Self-Reported Usage of Safety Equipment Provided Through a Community Partnership Approach to Injury Prevention in the Pediatric Emergency Department.

OBJECTIVES: Previous studies have shown that educational programs in conjunction with provision of free or low-cost safety equipment increases the likelihood of parents changing behaviors at home. This project surveyed caregivers in the pediatric emergency department (ED) about safety behaviors before and after provision of education and safety equipment related to medication storage, firearm storage, and drowning. METHODS: A convenience sample of families presenting to the ED for any complaint with a child of any age were approached for participation in this feasibility study. Exclusion criteria included patients presenting for a high acuity problem (Emergency Severity Index 1 or 2) and non-English-speaking caregivers. Enrollment, surveys, and educational intervention were performed by the graduate student investigator from the School of Public Health. Participants were surveyed regarding presence of firearms and medications within the home and their storage practices. Additional questions included relationship to the patient, number and age of children younger than 18 years in the home, and zip code of residence. Educational handouts were reviewed, and participants were provided with a medication lock box, trigger lock, toilet lock, and/or pool watcher tag as indicated by answers given to the survey questions. Process measures were collected for number of products given out, number of children potentially affected by the intervention, and time spent by the investigator. Follow-up calls assessed use of the products provided. RESULTS: The student investigator spent a total of 180 hours and enrolled 357 caregivers accounting for 843 children. Fifty-seven percent of the participants answered the follow-up phone call. Only 9% initially reported that they stored medications in a locked or latched place. Medication lock boxes were given to 316 participants. On follow-up, 88% of those who received a lock box reported using it to store medications and 86% reported satisfaction with the lock box and how it worked. Of the 161 participants who admitted to gun ownership, 45% reported storing their guns locked and unloaded. Of those who reported unsafe manners of gun storage, 96% also reported unsafe manners of medication storage. Although only 161 participants endorsed gun ownership, 236 participants took a gun lock when offered. At follow-up, 66% of participants had used the gun lock and 67% of participants who took the gun lock reported satisfaction with the device. For water safety, 195 toilet latches and 275 drowning prevention lanyards were provided. On follow-up, 48% of those who had received a toilet latch were using it and 62% reported satisfaction with the device. Data were not collected on use of or satisfaction with the drowning prevention lanyards. CONCLUSIONS: Families often report unsafe home storage of medications and firearms, which together account for a large amount of morbidity and mortality in pediatrics. Drowning risk for young children is ubiquitous in the home setting, and low rates of use of home safety devices indicates need for further education and outreach on making the home environment safe. Despite relying on self-reported behaviors and the risk of reporting bias skewing the data, the behaviors reported in the preintervention survey were still very unsafe, suggesting that children may have a much higher risk of injury in the actual home environments. The ED is traditionally thought of as a place to receive care when injuries happen, but any encounter with families should be seen as an opportunity for injury prevention messaging. Partnering with a local school of public health and other community resources can result in the establishment of a low-cost, consistent, and effective injury prevention program in the pediatric ED that reaches a large number of individuals without the added burden of additional tasks that take time away from already busy ED providers and staff.

Developing a virtual assessment protocol for the AMPLIFI Randomized Controlled Trial due to COVID-19: From assessing participants' preference to preparing the team.

Background During the COVID-19 pandemic, in-person research assessments needed to be adapted to ensure safety of participants and staff. Participants' willingness to participate in research activities, how to prepare assessors to ensure data integrity, and the feasibility of modified protocols, were unknown. Within the AMPLIFI randomized clinical trial (RCT) for cancer survivors, we elicited participants' preferences and willingness to participate in Clinic, Home, or Virtual assessments, prepared assessors for, and implemented virtual assessments. Methods 1) We conducted phone surveys of potential AMPLIFI participants; 2) Based on survey results, we modified assessments from in-person to virtual visits (VV) by videoconference. Assessors were trained and certified, i.e., assessors recorded 3 assessments that were reviewed and scored by 2 investigators. The modified protocol was proposed to 62 participants: we report numbers of those who agreed to attend VV. Results 1) Survey results: Among 74 survey respondents, 44.6% preferred, 75.7% were willing to attend Clinic Visits; 32.4% preferred, 83.8% were willing to do VV; 23% preferred, 77% were willing to do Home Visits. Survivors 70+ were less likely than 50-69 years old to be willing to do VV: no other differences were noted by gender, race, rural status or education. 2) Assessment uptake: 66.1% agreed to attend VV, and of them 75.6% completed them. Conclusion Diverse research participants adapted to protocols that prioritize their safety, although older participants may be reluctant to do virtual assessments. Virtual assessments are feasible and research teams can rigorously prepare to collect quality data through them.