PEM Fellow Eastern Virginia Medical School Norfolk, Virginia, United States
Background: Lethal means counseling (LMC) is an injury prevention strategy to limit access to firearms, drugs, and other common means of suicide and injury.1 Firearm related injuries are the leading cause of death for children and adolescents.2 Providing counseling with safe storage interventions and free firearm storage devices increases safe storage practices for firearms and medicines.3-7 Institutions that develop and implement a written LMC protocol increase rates of LMC and home safe storage.3 Studies demonstrate providing scripts for conducting LMC and completing Counseling on Access to Lethal Means (CALM) training increases non—physician comfort with counseling.8,9 Objective: Design and implement a standardized LMC protocol for social work intake and discharge education in emergency, trauma, and inpatient psychiatry settings. Design/Methods: This is a single center prospective QI study at an urban tertiary academic and level one trauma center. It takes place in three departments: pediatric emergency (ED), pediatric trauma, and inpatient psychiatry to capture a diverse patient population with varying acuity. This study was reviewed by the Eastern Virginia Medical School IRB. Social workers in each department conduct intake and discharge safety planning. LMC screening questions were added to each department’s electronic medical record template forms. A training video on screening and counseling on LMC was created and dispersed to all social workers with additional instructions for the CALM module.10 Pre and post training surveys were distributed through REDCap11,12 to measure provider screening and counseling comfort, and identify barriers to project implementation. All departments were provided with patient educational materials and free cable gun locks. Patient follow-up surveys will be utilized to compare rates of safe storage practice and adherence following appropriate counseling over time between study settings.
