Presentations

Abstract

Aims and Objectives:

Implement a congruent lethal means counseling (LMC) protocol as a part of standard discharge education at Children's Hospital of the King's Daughters (CHKD).

Background:

Firearm related injuries are the leading cause of death among children and adolescents in the United States excluding prematurity and congenital abnormalities.1 The presence of a firearm in the home increases the risk of injury and death. This risk increases when safe-storage practices are not implemented.2 Safe storage practices include storing firearms and ammunition locked separately with a locking device. Despite these risks, approximately 1/3 of households have a firearm, and among these households with children, 1/5 store one or more firearms loaded and unsecured.3 LMC in conjunction with free firearm storage devices significantly improves safe storage rates.2

Methods:

This is a quality improvement project within a pediatric emergency department (PED) mental health unit evaluating current rates of LMC provided by mental health social workers (SW). Baseline data was obtained through distribution of an electronic survey through REDCap4,5 to families presenting to the PED for a mental health evaluation or positive SSQ screen. Nominal dichotomous data was recorded deidentified in Google Sheets. This study was approved by EVMS IRB.

Results:

The baseline data demonstrates that 85% (11/13) of patients are provided with at least one form of LMC. In this counseling, mental health SW specifically discussed access to firearms in 38% (5/13) of encounters, pills 46% (6/13), and knives 77% (10/13).

Project Updates:

After identifying baseline rates of LMC, PDSA 1 was implemented on August 21, 2023. A PowerChart form has been added for SW in the Children's Pavilion, the CHKD Mental Health Emergency Services in the Emergency Department, and the CHKD trauma team. These departments have also been provided patient educational materials, survey QR codes, and free cable gun locks. Through future follow up surveys, this project aims to compare rates of safe storage practice, and adherence following appropriate counseling over time, and between departments.

Conclusions:

While mental health SW often conduct lethal means assessment, there is not consistent counseling on safe storage of all of the following: firearms, pills, and knives. There is a need for standardization of LMC to help prevent access to harm within this patient population.

References:

1. Andrews AL, Killings X, Oddo ER, Gastineau KAB, Hink AB. Pediatric Firearm Injury Mortality Epidemiology. Pediatrics. 2022 Mar 1;149(3):e2021052739. doi: 10.1542/peds.2021-052739. Erratum in: Pediatrics. 2022 May 30;: Erratum in: Pediatrics. 2022 Aug 1;150(2): PMID: 35224633.
2. Rowhani-Rahbar A, Simonetti JA, Rivara FP. Effectiveness of Interventions to Promote Safe Firearm Storage. Epidemiol Rev. 2016;38(1):111-24. doi: 10.1093/epirev/mxv006. Epub 2016 Jan 13. PMID: 26769724.
3. Azrael D, Cohen J, Salhi C, Miller M. Firearm Storage in Gun-Owning Households with Children: Results of a 2015 National Survey. J Urban Health. 2018 Jun;95(3):295-304. doi: 10.1007/s11524-018-0261-7. PMID: 29748766; PMCID: PMC5993703.
4. PA Harris, R Taylor, R Thielke, J Payne, N Gonzalez, JG. Conde, Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support, J Biomed Inform. 2009 Apr;42(2):377-81. 5. PA Harris, R Taylor, BL Minor, V Elliott, M Fernandez, L O'Neal, L McLeod, G Delacqua, F Delacqua, J Kirby, SN Duda, REDCap Consortium, The REDCap consortium: Building an international community of software partners, J Biomed Inform. 2019 May 9 [doi: 10.1016/j.jbi.2019.103208]