(1754) Outcomes of an Evidence-Based Firearm Safe Storage Intervention in the Pediatric Intensive Care Unit

Introduction: Firearm injury is the leading cause of death in children in the United States. Safe storage counseling and gun lock distribution are evidence-based practices in primary care to reduce firearm injury; however, the pediatric intensive care unit (PICU) is an increasingly important setting for high-risk children, where providers and families create a strong partnership and opportunity for behavior change. We assessed outcomes after implementing safe storage counseling in our PICU, hypothesizing that caregivers would find this practice acceptable and increase intent to safely secure firearms.

Methods: After completing contextual inquiry with multidisciplinary PICU providers and discussing with our family advisory board, we created a workflow for universal safe storage counseling and lock distribution. We identified patients intended to discharge or transfer daily; patients with a caregiver at bedside were approached. Caregivers received safe storage counseling and were offered a free cable gun lock. We noted the number of families eligible and approached, preferred language, and duration of counseling. Beginning in April 2024, we surveyed caregivers after receiving counseling and a gun lock.

Results: Of 344 potential patient transfers or discharges, 200 had a caregiver at bedside. Counseling and gun locks were delivered to 184 caregivers (92%). Most encounters (90%) were in English (6% Spanish, 4% Other) and the average counseling duration was 5 minutes. 91 of 164 caregivers (55%) completed the post-counseling survey. Respondents were primarily mothers (78%) and identified as White (73%), Black (11%), Asian (5%) or Other (11%). This was the first time receiving counseling from a healthcare provider for 78% of caregivers, and 98% found it acceptable to receive counseling in the PICU. The majority (73%) reported increased likelihood of asking about safe storage of firearms in other homes where their children spend time. Caregivers reported they intended to use the lock provided (46%), intended to remove a firearm (4%), and/or intended to change their firearm storage practices (4%); 53% responded that they would do none of the above.

Conclusions: We demonstrated high acceptability and potential impact of a universal approach to safe storage counseling and gun lock distribution in the PICU.