(1574) Provider Attitudes Surrounding Implementation of a Firearm Safety Program in the PICU

Introduction: Pediatric firearm-related deaths are the leading cause of death in children. Safe storage of firearms is a modifiable and evidence-based practice to reduce firearm injury, however it has not been applied to pediatric critical care settings. In a novel pilot project, we aimed to measure implementation outcomes and identify facilitators/barriers to a firearm safety program in the PICU. We hypothesized that PICU clinicians would find this program acceptable, and specific barriers would be identified to inform future implementation.

Methods: We surveyed interdisciplinary PICU providers in a large, 75-bed unit in a quaternary referral center between February 7-March 3, 2023. The survey used the Acceptability of Intervention and Feasibility of Intervention (AIM-IAM-FIM) framework with a 5-point Likert scale. The average percentage of agreement (a score of 4 or 5) for each domain was used to describe the program as acceptable, appropriate, or feasible. The three most frequently selected facilitators and barriers were reported.

Results: The survey was sent to four groups of PICU providers (458 total). Response rates were 68% for attending/fellow physicians, 50% for social workers, 36% for advanced practice providers/hospitalists, and 17% for nurses. 21% of providers reported that a firearm was present in their own household, with three reporting that the firearm was not safely stored. Overall, there was high acceptability (90%) and appropriateness (71.5%) with lower feasibility (63%). There was no significant different in these outcomes between firearm and non-firearm owners. Barriers identified were 1) insufficient time to provide education 2) not feeling equipped to provide education and 3) concern that families would not be accepting of program. Facilitators identified were 1) receiving training on how to educate families 2) dedicated providers to support the program and 3) dedicated staff apart from service team to provide education.

Conclusions: PICU providers, regardless of gun ownership, reported high acceptability, appropriateness and feasibility of a firearm safety education and gun lock distribution program in the PICU. This contextual inquiry is crucial to inform future implementation of firearm safety programs in higher acuity settings.