Direct Care Services Research Articles

Nursing interventions in a newly established community health nursing system: A cross sectional survey

BackgroundCommunity health nursing was introduced in Austria in 2022. Information about nurses' activities, their alignment with established public health frameworks, and their relationship to existing care services is crucial for understanding the role's implementation and potential impact. ObjectiveThis study examines the activities of the first cohort of Austrian Community Health Nurses, focusing on their alignment with the Public Health Intervention Wheel and the Nursing Intervention Classification. An important aspect comes from the question, whether these new services complement or substitute existing direct care services. In this process, we also address heterogeneity across urbanization levels. DesignCross-sectional survey. Setting(s)An online survey (April to June 2023) among Community Health Nurses captured their perception of activity frequencies based on the Public Health Intervention Wheel and Nursing Intervention Classification. Participants130 nurses (59 %, N = 220) answered >6 (out of 33) questions, 98 nurses (45 %, N = 220) provided all required information. MethodsThe analysis used descriptive statistics, statistical tests, and hierarchical cluster analysis, employing Excel®, Stata® and R. ResultsAustrian Community Health Nurses implement many principles of the Public Health Intervention Wheel, with a focus on counselling, consultation, and health teaching. Direct care interventions (according the Nursing Intervention Classification) are rarely performed. Findings indicate that community health nurses complement rather than substitute existing direct care and home nursing services. However, unlike international practices, activities are primarily at the individual level, with limited engagement at community and systems levels. ConclusionsCommunity health nursing in Austria demonstrates a public health focus and therefore complements existing care services. However, it focuses primarily at the individual level, which differs from international norms where activities span individual, community, and systems levels. Tweetable abstractFirst Austrian Community Health Nurses implement public health intervention principles mainly on individual level.

Medical student shadowing on hospital medicine direct-care services.

Medical student shadowing on hospital medicine direct-care services.

Effect of home care activities on labor participation in a developing country

This article analyzes the differences in labor participation due to home care activities in Colombia. Indirect and direct care activities can be inside or outside the market sphere. For example, a domestic service worker provides indirect and, sometimes, direct care services. A high percentage of care activities are delegated to women because these tasks are supposedly proper for their gender and are a natural part of their daily lives. To understand the disadvantaged position of women in the labor market, their participation in unpaid work must be considered. Our results show that gender stereotypes continue to overburden Colombian women in unpaid activities. Variables such as age, schooling, sex, and household headship are relevant when direct and indirect caregiving activities are included in the analysis of labor participation.

Effects of organisational factors and employee characteristics on employers' reporting of client violence in non‐institutional social services in Sweden

AbstractSocial services in the welfare sector consist of women‐dominated jobs generally characterised by arduous working conditions, including exposure to client violence. Although there is a rather extensive research base on client violence in institutional social services, less is known about how client violence is handled in noninstitutional social services. Using longitudinal data obtained from the Swedish Work Environment Agency's register on work injuries caused by workplace violence, we examined the effects of organisational factors and employee characteristics on the reporting of client violence in noninstitutional social services. We found that most of the reports about work injuries caused by client violence are filed by public employers and that most reports concern occupational groups performing direct care services in clients' homes. Moreover, although most reports include female employees and incidents of physical violence, reports concerning male employees are comparatively more likely to include physical violence, and reports concerning female employees are comparatively more likely to include threats. Taken together, our findings point to a much‐needed improvement of health and safety measures for care workers in noninstitutional social services in Sweden.

The potential role of religiosity, psychological immunity, gender, and age group in predicting the psychological well-being of diabetic patients in Saudi Arabia within the Bayesian framework.

