Suicide Prevention Through Safe Storage: Evaluating the Reach and Impact of a Hospital-Based Medication and Firearm Storage Safety Program

Adrienne R. Gallardo, BSW, MAOM, CPST-I
Chelsea M Heisler, BS, CCRP
Kyle P. Johnson, MD
Christina Anderson, LCSW
Bobbie Hildreth, MN, RN, CPN
Judith A. Guzman-Cottrill, DO
Catlin Dennis, MPH

Doernbecher Children’s Hospital’s (DCH) Injury Prevention Program (IPP) provides safety resources - including medication lockboxes, firearm lockboxes, and firearm locking devices - along with targeted injury prevention education to patients presenting with acute mental health crises. This intervention is initiated either through an Emergency Department (ED) provider’s IPP consult order or during routine IPP inpatient rounds. An assessment was completed of the proportion of eligible patients who received an IPP consult and associated safety products. In addition, evaluation of the program’s impact was conducted through interviews with patients and their families.

A retrospective chart review was conducted of all patients under 18 years of age who were evaluated in the Doernbecher Children’s Hospital (DCH) Emergency Department (ED) or admitted to inpatient units for an acute mental health crisis between March 1, 2023, and September 30, 2024. The review assessed the number of patients for whom an Injury Prevention Program (IPP) consult was requested, the proportion of consults that resulted in an IPP intervention, and the number of patients who accepted or declined safety products. Qualitative feedback was obtained from families through a standardized telephone survey. Survey questions focused on the use of provided safety products in the home and families’ perceptions of the impact of the IPP consultation.

A total of 810 patients were eligible for IPP consult during the study period. Of these, 26% (210/810) had a consult order placed by the provider and the IPP responded to 206/210 (99%) of orders placed. Of the orders received, 86% (180/210) of families received at least one safety product. An additional 40 patients were identified by the IPP and received products without an order; thus, a total of 220 received products. 43% (94/220) of families were successfully reached via telephone, and of these families 62% (58/94) completed the phone survey. Most (90%, 52/58) reported that some or all safety products they received were used or remain in use, and 98% (57/58) found them to improve their child’s safety following discharge.

Our IPP consulted on 26% of eligible patients, suggesting that we can improve ED provider awareness to order IPP consults for all eligible patients, or create an automated order within ED work workflow and emphasize the importance of placing IPP orders for education and resources. Nearly all families found value in the IPP consults which were durable: the majority reported continued use of safety products at home beyond the child's acute crisis. A study limitation is possibly missing IPP interventions during chart review. Survey limitations included unanswered phone calls, outdated contact information, and parents' limited times. Future efforts will focus on continued program and product investment and growth, as our findings indicate a meaningful impact on patient safety.

1. Providing safety resources to caregivers prior to discharge can reduce barriers during an acute crisis and support the development and implementation of a safe discharge plan for pediatric patients.

2. Delivering injury prevention education and resources during a time of crisis has the potential to significantly enhance a child’s safety in the home environment.

3. Collaboration between the Injury Prevention Program and Child Psychiatry enables the delivery of comprehensive, coordinated services and resources to support pediatric patients and their families.