Trial of a Nurse-Led Firearm Safety Intervention in the Pediatric Inpatient Setting

The proposed study aims to reduce firearm-related deaths in children by scaling out an evidence-based secure firearm storage program. S.A.F.E. Firearm is an evidence-based program that includes (1) brief, parent-directed discussion on secure firearm storage using a harm reduction approach and (2) free cable locks offers to all parents during well child visits in pediatric primary care. Importantly, S.A.F.E. Firearm has potential to save lives beyond primary care, and pediatric inpatient settings are an advantageous context for S.A.F.E. Firearm implementation. Across the U.S. there are over 250 children's hospitals, approximately two million children are hospitalized yearly, and parental engagement is a core feature of care. Children's Hospital of Philadelphia (CHOP) is a large, nonprofit pediatric health care system with two freestanding children's hospitals in the greater Philadelphia region. As part of Aim 1 of this project, the research team is adapting S.A.F.E. Firearm for the pediatric inpatient setting and nurse-led delivery, plus developing a bundle of implementation strategies. The research team anticipates including an electronic health record-based reminder, education, and champions as part of the bundle.

In the present study, the research team will conduct a pragmatic parallel cluster randomized hybrid type II effectiveness-implementation trial across two CHOP hospitals. Inpatient nursing unit clusters will be randomized to receive adapted S.A.F.E. Firearm or usual care, defined as routine clinical care plus free cable locks available in the hospital safety center. Implementation outcomes will be examined through mixed methods.

Aims for the study include:

Aim 2. Conduct a pragmatic parallel cluster randomized hybrid type II effectiveness-implementation trial with inpatient nursing units at CHOP to test whether parents exposed to adapted S.A.F.E. Firearm report greater improvements in secure storage (primary outcome) compared to parents exposed to usual care over one year of active implementation. Secondary outcomes are additional firearm safety behaviors (e.g., firearm removal).

Aim 3. Examine the effect of the implementation strategy bundle on S.A.F.E. Firearm implementation outcomes. The research team will evaluate the proximal impacts of the implementation strategy bundle. The primary implementation outcome is reach (i.e., electronic health record-documented program delivery). Secondary outcomes include fidelity, acceptability, and maintenance. The research team will also explore implementation strategy processes and mechanisms via qualitative interviews with nurses.

• Behavioral intention to increase secure firearm storage [Срок оценки: 24-72 hour post-discharge]
• Behavioral intention to ask about firearms where child stays/visits [Срок оценки: 24-72 hour post-discharge]
• Permanent or temporary removal of firearms [Срок оценки: 2-4 week post-discharge]
• Use of cable locks [Срок оценки: 2-4 week post-discharge]
• Purchase of additional safety devices [Срок оценки: 2-4 week post-discharge]
• Load status [Срок оценки: 2-4 week post-discharge]
• Lock and load status combined [Срок оценки: 2-4 week post-discharge]
• Ammunition status [Срок оценки: 2-4 week post-discharge]
• Inquiry about firearms where child stays/visits [Срок оценки: 2-4 week post-discharge]
• Secure storage (3 months) [Срок оценки: 3 month post-discharge]
• Permanent or temporary removal of firearms (3 months) [Срок оценки: 3 month post-discharge]
• Use of cable locks (3 months) [Срок оценки: 3 month post-discharge]