This study aimed to investigate the differences in Religiosity (R), Mental Immunity (MI), and Psychological Well-Being (PWB) in patients with diabetes due to gender and age group variables, and to detect the best predictors of PWB in diabetic patients within the Bayesian framework. The study was conducted from May 2022 to February 2023 on a random sample of 186 Saudis diagnosed with diabetes. After obtaining participants' consent, they completed three R, MI, and PWB scales. Bayesian Independent Samples t-test was performed to identify differences, and Bayesian linear regression analysis was used to reveal the best prediction model of PWB. The results of the Bayesian independent samples t-test indicated strong evidence supporting the alternative hypothesis H1, suggesting differences between male and female diabetic patients in R, MI, and PWB, with Bayesian factor values exceeding 10 (8.338×10+23, 1.762×10+25, and 1.866×10+24), and Cohen's δ of (-1.866, -1.934, -1.884). These results indicated that females with diabetes have higher means of R, MI, and PWB compared to males. However, the results also suggested evidence for the null hypothesis H0 of no differences in R, MI, and PWB among diabetic patients due to age group, with Bayesian factor values (0.176, 0.181, and 0.187) less than 1.00 and small Cohen's δ of (-0.034, -0.050, -0.063). Bayesian linear regression analysis detected strong evidence that the model including MI is the best predictive model (BF10 for mental immunity is 1.00 and for the other two models are 0.07 and 4.249×10-16) for the PWB of diabetic patients, however, there is no evidence that the model including R or the interaction between R and MI is the best predictor of PWB for diabetic patients. These findings highlight the need for direct psychological care services for male diabetic patients and the urgent need to enhance IM in diabetic patients to improve their PWB. Furthermore, results recommended that healthcare providers in Saudi Arabia integrate MI interventions into diabetes care programs.

A Collective Impact approach to improving the physical health of people living with mental illness.

Introduction: Eighty percent of people living with mental illness have a co-existing physical health condition. Yet due to ‘diagnostic overshadowing’ (where the presenting problem overshadows all other concerns and risks), stigma and systemic discrimination, the rate of screening and treatment for mortality-related chronic health conditions in this part of our community is low. Consequently, as a group, people living with mental illness have poor health and have a 13 - 23 year reduced life expectancy. This pattern of poor health and reduced life-expectancy has been consistently reported in research studies across the world for more than 20 years.
 Aims, Objectives, Theory or Methods: The aim of this paper is to show how the countries of Australia, France, New Zealand and England have applied the collective impact approach to address the issue of the poor health and reduced life-expectancy of people living with mental illness. A collective approach seeks to coordinate organisations to reduce duplication and amplify impact. Co-chaired by consumers and with an emphasis on consumer-led initiatives, a collective impact approach seeks to coalesce multiple agencies/stakeholders through a common goal to address complex personal and system challenges. 
 Highlights or Results or Key Findings: Although each country has adopted a collective impact approach, the way this has been implemented in different contexts has been quite different. The paper compares and contrasts approaches to ‘developing a shared agenda’, ‘mutually reinforcing activities’, and facilitating coordination. Common to each of these collective impact core elements is the need for a strategic approach to communication. This presentation will challenge the collective impact theory of ‘continuous communication’ using examples of the communication strategies from each country.
 Further, this paper will present how each country measures progress and seeks to demonstrate public value. This is a particularly important issue for intermediary organisations who do not provide direct health care services.
 Finally, it will highlight how by networking and working together internationally, these countries have successfully initiated reform in policy, and practice changes in areas such as cardiovascular disease management and vaccination for people living with mental illness.
 
 Conclusions: Collective impact appears to be an effective way to mobilise diverse organisations and amplify actions converting policy to practice. There is scope to apply a collective impact approach flexibly to different service system contects. Consistent across systems is the need for a backbone team to drive change and maintain momentum. 
 Implications for applicability/transferability, sustainability, and limitations: The processes and methods of a collective impact approach can be applied to a range of health scenarios to facilitate enhanced integration and collaboration. However, sustainability requires a backbone team and providing ongoing evidence of impact and success.

Effect of chair placement on physicians’ behavior and patients’ satisfaction: randomized deception trial

ObjectiveTo evaluate the effect of chair placement on length of time physicians sit during a bedside consultation and patients’ satisfaction.DesignSingle center, double blind, randomized controlled deception trial.SettingCounty hospital in Texas,...

Barriers to accessing pain management services among veterans with bipolar disorder.

