Walkers, Canes and More: Disclosures Prescribing Rehab-Related Durable Medical Equipment None Lisa U. Pascual, MD Clinical Professor UCSF Department of Orthopaedic Surgery Orthopaedic Trauma Institute Zuckerberg San Francisco General Medical Care of Vulnerable and Underserved Populations February 23, 2017 Objectives What is durable medical equipment (DME)? • Become familiar with commonly prescribed • Any equipment that provides therapeutic DME that may help improve a patient’s benefits to a patient because of certain medical conditions and/or illness functional status • Learn how to order and where to order these devices • Become familiar with which devices may/may not be covered by insurance
Where can DME be dispensed? Who else can help procure DME? • • CPD (aka Central Supply) at ZSFG (Ground Health at Home • Floor Bldg. 5) ZSFG outpatient social worker • • Orthotics and Prosthetics (aka O & P) (Bldg. 9, Laguna Honda Hospital 1 st Floor) • Direct home delivery by a vendor Who else can help to procure DME? How do I order DME? • Depending on eligibility, Social Services at ZSFG may be able to obtain DME that is paid for by the Medically Indigent Adult (MIA) fund • Health at Home and Laguna Honda utilize community vendors that deliver equipment to the home • Health at Home may utilize ReCares equipment recyclers (no guarantee if equipment will be available) • Outpatient Order Form • Available at ZSFG clinics and community clinics • May be used at CPD and O & P
How do I order DME? How do I order DME? • O & P Prescription Form • • Available at 3M Clinic Orthotic and Prosthetic Prescription Form • Has also been sent to • Available at O & P and 3M Clinic other clinics (and can be • If not available, utilize the Outpatient Order sent to other clinics Form electronically) • Include the diagnosis • A similar form will soon be • Include the justification for the device available on eReferral (hopefully within the next month) CPD Process ZSFG Outpatient SW process • The outpatient SW may be called if the patient is being seen in clinic and needs equipment urgently • Patient presents form/Rx at CPD window • SW may help facilitate obtaining these items thru CPD • The Rx is good for 30 days after the last patient • If not urgent, and the pt has a PCP, then SW refers the pt to their the patient ’ s last encounter was encounter PCP for all DME requests • CPD will look on the LCR to determine when • PCP would write an Rx for the DME and pass it on to the DME coordinator (e.g. Behavioral Assistance) • If > 30 days, the patient will be sent to the 1st floor (Building 5) to Eligibility • CPD does not fit devices or instruct on use; pts are often directed to PT for assistance
ZSFG Outpatient SW process • If urgent, and the pt does not have a PCP, SW may: • Help to order the following thru a vendor for home delivery: • Hospital beds • Bathroom equipment Commonly Prescribed Rehabilitation-Related DME • Toileting equipment (urinals, bedpans, incontinent supplies, diapers, etc.) and • Help to obtain access to primary care • If the pt is homeless (no address) and the DME is not stocked at ZSFG: • The pt may pick the DME up directly from the DME provider (e.g. Sincere Care), or • The DME may be delivered to SW where the pt can then pick it up at a later date Single Point Canes Quad Canes • Where: May be ordered through outpatient SW • Not commonly ordered for outpatients unless they are for replacement of a lost or damaged • Where: May be obtained at CPD cane (usually PT is involved if the pt is using • To fit: hand piece should be at level this type of cane) of wrist crease with elbow bent 15-20 • Comes in a wide based or small based degrees model • Provides a wider base of support than single point cane • More cumbersome, quad piece may not fit on certain stairs • To fit: hand piece should be at level of wrist crease with elbow bent 15-20 degrees
