A Site Check Prior to Regional Anaesthesia to Prevent Wrong-Sided Blocks

Abstract

This paper describes the implementation of the 'Stop Before You Block' (SB4YB) initiative in an Australian teaching hospital. This process, which began in the UK in 2010, is a pre-procedure pause to confirm the correct side of a regional anaesthetic block. A change in practice was implemented with the formal roll out of a SB4YB educational program. Use of the initiative was then audited over a subsequent three-month period. It was hoped that after implementing the initiative, at least 80% of blocks would have a site check performed. However, despite apparent support for the initiative, uptake was less than expected with only about 57% of blocks having a site check performed. A site check was less frequent if the block was done as an emergency procedure, outside of an operating theatre or by a locum or visiting anaesthetist. Our conclusion from the audit was that education is insufficient to promote a change in this practice. We propose that Stop Before You Block or a block time-out should be performed prior to all unilateral nerve blocks. Success of this initiative requires education, and both cultural and systems changes to occur. We propose that a formal block time-out should become part of the surgical safety checklist and this activity should be endorsed and promoted by anaesthetic professional bodies.

The quality and safety of locum doctors: a narrative review

“…Other papers examined locum medical practice in settings such as anaesthesia, 23 primary care 24–26 and hospital medicine, 22 and some explored doctors' attitudes to and experience of locum working. 27,28 Overall, there was some limited empirical evidence to suggest that locums may have a detrimental impact on quality and safety.…”

“…27,28 Overall, there was some limited empirical evidence to suggest that locums may have a detrimental impact on quality and safety. 22–25,27,28 This was attributed in part to locum doctors being less likely to be familiar with patients and less aware of local policies and processes, 25 which had a number of consequences, including delays in discharging patients 26 and safety procedures being less likely to be carried out. 23 There was some qualitative evidence to suggest that working with locums was viewed unfavourably by other doctors as their lack of familiarity could be burdensome for other healthcare professionals, who reported having to work outside of their scope of practice in order to compensate for locum unfamiliarity with local contexts.…”

Introduction of a Mandatory Pre-Block Safety Checklist into a Regional Anaesthesia Block Room Service: A Quality Improvement Project

“…This is the first description in the literature that we are aware of where a SB4YB strategy has been shown to be successfully implemented with a high compliance rate across an institution. A previous attempt to introduce a SB4YB policy achieved only 57% compliance despite a high level of local acceptance following a wrong-side block at that institution 6 . We believe that the reason for our success is that we did not rely solely on education and visual prompts.…”

In reply

“…Prior to our study, the highest compliance rate in the published literature that we identified was 57%. 3 Our post-intervention compliance rate of 91% is a big improvement on this, and we hope that future audits will be able to demonstrate compliance rates closer to the theoretically ideal 100%. We disagree with the suggestion that anything less than 100% is inadequate.…”