To identify barriers veterans with bipolar disorder face to accessing chronic pain management services within a Veterans Affairs (VA) health care system. Veterans (n = 15) with chronic pain and bipolar disorder and providers (n = 15) working within a mid-Atlantic VA health care system. Data were collected from August 2017-June 2018. Veteran interviews focused on their chronic pain experiences and treatment, including barriers that arose when trying to access pain management services. Provider interviews focused on whether they address chronic pain with veteran patients and, if so, what considerations arise when addressing pain in veterans with bipolar disorder and other serious mental illnesses. Veterans were at least 18 years old, had a confirmed bipolar disorder and chronic pain diagnosis, and engaged in outpatient care within the VA health care system. Clinicians provided direct care services to veterans within the same VA. Interviews lasted approximately 60 min and were transcribed and analyzed using a rapid analysis protocol. Four major themes emerged from veteran and provider interviews: siloed care (unintegrated and uncoordinated mental and physical health care), mental health primacy (prioritization of mental health symptoms at expense of physical health symptoms), lagging expectations (unfamiliarity with comprehensive evidence-based pain management options), and provider-patient communication concerns (inefficient communication about pain concerns and treatment options). Veterans with co-occurring pain and bipolar disorder face unique barriers that compromise equitable access to evidence-based pain treatment. Our findings suggest that educating providers about bipolar disorder and other serious mental illnesses and the benefit of effective non-pharmacological pain interventions for this group may improve care coordination and care quality and reduce access disparities.

REIMAGINING AGING WITH DISABILITY THROUGH TECHNOLOGY

Abstract Individuals aging with long-term disabilities are likely to require support for managing challenges with everyday activities. To effectively promote independence and aging-in-place for this population, we must consider innovative technology solutions that go beyond traditional direct care services. This symposium will highlight technology research and development efforts from the Rehabilitation Engineering Research Center on Technologies to Support Aging-in-Place for People with Long-Term Disabilities (RERC TechSAge). TechSAge is an interdisciplinary collaboration between Georgia Tech, the University of Illinois Urbana-Champaign, and Georgia State University, dedicated to understanding the needs of, and developing supportive technologies for people aging with long-term vision, hearing, and mobility disabilities. First, Remillard et al., will present interview findings from individuals aging with long-term vision loss on challenges performing instrumental activities of daily living. Next, Mitzner et al., will describe TechSAge research-driven guidelines for designing and delivering wellness classes via video-conferencing to older adults with and without disabilities. Blocker et al., will highlight a field trial evaluating how digital home assistants (e.g., Amazon Echo devices) and smart home devices, along with user-friendly support guides, can support older adults with mobility disabilities at home. Finally, Jones et al., will describe the latest feature of the SmartBathroom laboratory – a SmartBathing Transfer Testbed prototype that will enable us to study of how different bathing environment configurations can impact transfer performance. Margaret Campbell (Retired Senior Scientist for Planning and Policy Support, National Institute on Disability, Independent Living, and Rehabilitation Research) will serve as the discussant for the symposium.

Здоровьеориентированное городское и поселенческое планирование в восприятии студентов вузов и учащихся техникумов Ярославской области

The article analyzes students’ perception of health-oriented urban and settlement planning depending on the type of family (status, level of education, material well-being of parents, residential area) and their attitude to a healthy lifestyle. In 2021, the author conducted a survey of university students and students of colleges (technical schools) of the Yaroslavl region. Sample population, n = 2400. In addition, a series of in-depth interviews were conducted with university students and students of technical schools (colleges) from Yaroslavl, single-industry towns, small, medium, large, large rural settlements, sample, n =48. As part of the study, it was studied how satisfied students are with the quantity and quality of institutions and elements of urban infrastructure in their place of residence (city, settlement, micro district). The influence of a healthy-oriented space on the degree of perception by students and trainees of their well-being (health) is analyzed. Participation in physical activity depends on gender, regardless of the place of residence (city, settlement, micro district). Girls are more involved in sports than boys. This is due to the fact that girls have self-preservation behavior to a greater extent than boys. It has been established that the more physically active students are, the less they apply for direct health care services during the year. An insignificant part of university students and students of technical schools (colleges) has a low health culture. It was revealed that the more developed, varied and multifaceted the sports (wellness) infrastructure of the micro district in which the respondent lives, the higher his satisfaction with his well-being (health). The more developed the residential area of the respondent, the more satisfied he is with the conditions for physical culture and sports. Girls, to a greater extent than boys, are dissatisfied with the conditions for physical culture and sports at their place of residence. In addition, it has been established that the smaller the city (settlement, etc.), the lower the satisfaction with the quantity and quality of institutions and elements of the urban environment. For the most part, girls, regardless of the micro district of residence, age, educational institution (university, college), are less satisfied than boys with the number and quality of institutions and elements of the urban environment. It was revealed that the larger the city, the more places with contaminated soil, the greater the building density. The smaller locality (village, city), the better the air exchange in the residential area (good ventilation), the lower the noise level, gas pollution, the better the solar illumination of the rooms. The measures aimed at improving health-oriented urban and settlement planning are proposed.

