Stop Before You BlockA site check to prevent

wrong side blocks

STOP BEFORE YOU BLOCKThe principle

Anaesthetist and an assistant conduct a “stop moment” to check correct site

and side of procedure

IMMEDIATELY BEFORE NEEDLE INSERTION

when performing a peripheral nerve block.

Why the campaign?

• UK data of wrong-sided blocks despite correct surgical site marking and “surgical safety checklist” sign- in.

• Multiple inadvertent wrong site blocks in Australian and New Zealand hospitals.

• Even the most experienced anaesthetist may have a wrong side block.

Consequences of wrong-side block

• Complications from the unnecessary block eg nerve injury, pneumothorax.• Complications from performing a second block eg LA toxicity, impaired mobility/dexterity.• Inability to provide optimal analgesia.• Potential for cancellation of surgical procedure.• Trespass – procedure on unconsented body part.• Delayed hospital discharge.• Potential to proceed to wrong-side surgery.

Factors contributing to wrong-sided block

Human factors• Distraction.• Time pressure.• Ambiguous terminology

(“right”), language difficulties (patient or operator).

• Teaching, change in routine or technique or personnel.

System factors• Time delay between WHO

surgical safety checklist and performance of block.

• Change in position.• Lack of visible site mark

(drapes/blankets, dark room for US, site mark distant from block).

• Bilateral pathology.• No block time out.

Performing a “block time out”

Safe surgery/WHO checklist “sign in”• Confirm patient identity, surgical consent, surgical mark.

Mark site of block after confirming with patient

IMMEDIATELY before needle insertion, in association with anaesthetic assistant, the anaesthetist should:

• Check consent form for operative side.• Ask patient to confirm side (if not sedated).• Visualise anaesthetic mark indicating site of block.

After initial block

Pause before each needle insertion if:• Position changed.• Blocks separated in time.• New team or personnel.• Distraction.

Document performance of a “block time out”.

Beware

• Time pressure.

• Distraction – busy environment, teaching.

• Changing patient position – turning, left/right confusion.

Implementing the program

Hospital Level

• Educate and Engage – anaesthetists, anaesthesia assistants and perioperative staff.

• Advertise – display campaign poster in all areas where a nerve block is likely to be performed.

• Audit – uptake of the initiative, incidence of wrong-sided block.

National Level

• SB4UB supported by ANZCA and ASA, Regional Anaesthesia SIG.

• “Block time out” should be standard practice and recorded on a surgical safety checklist or equivalent.

• For further information see ANZCA website safety and quality resources: www.anzca.edu.au/fellows/safety‐quality/publications-and-resources.

Acknowledgements• Dr Paul Slocombe, Dr Simon Pattullo, Gold Coast Health.• Safety and Quality Committee, Australian and New Zealand College

of Anaesthetists.• Dr J French, Dr N Bedforth, Dr P Townsley, Nottingham University Hospital,

UK.

References/resources• ANZCA website: www.anzca.edu.au/fellows/safety‐quality.• ANZCA professional standard: PS03 Guidelines for the Management

of Major Regional Analgesia.• RCOA: www.rcoa.ac.uk/standards-of-clinical-practice/wrong-site-block.

Thank you for your help with this important safety initiative