A New Approach to Preanesthetic Site Verification After 2 Cases of Wrong Site Peripheral Nerve Blocks

Stanton, Maureen A.; Tong-Ngork, Sarani; Liguori, Gregory A.; Edmonds, Chris

doi:10.1097/00115550-200803000-00013

Cited by 28 publications

(6 citation statements)

References 7 publications

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“…One regional block center developed a process by which a nurse provides the regional block needles only after the checklist is performed. 5 Although not a guarantee of outcome or safety, checklists have proven their worth in and outside of medicine and should be incorporated into the practice of regional anesthesia. A "pause" or "time-out" before each new block procedure starts should become an automatic and thoughtful step in every regional anesthetic.…”

Section: Discussionmentioning

confidence: 99%

A Checklist for Performing Regional Nerve Blocks

Mulroy

Weller

Liguori

2014

Regional Anesthesia and Pain Medicine

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Regional blocks are frequently invasive procedures that create the risk of infection, local anesthetic toxicity, and wrong-site performance. National guidelines have been developed by the Joint Commission and the American Society of Regional Anesthesia and Pain Medicine (ASRA) to reduce the potential for each of these risks. Checklists have been shown to reduce errors and complications in medicine: it seems prudent to incorporate the recommended safety steps into a formalized checklist to be reviewed before performance of a regional block. A task force appointed by the ASRA President reviewed available resources and recommendations and performed a survey of RAPM members at the ASRA annual meeting in May 2013 and proposed a 9-point checklist to fulfill this role. Although it is apparent that local modification will be needed, the basic points and principles should be adopted for the performance of regional blocks.

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Section: Discussionmentioning

confidence: 99%

A Checklist for Performing Regional Nerve Blocks

Mulroy

Weller

Liguori

2014

Regional Anesthesia and Pain Medicine

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“…However, in aggregate, themes were identified: in none of the 13 wrong-site block events were the preoperative site verification, surgical site mark and regional anesthesia time-out adequately completed. Factors contributing to wrong-site block include physician distraction, patient position change, scheduling changes, inadequate documentation, poor communication, lack of surgical consent, site marking not visible, inadequate supervision and no time-out being performed [1]. In a report of 26 local anesthetic injections or wrong-site blocks (not all by anesthetic specialists), the time-out processes were incomplete [2].…”

Section: Key Pointsmentioning

confidence: 99%

“…Ongoing audits are required to assess the success of a new policy. A physical 'trigger' for the time-out in the form of the block needle passed to the anesthesiologist from the circulating nurse has been recommended [1]. Anesthesiologists should be aware of scenarios where the risk of wrong-site block may be increased including poor communication or documentation, delay between the initial sign-in or preoperative verification and block performance, patient repositioning, physician distraction, lack of situational awareness, perceived time pressure and cognitive overload.…”

Section: Strategies To Prevent Wrong-site Blocksmentioning

confidence: 99%

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Wrong-site regional anesthesia

Barrington

Uda

Pattullo

et al. 2015

Current Opinion in Anaesthesiology

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Preoperative site verification and surgical site marking are mandatory. A time-out should occur immediately before any invasive procedure. Confirming the correct patient and block site with a time-out should occur immediately before all regional anesthetic procedures. If more than one block is performed on one patient, it is recommended that time-out be repeated each time the patient position is changed or separated in time or performed by a different team. The anesthetic team should uniformly implement robust guidelines and checklists to reduce the occurrence of wrong-site regional anesthetic procedures.

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“…Some institutions have incorporated the JCAHO recommendations into their own "Preanesthetic Site Verification" policy to include the procurement of written, independent site verification by the patient on the anesthesia consent form [2]. However, subsequent cases of wrong-site peripheral nerve block have occurred, prompting amendment of the original policy to include initiatives that trigger the execution of site verification immediately prior to block installation [3]. Implementation of either policy probably would not have prevented the incident described in this report.…”

mentioning

confidence: 99%