Characteristics of a Pediatric Emergency Psychiatric Telephone Triage Service.

Caregivers of youth in psychiatric crisis often seek treatment from hospital emergency departments (EDs) as their first point of entry into the mental health system. Emergency departments have struggled over the last decade with growing numbers and now, because of the pandemic, have experienced a deluge of mental health crises. As one approach to divert unnecessary ED admissions, pediatric emergency psychiatric telephone triage services have been created. This study aimed to define the characteristics and utilization of a pediatric triage service and to examine clinician documentation of calls to identify the assessment of risk and disposition. This study included 517 youth (2-18 years; mean, 12.42 years; SD, 3.40 years) who received triage services in the winter of 2 consecutive years. Triage calls were received from caregivers (>75%), schools (17.0%), and providers (6.6%) regarding concerns, including suicidal ideation (28.6%), school issues (28.6%), and physical aggression (23.4%). Dispositions were for acute, same-day evaluation (9.7%), direct care service (28.8%), further evaluation (within 48-72 hours, 40.0%), and resource/service update information (21.5%). Findings revealed that most clinical concerns were referred for further evaluation. Both adolescent females and males were referred for emergency evaluations at high rates. A dearth of information on pediatric crisis telephone triage services exists; thus, developing an evidence base is an important area for future work. This information assists not only in our understanding of which, why, and how many youths are diverted from the ED but allows us to extrapolate significant costs that have been saved because of the utilization of the triage service.

How States Supported Older Adults and Persons With Disabilities During COVID-19 Through the Medicaid Program

COVID-19 has presented challenges for older adults who receive Medicaid home and community-based services. The federal government has allowed states to seek approval for certain flexibilities to better serve this population, including increasing provider payment rates, allowing family members to be caregivers, and permitting case management entities to provide direct services. This study uses cross-sectional data to identify factors associated with states’ adopting these Medicaid flexibilities using multivariate methods. The results indicate that the factors associated with state adoption varied depending on the flexibility. The findings suggest that states increased provider payment rates in response to prevalence of COVID-19 within their state. As cases increase, states may come under pressure to increase provider rates further which may not be feasible because of budget constraints. The results also suggest that demand for and supply of services may be a factor in whether states allowed family members to be paid caregivers. States with a higher proportion of individuals aged 85 years and older were more likely to permit caregivers to be paid which may suggest that these states may not have enough providers to care for the population. Lastly, the results suggest that provider supply was associated with whether a state allowed case management entities to provide direct care services. States with fewer home health agencies were more likely to allow this flexibility. Based on these results, states may be pursuing available Medicaid flexibilities to address provider and workforce shortages which existed prior to COVID-19 but have been exacerbated by the pandemic.

LTSS Direct Care Worker Employment During COVID-19

The crisis of COVID-19 in long-term care services and supports (LTSS) has brought attention to challenges in staffing long-term care organizations, as shortages of direct care workers led to a dramatic inability to provide needed care for many residents in nursing homes and other residential care settings. In this study, we examine unemployment among LTSS direct care workers during the crisis and recovery. This study uses monthly data from January 2019 to December 2020 from the Current Population Survey, a monthly household survey collected by the Bureau of Labor Statistics, and we compare an individual’s 2019 monthly employment patterns to their 2020 monthly employment. Long-term care workers had an unemployment rate of 2.8% in April 2020, when unemployment rates in the US reached a peak; however, new unemployment among long-term care workers has not declined as consistently as in other settings. Female health care workers were significantly more likely to be unemployed compared to their male counterparts, a trend that is consistent with the overall economy, and workers who earned the lowest wages were more likely to have transitioned to unemployment. COVID-19 has added significant complexity to the provision of direct care services, making LTSS a hazardous place to work. Concerns remain about unemployment in long-term care where demand for workers remains high; additional measures need to be taken to ensure that direct care workers have the resources they need to remain employed.

