Related Experiment Video
Updated: Sep 9, 2025
Setup and Execution of the Rapid Cycle Deliberate Practice Death Notification Curriculum
Published on: August 5, 2020
Multidisciplinary lethal means safety counseling design and implementation: training and identifying barriers in a
Cassandra L Stegall1,2, Brendon Carnell3, Jamie M Golden4
1Department of Pediatric Emergency Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA. clstegall92@gmail.com.
Insights
Implementing lethal means safety counseling (LMSC) in pediatric trauma settings improved discussions on safe medicine storage. Further improvements are needed for firearm safety counseling to enhance suicide prevention strategies.
Area of Science:
- Pediatric injury prevention
- Public health interventions
- Suicide prevention strategies
Background:
- Access to lethal means is a significant factor in suicide completion.
- Lethal Means Safety Counseling (LMSC) is an injury prevention strategy.
- LMSC has not been previously evaluated in pediatric trauma settings.
Purpose of the Study:
- To design and implement a standardized LMSC protocol for pediatric patient discharge education.
- To evaluate LMSC in emergency, trauma, and inpatient psychiatry settings.
- To improve patient safety through injury prevention education.
Main Methods:
- A single-center quality improvement study conducted from July 2023 to February 2024.
- Implementation of an electronic medical record (EMR)-based LMSC protocol, including screening questions and provider training (CALM module, educational video).
- Distribution of free cable gun locks and medicine lock boxes to families; pre- and post-training surveys for healthcare providers.
Main Results:
- Increased caregiver discussions regarding safe medicine storage (p=0.029).
- No significant differences in discussions about safe firearm or knife storage.
- Increased clinical frequency of cable gun lock distribution observed.
Conclusions:
- A standardized LMSC protocol was successfully implemented across three pediatric hospital departments.
- Self-reported provider improvements in LMSC were noted.
- Identified barriers present opportunities for enhancing future preventative patient care.
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.
Related Concept Videos
01:30Specialized Care Centers and Settings-I
Daycare centers
They provide several functions. Some facilities care for healthy newborns and children whose parents work, while others are medically focused and care for...
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
01:30Ethical Dilemmas II
01:18Interdisciplinary Care: The Health Care Team-II
Physical Therapist
A physical therapist (PT) aims to restore function or prevent additional impairment in a patient following an injury or disease. Massage, heat, cold, water, sonar waves, exercises, and electrical stimulation are some treatments used by PTs to treat...
01:21Interdisciplinary Care: The Health Care Team-I
Physicians
The physician's primary responsibility is to diagnose illness and direct the medical or surgical treatment of the condition. The authority to admit patients to a healthcare agency or institution and practice care within that setting is granted to physicians by the healthcare agency or institution...