Evidence-Based Safe Firearm Storage Counseling in the Pediatric Intensive Care Unit

Firearm-related injury is the leading cause of death in children in the United States. Safe storage counseling with gun lock distribution is an evidence-based practice to reduce firearm injury; however, it is infrequently employed in the pediatric intensive care unit (PICU), creating a missed opportunity for injury prevention. We assessed caregiver perceptions after implementing safe storage counseling in our PICU, hypothesizing that caregivers would find this practice acceptable and increase intent to safely secure firearms.

With multidisciplinary PICU clinicians and family advisory board input, we created a workflow for universal safe storage counseling and lock distribution. We identified patients with planned discharge or transfer daily and approached those with a caregiver at bedside to provide safe storage counseling, a free cable gun lock, and a postcounseling survey.

350 (86%) of 407 caregivers, predominantly mothers, completed the postcounseling survey. This was the first time receiving counseling from a health care clinician for 87% of caregivers; 97% found the PICU an acceptable location. The majority (78%) reported an increased likelihood of asking about safe storage of firearms in other homes where their children spend time, 87% reported they intended to share information received. 30% planned to use the lock provided, and 56% would give the lock to someone else. Others planned to remove a firearm (3%) and/or change their firearm storage practices (17%).

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