The informal culture of a direct care staff team supporting people with intellectual disabilities who present with behaviours that challenge

PurposeResearch into culture within intellectual disability services, has predominantly focussed on small group homes in Australia. The current investigation aimed to explore the transferability of the dimensions of culture identified in the literature, to a residential Intellectual Disability service in the UK. The purpose of this study was to better understand the impact of informal culture upon the behaviour of direct care staff, particularly around managing behaviour that challenges.Design/methodology/approachSemi-structured interviews were conducted with direct care staff. Interview transcripts were analysed thematically using template analysis.FindingsThemes regarding leadership, perceptions of managers, team functioning, and relationships between direct care staff and service users, were identified, corroborating the existing literature. Additional themes relating to being aware of the risks posed by service users, and the emotional impact of behaviour that challenges, also emerged.Originality/valueTo the best of the authors’ knowledge, this is the first qualitative study to explore informal culture within a community residential Intellectual Disability service in the UK.

Results of the Missouri Quality Initiative in Sustaining Changes in Nursing Home Care: Six-Year Trends of Reducing Hospitalizations of Nursing Home Residents.

The purpose of this article is to present six-year findings of the Missouri Quality Initiative (MOQI) to reduce unnecessary hospitalizations for long-stay nursing home residents. A CMS funded demonstration project analyzed over 6-years using a single group design. The setting was 16 Midwestern US nursing homes ranging in size between 121 and 321 beds located in urban and rural areas in one geographic region. The sample of eligible residents averaged from 1819 in 2014 to 1068 in 2019. Resident data were analyzed using descriptive methods of aggregate facilities' hospital transfer rates per 1000 resident days and changes per year of average hospital transfer rates. Individual facility transfer rates were grouped by level of performance (best, mixed, and low). Leadership turnover and engagement were also described. Full-time advanced practice registered nurses (APRN) and an operations support team focused on reducing unnecessary hospitalizations for long-stay nursing home residents. Total transfers for 2014-2019 was 6913 and the average transfer rate per 1000 resident days declined from 2.48 in 2014 to a low of 1.89 in 2018 and slightly increased to 1.99 in 2019. Eleven nursing homes achieved sustained improvement, five did not. Differences in leadership turnover and engagement were noted by level of performance; however, three outlier facilities were identified. The MOQI intervention achieved improved outcomes over six-years in the majority of nursing homes in the project. The embedded APRN's daily focus on project goals supported by a multi-disciplinary operations team facilitated success. Facility leadership stability and engagement in the project likely contributed to outcomes. Full-time presence of APRNs coupled with an operations' support team improved nursing homes outcomes, however Medicare currently restricts APRNs hired by nursing homes from billing Medicare for direct care services. This unnecessary restriction of practice discourages nursing homes from hiring APRNs and should be abolished.

Factors Affecting the Competence of Nursing Assistants in Taiwan Long-Term Care Institutions

With the increasing number of people with disabilities caused by an aging global population, the need for long-term care is gradually increasing. Nursing assistants (NAs) are the primary providers of direct care services to older adults with disabilities, whose knowledge, skills, and beliefs affect the quality of care provided. This study aimed to investigate the influential factors affecting NAs’ current competences. A total of 255 NAs’ valid questionnaires were collected from 20 long-term care institutions in Taiwan through convenience sampling. The questionnaire comprised dimensions of demographics and care competence. The study results indicated that NAs had the greatest care competence in the domain of recognition of patient rights (4.64 ± 0.54 points). The multiple regression indicated that age, religion, job category, disability care experience, the receiving of performance bonuses, and the receiving of year-end bonuses significantly affected the level of care competence (p < 0.05). With the aforementioned findings, the results of this study serve as references for the government in employing long-term care NAs and developing management policies. Training programs for NAs should be developed to improve the quality of care provided to older adults with disabilities.

Role of Religious Practices in the Spread and Mitigation of COVID-19

AbstractThe World Health Organization (WHO) declared novel coronavirus disease 2019 (COVID-19) as a global pandemic on March 11, 2020 which engulfed the world like wild fire in less than 2 months. It has played havoc with the lives of people restricting their movement, confining them to their homes for months, devastating the economy, and causing psychological issues in some of them. In the unprecedented threat of the COVID-19 pandemic and its devastating impact on communities and nations across the globe, religious leaders and faith-based organizations may play a crucial role in saving lives and mitigating the spread of the disease. Religious leaders and faith-based organizations are primary source of support, comfort, guidance, direct health care and social service, for the communities they serve and people who have staunch belief in them. Most of the religious-minded people visit their places of worship frequently and often join the congregations on special occasions, making them vulnerable to any infectious disease prevailing at that time. Ensuring awareness and dispelling pseudoscientific practices is a necessity for such communities in India to contain and control the coronavirus infection, as it presents unique threat owing to the geographical vastness and the complexity of its cultural and religious diversity, beliefs, and practices coexisting with poor social indicators in this country. A study was conducted to understand the role of religious practices in the spread and mitigation of COVID-19.