Using a Cane Crutches (Axillary) side of the impaired limb (on the “ good side ” ) • Usually for short term use • Cane should be held in the hand opposite the • Where: CPD at ZSFG • Sizes: Small, Regular, Tall • Details: • Level surfaces: impaired leg and cane • To fit: advance together followed by good leg • Hand piece should be level at the wrist • Stairs: crease (elbow should be bent approx 30 • Going up: Good leg up � cane up � degrees) impaired leg up • Axilla should NOT rest on the top piece • Going down: Cane � impaired leg down (2-3 inches distance below the axilla) • Pt may drop by PT to see if there is staff � good leg down available to fit Crutches (Forearm) Crutches (Forearm) • To fit: • Often for longer term crutch use • Hand piece should be level at the • Initially harder to learn, better for posture, wrist crease (elbow should be bent alternative terrains, different gait style approx 30 degrees) • Also known as Lofstrand or Canadian • The opening of the cuff piece crutches should face forward • Where: Outpatient SW may help to • Position the cuff 1-2 inches below procure; these are not available at CPD the elbow • Sizes: Small, Regular, Tall
Using Crutches Walkers • Types: • Swing To Gait: • Basic • Move crutches forward • Front Wheeled • Shift weight onto crutches to move body forward • Rollator (swing) landing on the good leg to meet where the • How to Fit: crutches are positioned • Hand piece should be level with • Stairs: wrist crease (elbow at 15-20 • Going up: Good leg up (keeping impaired leg degrees of flexion) bent) � crutches up • Worn tips may be obtained at CPD • Going down: Crutches down � hop down with • Tennis balls (cut open) are sometimes good leg used when the wheels are worn/broken Walkers Basic Walker Basic walker: no wheels • How to obtain: • Advantages: • These need to be ordered through • Offers most stability when weight a medical vendor applied, therefore, best for pts who • Outpatient SW may help to procure need to put significant weight on • An order form/ Rx is needed the walker • Health at Home and Laguna • Good for use on indoor, level Honda may order these through a surfaces vendor if the patient is actively • Can be folded being followed by their service • Disadvantages: • Walker must be picked up every 2 steps to advance
Front Wheeled Walker Rollator Walker Rollator walker: four wheels Front wheeled walker: two wheels in • Advantages: front • More ease of mobility indoors and • Advantages: outdoors • • More ease of mobility indoors For patients who need walker for balance but not for significant and outdoors weightbearing • Can be folded • May be equipped with brakes, seat • Disadvantages: and basket • Less stable than basic walker • Disadvantages: • Less stable than other walkers • May not fit thru tight spaces or doorways Controlled Ankle Movement (CAM) Boot Knee Scooters AKA Walking boot or Bledsoe boot • How to obtain: • Often used post op • Outpatient SW may help to • Indication must be procure related to a ligamentous • Requires complete avulsion, fx or high ankle prescription + Knee sprain to be covered Scooter Authorization Form (should be stated in Rx) (available on 3M) • How to obtain: Need • Rental maximum of 3 order form/RX months • Where to obtain: O & P • Delivered to home
Wrist Splint Elbow Brace OT ’ s may facilitate OT ’ s may facilitate • • Often used for carpal May be use to fix position tunnel syndrome or limit range of motion • • obtaining (as long as has obtaining (as long as has order/Rx) if pt is seen order/Rx) if pt is seen while in 3M Clinic or OT while in 3M Clinic or OT clinic clinic • • How to obtain: Need How to obtain: Need order form/RX order form/RX • • Where to obtain: O & P Where to obtain: O & P Knee Brace Hinged Knee Brace (adjustable) • • Has rigid medial and lateral Used to manage range of motion rigid stays for support requiring a fixed position or to limit • Used to protect knee from a movement. May be used: • recent injury, future injury or Post op • to provide support To prevent further or future injury • • How to obtain: Need order To provide more rigid support • form/RX Has joints where range of motion • Where to obtain: O & P can be dialed in • • Off the shelf knees sleeves How to obtain: Need order form/RX • are not provided as they not Where to obtain: O & P, CPD • covered by insurance O & P will help to fit and instruct on donning
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