392 - Firearm and Medication Access and Safe Storage Practices Among Pediatric Emergency Department Patients with a Behavioral Health Chief Complaint: Implications for Lethal Means Reduction Counseling
Saturday, April 29, 2023
3:30 PM – 6:00 PM ET
Poster Number: 392 Publication Number: 392.231
Ilana S. Lavina, Children's National Hospital, Hyattsville, MD, United States; Rachel Margolis, Children's National Health System, Washington, DC, United States; Bilal Negash, George Washington University, Washington, DC, United States; Jennifer Jiggetts, Children's National Health System, Washington, DC, United States; Shilpa J.. Patel, Children's National Health System, Washington, DC, United States
Fellow Physician, Pediatric Emergency Medicine Children's National Hospital Hyattsville, Maryland, United States
Background: Pediatric emergency department (ED) visits for suicidality have increased over the past decade.Self-poisoning with medications and self-injury with firearms are common methods by which youth attempt suicide.Lethal means reduction (LMR) counseling is an effective intervention to reduce suicide risk, but little is known about best practices for implementation in pediatric settings. Objective: To describe firearm and medication access and storage practices among patients with a behavioral health (BH) chief complaint presenting to our p</span>ediatric ED and to evaluate frequency of documented LMR counseling by ED personnel. Design/Methods: ED-based LMR (see Table 1) and suicide risk screening (using the Columbia-Suicide Severity Rating Scale) were implemented in 2020 for patients with a BH chief complaint presenting to ourpediatric ED. We conducted a retrospective cross-sectional study of patients ages 6-17 who received this screening between 8/2020-4/2022.Demographic data and screening results were obtained from an electronic medical record-based suicide risk registry. Multivariable logistic regression was performed to identify factors associated with 1) reported safe storage of medications and 2) reported access to firearms. For patients reporting firearm access, details about documentation of LMR counseling were extracted by manual chart review. Results: A total of 2789 patients were screened. Of the 94% (2630/2789) of families with medications in the home, 37% (979/2630) reported safe storage. Hispanic ethnicity andpositive suicide risk were associated with lower odds of safe medication storage.Female sex, non-Hispanic Black race/ethnicity, Hispanic ethnicity and discharge disposition were associated with lower odds of reported firearm access. Adolescent age was associated with higher odds of reported firearm access.Of the 3% (85/2789) of families who reported a firearm in the home, 85% (72/85) reported safe storage. LMR counseling by a social worker was documented for 80% (43/54)of dischargedpatients with a firearm in the home, with additional counseling documented by a physician in 7% (4/54) of cases.
Conclusion(s): Nearly two-thirds of families with medications in the home do not store them safely, suggesting an opportunity for intervention to reduce risk of self-poisoning among youth. Reported access to firearms was low, with racial/ethnic differences identified. Further investigation of these differences is warranted to ensure that LMR screening and counseling is implemented equitably. Physicians rarely documented LMR counseling, illuminating a need for increased educationaround this practice.
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