Scribd
Upload
68 views

Stop Before You Block

The document introduces the "Stop Before You Block" campaign aimed at reducing inadvertent wrong-sided nerve blocks during regional anesthesia. It describes how wrong-sided blocks have serious consequences and were classified as "Never Events". The campaign implements an additional "stop moment" where the correct block site is confirmed immediately before needle insertion, in addition to the existing WHO checklist. This involves visualizing the surgical site marking, asking conscious patients, and double-checking consent forms for unconscious patients. The goal is for all operating room staff to be trained in and aware of the "Stop Before You Block" process.

Uploaded by

Andrew O'Donoghue
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
68 views

Stop Before You Block

The document introduces the "Stop Before You Block" campaign aimed at reducing inadvertent wrong-sided nerve blocks during regional anesthesia. It describes how wrong-sided blocks have serious consequences and were classified as "Never Events". The campaign implements an additional "stop moment" where the correct block site is confirmed immediately before needle insertion, in addition to the existing WHO checklist. This involves visualizing the surgical site marking, asking conscious patients, and double-checking consent forms for unconscious patients. The goal is for all operating room staff to be trained in and aware of the "Stop Before You Block" process.

Uploaded by

Andrew O'Donoghue
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

STOP BEFORE YOU BLOCK CAMPAIGN

We introduce a national patient safety initiative called Stop Before You Block. The campaign is aimed at
reducing the incidence of inadvertent wrong-sided nerve block during regional anaesthesia.

BACKGROUND
Inadvertent wrong-sided peripheral nerve blocks are uncommon but can have serious consequences
including complications from the unnecessary block such as nerve injury and local anaesthetic toxicity.
Hospital discharge may also be delayed due to reduced mobility or dexterity. At worst, a wrong-sided nerve
block may lead the team to continue to wrong-site surgery.

NHS England describe a ‘Never Event’ as a serious, largely preventable patient safety incident that should not
occur if the available preventative measures have been implemented.1 In 2015 wrong-sided nerve blocks
were classified by NHS England as ‘Never Events’, in recognition that they are unacceptable, and preventative
measures are required to help reduce their incidence.

In November 2010, the Safe Anaesthesia Liaison Group (SALG) published an alert highlighting details and
learning points from 67 inadvertent wrong-sided nerve blocks reported via the National Reporting and
Learning Service (NRLS) over a 15-month period.2 The recommendation from this alert was to check that the
surgical site had been marked by the surgical team before performing a peripheral nerve block, as per the
World Health Organization (WHO) checklist.3

At Nottingham University Hospitals NHS Trust, we had already conducted a local investigation in response
to 5 reported wrong-sided blocks during a 12-month period. Analysis revealed that in ALL of these cases the
surgical site had been marked appropriately and the WHO ‘sign in’ performed correctly. We identified several
important factors contributing to the performance of the wrong-sided nerve blocks that were common in
most cases. These included:

●● Distraction in the anaesthetic room


●● Time delay between the WHO sign and performance of the nerve block (e.g. a femoral block performed
after a difficult and time-consuming spinal anaesthetic)
●● Covering-up of the surgical mark with blankets in an attempt to keep the patient warm

These factors were also found to be recurring themes throughout the 67 incident reports received by the
NRLS.

We felt that the initial advice from the SALG, whilst important, needed to be bolder and therefore introduced
a local STOP BEFORE YOU BLOCK campaign. We requested that anaesthetists and operating department
personnel conduct an additional ‘stop moment’; in addition to the WHO checklist, IMMEDIATELY BEFORE
NEEDLE INSERTION when performing a peripheral nerve block. The conduct of the STOP BEFORE YOU BLOCK
process is described below.

Page 1
THE STOP BEFORE YOU BLOCK PROCESS
1 The WHO ‘sign in’ is performed as usual. The patient identity, consent form and marking of the correct
surgical site are confirmed.
2 IMMEDIATELY before needle insertion in the nerve block process the correct site is confirmed again. This
involves:
●● Visualising the surgical arrow indicating site of surgery
●● Asking the patient to confirm the side of surgery (if conscious)
●● Double checking the consent form for operative side (if patient unconscious)

The Stop Before You Block moment can be instigated by any member of the anaesthetic team (anaesthetist,
anaesthetic nurse, operating department practitioner or anaesthetic physician’s assistant). Success of the
campaign will rely upon all team members being aware of, and trained in the process.

Posters advertising the campaign accompany this alert and should be printed then displayed in all
anaesthetic rooms in your hospital where nerve blocks take place. Local additions to this project are to be
encouraged. Suggested adjuncts include block site marking by the anaesthetist at the time of the WHO
Checklist ‘Sign in’ and smaller versions of this poster attached to nerve stimulators and ultrasound machines.
Local clinical governance procedures should also be put in place to audit the uptake of the Stop Before You
Block process.

RECOMMENDATIONS SUMMARY - STOP BEFORE YOU BLOCK


1 WHO Checklist ‘Sign in’ is performed as usual to confirm patient identity and consent form with operation
and site of surgery
2 Particular vigilance should be taken where:
●● There is a delay between the ‘Sign in’ and the performance of the nerve block
●● After turning the patient, when the block site will have ‘moved’ relative to the anaesthetist
●● If there are obvious distractions in the anaesthetic room (such as excess personnel or interruptions
since ‘Sign in’)
●● Lower limb nerve blocks are performed (as the surgical site arrow may not be immediately visible)
●● Personnel performing the nerve block less regularly performing regional anaesthesia, e.g. trainees or
locums
3 ‘STOP’ moment occurs IMMEDIATELY before needle insertion in the nerve block process and the correct
site is confirmed again.
The anaesthetist and anaesthetic assistant must double check:
●● The surgical site marking
●● The side of the block

REFERENCES
1 Never Events; Framework: Update for 2010/2011. NPSA, London 2010 (www.nrls.npsa.nhs.uk/resources/?entryid45=68518).
2 Wrong Site Blocks During Surgery . SALG, London 2011 (www.rcoa.ac.uk/node/631).
3 WHO Surgical Safety Checklist. WHO, 2009 (www.nrls.npsa.nhs.uk/resources/?entryid45=59860).

Dr J French, Dr N Bedforth, Dr P Townsley (With thanks to Dr N Bhandal, Ms L Skaife, Mr Neal Hughes and the NUH Governance
Committee) Nottingham University Hospitals NHS Trust, Nottingham, UK

Page 2

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy