Resident Inova Children's Hospital Fairfax, Virginia, United States
Background: Suicide is a leading cause of death among adolescents. Lethal means restriction (LMR) counseling is an effective, evidence-based healthcare intervention that prevents suicidal injury and death by helping patients and families reduce access to lethal means, including firearms and medications. Objective: We aim to increase LMR counseling for patients discharged from the pediatric emergency department (ED) and inpatient units with suicidal ideation or attempted suicide from 8% to 30% in six months. Design/Methods: Methods: We conducted a needs assessment, created LMR handouts for families and documentation templates for providers, integrated them into the electronic medical record, and educated physicians and psychiatry staff on the new process. We plan to expand training to nurses while monitoring screening for lethal means access and LMR counseling documentation over time.
Results: Of the residents, 73% (n=21) are comfortable screening for lethal means access, but only 35% (n=10) do so consistently. For LMR counseling, 37% (n=11) are comfortable, with 38% (n=11) consistently counseling. Methods of LMR most commonly discussed were storing guns in a safe or lockbox (66%, n=19), storing guns separately from ammunition (48%, n=14), and temporarily removing guns from the home (28%, n=8). Barriers to counseling included lack of comfort and experience (83%, n=24), lack of knowledge of LMR resources (83%, n=24), and a lack of time (76%, n=22). Retrospective baseline data from March to August 2023 included 86 patient encounters. 28% (n=24) of patient encounters had documentation of screening for lethal means access. 8% (n=7) of patient encounters had documentation of LMR counseling, and 19% (n=16) had the LMR resource handout provided in the AVS. Post-intervention data is being collected.
Conclusions: LMR counseling is underutilized in suicide prevention due to resident discomfort and lack of knowledge. This quality improvement study provides interventions that address these barriers and promote screening and LMR counseling for at-risk patients.