Analysis of Services Performed by Recreational Therapists

The purpose of this study was to determine services performed by recreation therapists. This study surveyed currently practicing CTRSs to determine the workload and elements of service provision. A total of 1178 CTRSs responded to the survey (23.6%). A total of 18,539 hours of direct therapy interventions were provided by 812 fulltime therapists in a week; or an average of 23 hours of direct care services per therapist. CTRSs had, on average, 108 client therapy contacts per week per therapist. The number of treatment groups offered, one-on-one interventions, and other weekly tasks were also explored. Types of services provided were significantly different by population served. The discipline should explore the creation of a data center to gather critical data to understand and determine the nature of services provided by CTRSs. It is a critical step for the discipline to grow, defend, and/ or maintain important RT services. Subscribe to TRJ

Virtual academic detailing (e-Detailing): A vital tool during the COVID-19 pandemic

As the coronavirus disease (COVID-19) pandemic continues its course in 2020, telehealth technology provides opportunities to connect patients and providers. Health policies have been amended to allow easy access to virtual health care, highlighting the field’s dynamic ability to adapt to a public health crisis. Academic detailing, a peer-to-peer collaborative outreach designed to improve clinical decision-making, has traditionally relied on in-person encounters for effectiveness. A growth in the adoption of telehealth technology translates to increases in academic detailing reach for providers unable to meet with academic detailers in person. The U.S. Department of Veterans Affairs (VA) has used academic detailing to promote and reinforce evidence-based practices and has encouraged more virtual academic detailing (e-Detailing). Moreover, VA academic detailers are primarily clinical pharmacy specialists who provide clinical services and education and have made meaningful contributions to improving health care at VA. Amid the COVID-19 pandemic and physical isolation orders, VA academic detailers have continued to meet with providers to disseminate critical health care information in a timely fashion by using video-based telehealth. When working through the adoption of virtual technology for the delivery of medical care, providers may need time and nontraditional delivery of “evidence” before eliciting signals for change. Academic detailers are well suited for this role and can develop plans to help address provider discomfort surrounding the use of telehealth technology. By using e-Detailing as a method for both familiarizing and normalizing health professionals with video-based telehealth technology, pharmacists are uniquely poised to deliver consultation and direct-care services. Moreover, academic detailing pharmacists are ambassadors of change, serving an important role navigating the evolution of health care in response to emergent public health crises and helping define the norms of care delivery to follow.

Abstract 391: Telemetry Talk: A Quality Improvement Initiative To Decrease Inappropriate Telemetry Use

Objectives: The purpose of this study was to identify the percentage of inappropriate telemetry and reduce inappropriate use via a multidisciplinary interventional approach. Background: Nationally studies have demonstrated that up to 43% of telemetry orders are inappropriate and do not change patient outcomes or clinical decision making. Overuse may also lead to unnecessary diagnostic workup, hospital costs, clinical duties, and even hospital divert status. Methods: Using the AHA guidelines and the TUH official policy, we created an updated table of appropriate telemetry indications (Table 1). We used the Epic telemetry column to identify active orders. Then, each patient’s chart was reviewed to determine whether the order was appropriate."We reviewed all active telemetry orders on our medicine services over four days. Results: Teaching services had 72/140 (51%) inappropriate orders while direct-care services had 4/19 (21%) inappropriate orders (Table 2). "Subspecialty teaching services had 10/15 (67%) inappropriate orders. Discussion: Inappropriate telemetry use is a systems-based, multidisciplinary problem requiring interventions at multiple levels Our goal was to reduce overall inappropriate telemetry use from 49% to 35% At our center, interventions underway include: Posting the indications on workstations, Encouraging “Time out for Tele!” review on rounds, Educating hospital teams, Additional Epic modifications. Conclusions: Inappropriate telemetry use on medicine services at our institution is higher than national averages. We increased physician awareness of orders and performed education on appropriate use. We plan to re-assess telemetry use at interval periods to assess for improvement.