Multidisciplinary lethal means safety counseling design and implementation: training and identifying barriers in a children's hospital.

Background: Access to lethal means contributes significantly to suicide completion. Lethal means safety counseling (LMSC) is an injury prevention strategy to limit access to firearms, medications, and other means of injury. Not previously evaluated in the trauma setting, this study aims to design and implement a standardized LMSC protocol for pediatric patient discharge education in emergency (ED), trauma, and inpatient psychiatry settings.

Methods: A single-center quality improvement study at an academic pediatric urban tertiary Level-one trauma center was performed from July 2023 to February 2024. Protocol was implemented for pediatric patients discharged from three departments: ED, surgery trauma service, and psychiatry. Interventions included electronic medical record (EMR) based LMSC screening questions, training with Counseling on Access to Lethal Means (CALM) module, a de novo educational training video, and providing families free cable gun locks and medicine lock boxes. Healthcare collaborators completed pre- and post-training surveys. Data was recorded in Redcap and analyzed as descriptive and parametric data. Primary outcome was incorporation of LMSC and intervention into social worker's workflow. Secondary outcomes included project barriers and outcomes, familial impression of counseling, and healthcare provider impression of intervention.

Results: Out of forty-eight persons, 29 providers completed the pre-training survey and 17 completed the post-training survey. Results indicated increased discussions with caregivers about safe medicine storage comparing averages of pre and post-test results (mean difference 0.44, 95% CI 0.05-0.83, p = 0.029), but no differences in discussions about safe firearm storage (mean difference 0.50, 95% CI - 0.05-1.05, p = 0.07) or knives (mean difference 0.56, 95% CI 0.05-1.18 p = 0.07). Provider behavior changes occurred with increased clinical frequency of cable gun lock distribution.

Conclusions: This study describes implementing a standardized LMSC protocol in three pediatric hospital departments with self-reported provider improvements in LMSC. Barriers identified to protocol implementation are an opportunity to improve future preventative patient care.