7 - Improving Firearm Screening and Safe Storage Counseling in a Primary Care Pediatric Practice

Poster Number: 7
Publication Number: 7.3155

Background: Youth access to firearms is a modifiable risk factor for firearm related injury and death that clinicians can address during outpatient visits. AAP recommends screening for firearm access and counseling on the benefits of safe storage. We conducted a quality improvement (QI) study to address this need.

Objective: Our SMART aim was to increase rates of firearm screening in children (4-18 yrs) presenting for a preventive visit by 25% over 9-mo in an academic continuity clinic. Process measures assessed provider confidence with screening/safe storage counseling and knowledge about use of firearm safety devices.

Design/Methods: For baseline data, we reviewed 20 charts per month and assessed documentation of screening for firearms in the home and counseling on safe firearm storage at preventive visits from 6/22 -12/22. A provider survey was conducted to assess provider confidence in screening and providing cable locks to patients (12/22). Plan-Do-Study-Act (PDSA) 1 (1/23) consisted of a brief presentation to all providers about best practices for screening, counseling on safe storage, and how to use a cable firearm lock. PDSA 2 (5/23) revised the preventive visit note template to prompt providers on best practices. PDSA 3 (9/23) included providing posters, handouts, and electronic resources that helped support safe firearm storage practices. A follow up provider survey was conducted (10/23). Run charts showed changes over time (Figure). Survey responses were analyzed with descriptive statistics.

Results: The baseline rate of firearm screening was 38% with a goal of 63%. After PDSA 1, screening rates were 34%. Following PDSA 2, screening rates increased to 82.5%. By the end of PDSA 3, screening rates remained high at 95%. Initial survey response rate was 58% with follow up survey response rate of 51%. T-test showed statistically significant increase in: provider confidence in screening for firearm access (p=0.0006), discussing locks with patients (p=0.0327), and explaining how to use a lock (p=0.0096).

Conclusion(s): A QI intervention increased screening for firearms at home, counseling on safe storage, and confidence with use of cable firearm locks during preventive visits. Revising the note template had the largest effect on increased screening rates. Survey results indicate statistically significant improvement in provider confidence discussing these topics with patients.