Improving Firearm Injury Prevention Anticipatory Guidance in the Pediatrician’s Office – A Quality Improvement Initiative

Kiesha Fraser Doh, MD
Sofia Chaudhary, MD
Claudia Fruin, MD
Shreya Gautam, BA
Fozia Eskew, BS
Bolanle Akinsola, MD

80% of unintentional pediatric firearm-related deaths in the US occur in the home often while playing with an unsecured firearm. A survey of Georgia pediatricians indicates that anticipatory guidance (AG) around prevention of firearm injury and deaths within pediatric well child care visits (WCC) is very limited. Although physician counseling can lead to safer firearm storage behaviors, only 40% of previously surveyed Georgia pediatricians feel equipped to provide this guidance. Thus, our primary objective aimed to increase the delivery and documentation of firearm safety anticipatory guidance, along with distribution of firearm storage devices, to 75% from baseline within a 6-month period for families who present for their 3-year-old WCC.

Setting: 6 primary care pediatric practices (PCPP) across rural and urban Georgia participated in this QI project between July 2023 and February 2024.

Interventions included (1) participation in monthly webinars including sessions on general guidance on how to provide firearm secure storage education, types of firearms and secure storage devices; educational sessions on QI methodologies; sessions to address concerns, and a final session to review outcomes and plan future efforts. (2) Appointing practice champions, one physician and one office staff manager to drive improvement. (3) Tracking distribution of gun locks and safes with chart audits for the first 10 days of each month for 6 months. (4) Group practice review and feedback.

QI tools used included a firearm injury prevention algorithm, risk assessments, key driver diagrams, PDSA worksheets, and run charts. Key measures aimed to 1) increase firearm safe storage counseling at 3-year WCC, 2) provide secure storage devices to families with firearms, and 3) complete follow-up calls to confirm use of these devices. We used run charts to track our data.

Three practices increased their AG documentation on 3 y/o WCC from 0% to 33%-50%. Two practices were able to maintain a minimum of 10% improvement throughout the study period. All practices had challenges with distribution of secure storage devices and with follow-up phone calls on utilization of devices distributed. Both firearm secure storage device distribution and follow-up phone call were less than predicted with only 4 families receiving a device and 3 families receiving a follow up phone call at one practice. One practice screened 21% of 3-year-old WCC which was a 19% increase from their baseline

This QI initiative showed that AG on firearm safety can be increased through targeted education, practice support, and use of QI tools. Although the 75% goal was not met, important progress was made in initiating firearm safety discussions that were previously absent. Barriers such as differences in resources, staffing, and administrative support likely contributed to limited overall change. Future efforts should include ongoing training, especially in culturally sensitive counseling, structural racism, and firearm-related equity issues to enhance pediatricians’ comfort and effectiveness in discussing firearm safety.

1. Identify the prevalence and contributing factors of unintentional firearm injuries occurring in the home environment.
2. Explore strategies to establish a structured framework for implementing a firearm safety counseling and storage program within their own community or clinical setting.
3. Evaluate the challenges and benefits of integrating firearm safety screening and secure storage device distribution into pediatric practice policies