Increasing Documentation of Firearm Safety Inquiry During Well Child Checks

Purpose/Objectives: Firearm storage is an important issue for our pediatric population because approximately 38% of households have a firearm in the U.S.A. Additionally, firearm violence or accidents account for one of the top three causes of death and or injuries in children less than 18 years old. Furthermore, households with firearms with children between the ages of 0-12 report 29% unlocked firearms. By implementing additional educational materials and asking parents/caregivers about firearm access, we would be following the AAP policy statement advising that pediatricians should ask about firearms at regular well child checks. Our objective was to increase the rate of documentation regarding inquiry about firearms in the home during well child checks by 20% over the course of all PDSA cycles.

Design/Methods: PDSA Cycle 1 involved educating the medical assistants on the topic and they were instructed to ask every patient’s caregiver about firearm safety in the home and document the answers. PDSA Cycle 2 involved educating residents and attendings in a lecture and subsequent email. PDSA Cycle 3 included placing handouts and posters about gun safety from the Be SMART campaign around the clinic. Before the first cycle we reviewed all patient well child checks over a two-week period. After each PDSA cycle we reviewed all well child checks over each subsequent two-week period.

Results: A total of 658 patient visit encounters were reviewed and included. Each two-week cycle contained between 152 to 181 patient encounters. Before the first PDSA cycle, there was a 33% documentation rate of firearm safety inquiry. After the first PDSA cycle, the rate increased to 74%, then increased to 93%, after the second cycle. The documentation inquiry rate remained at 93% after the final PDSA cycle.

Conclusion/Discussion: Implementing education for medical assistants, residents and attending physicians regarding the importance of firearm screening during well child checks demonstrated a 2.8x increase from baseline inquiry documentation rates. While not a focus of the original research question, we also implemented education regarding firearm safety for the medical assistants, residents and attendings to provide to caregivers in possession of a firearm. Ensuring appropriate education and documentation of firearms in children’s homes at well child checks is vital to decreasing the rates of firearm injuries and deaths in children.