Background House fires remain a significant problem in the U.S. and around the world. Despite a decades-long Home Visit (HV) program by the Baltimore City Fire Department (BCFD), including free smoke alarm installation, homes remain unprotected and fire-related injuries persist. We collaborated with BCFD to enhance their HV program and monitor its implementation.

Aims/Objectives/Purpose To describe HV program enhancements, present novel program monitoring data, and discuss implications for program implementation monitoring in injury prevention programs.

Methods Focus groups with firefighters identified needed HV program enhancements. When the enhanced HV program was in place, study observers accompanied BCFD teams and documented what transpired at each HV.

Results/Outcomes Data were collected on 2139 HV conducted between April 2010 to April 2011 after program enhancements were made. Most of the time, BCFD staff followed the new protocol of installing the alarms using screws (73%) and explaining the 10-year lithium battery feature (66%). BCFD staff rarely explained how to use the alarm (18%) or pointed out its ‘hush’ feature (19%). Other educational messages were also conveyed infrequently: carbon monoxide risks (27%), escape planning (25%) and cooking (10%) and electrical (6%) safety. Results were shared with BCFD leadership.

Significance/Contribution to the field Careful monitoring of program implementation is feasible and necessary to document compliance with protocols, to identify needed program improvements, to better understand program impacts, and to discover additional training needs.