Screening for Firearm Safety in the Inpatient Setting

Purpose/Objectives: Firearm-related injuries are leading causes of unintentional injury and deaths in children and adolescents. However, screening for safe firearm storage is rarely done in the pediatric setting with literature showing less than 3% of inpatient pediatric admissions documented screening for firearms in the home.

In a 2012 policy statement, the American Academy of Pediatrics (AAP) urged pediatricians to ask about the availability and access of firearms. Limited chart review of 30 randomly selected patients from January 2020 – March 2020 admitted in the inpatient setting revealed no documentation (0%) regarding firearm screening, consistent with the project leader’s observation of this gap. Our quality improvement aim was to increase screening for the presence of firearms for patients admitted to the general pediatric resident teams at a free-standing children’s hospital from 0% to 50%.

Design/Methods: Utilizing the Model for Improvement, Plan Do Study Act cycles and a key driver diagram were used for this project. Key drivers included reliable documentation template and physician buy-in (Figure 1).

To identify high-risk patients, a firearm safety screening question was implemented into the social history section of the most frequently used inpatient History and Physical (H&P) template in April 2020 using information from “Store It Safe” Ohio AAP campaign. If caregivers answer yes to the question, “Are there firearms in the home?” a multi-select menu prompts the physician to ask further questions regarding storage including the options “stored in a locked location”, “stored using gun lock”, “ammunition stored separately”, or “firearms are not stored safely” and a free text option. Residents received education about the importance of screening, how to screen, and education regarding safe storage. A second step was to build an education order to link to “Store it Safe” handout by the Ohio AAP in May 2021.

Results: From April 2020 to June 2021, a total of 5196 patients were admitted to the general medical inpatient pediatric resident teams. Of the 5196 patients, 3310 (63%) patients were screened for the presence and storage of firearms in the home during their admission (Figure 2). 811 (25%) patients screened positive for the presence of firearms in the home. 28 (3%) of those patients did not report safe storage of their firearms. The screening goal was surpassed and maintained throughout the project without negative feedback and became part of the regular workflow.

Conclusion/Discussion: Implementation of a firearm safety screening into the social history section of the H&P template increased the rate of screenings from 0% to a mean of 66%. Screening for the presence of firearms in the home has the potential to drastically reduce the number of firearm-related injuries. The next steps include providing resources such as safe storage information to caregivers and gun locks.