed, patients can use a glucometer, or blood sugar measuring device. Patients insert a test strip (explanation to follow) in the machine and add a drop of blood (most often from a fingertip). The glucometer then screens the blood to check the glucose levels.

Diabetes patients are often frequent customers, needing glucose tablets and gels, lancets, alcohol wipes, and different sizes and gauges of needles, among other supplies.

Glucometers are available from several manufacturers in different sizes. They vary as to the amount of blood needed to make a reading, the time period necessary to provide the results, the memory capacity, and the ability to interface with a computer. Patients without insurance coverage for this equipment can often purchase glucometers with generous manufacturer rebates that negate the majority of the stated purchase prices. Companies frequently upgrade their glucometers, so it is essential for both the pharmacist and the technician to keep abreast of product changes.

Test Strips, Lancets, and Alcohol Wipes

Specialized disposable test strips are needed with each glucometer. The test strips are machine specific and must be matched for the glucometer type being used. Technicians can assist patients in product matching. Some bottles of test strips come with a computer chip that has a specified lot number that must be inserted in the glucometer. Failure to replace this glucometer chip when using a new bottle of test strips (with a different lot number) leads to errors in the blood glucose readings. Technicians always need to check the expiration dates of the strips as well. Since patients test their blood using new test strips from one to six times daily, strips are expensive if patients do not have insurance coverage. However, purchasing generic or store-brand test strips, especially with discount coupons, can result in up to a 50% patient savings.

In addition to the test strips, patients need alcohol wipes and lancets, or mini blades, to make the sterile pinpricks to access blood. Technicians can assist them in finding and purchasing these items.

Insulin Syringes and Needles

As explained in Chapter 5, insulin syringes and needles come in different sizes, and technicians can help patients select the correct length and gauge. Remind patients that the higher the gauge of the needle, the smaller the width, potentially resulting in less pain at the injection site. Insulin-pen needles have to be purchased separately and are available with gauges from 29 to 32. Pen-needle lengths are commercially available as original (12.7 mm, or ½ inch), short (8 mm, or ⅓ inch), mini (6 mm, or ¼ inch; 5 mm, or ⅕ inch), and nano (4 mm, or ⅙ inch). The shortest pen needle, which usually causes the least pain, is the 4 mm, 32-gauge needle. States vary in their laws about selling syringes, concerned that they will be used for illegal drug administration. Some pharmacies have a policy that no insulin syringes can be sold unless the patient comes with a prescription or is a known customer of the pharmacy.

Large Durable Medical Equipment

In addition to the smaller DME, some independent community pharmacies with more storage or warehouse space also specialize in the sale or rental of larger DME, such as hospital beds, wheelchairs, prosthetics, orthotics, and so on. These pharmacies generally host a more limited inventory of standard retail merchandise (products that are nonhealth-related) to have more room for home healthcare supplies and equipment.

The orthopedic equipment to correct a clubfoot in a child or a foot boot for those who have undergone surgery are examples of DMEs that a pharmacy might sell.

Community pharmacies that provide home healthcare supplies and equipment must meet quality standards and accreditation requirements set by the Centers for Medicare and Medicaid Services (CMS). CMS generally awards contracts to pharmacies or medical supply warehouses to provide DME that is directly reimbursable by Medicare Part B. Besides assisting customers in finding and completing the sales for medical supplies, technicians often help assemble the equipment, bill insurance, and restock items.