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

Abstract

Wrong-side block is an uncommon yet potentially preventable complication of regional anaesthesia. One strategy for reducing the incidence of wrong-side block is to introduce an additional check into the pre-block workflow in the form of a block 'time out' or 'stop before you block'. In the aftermath of a wrong-side block incident at our institution, the mandatory use of a preblock safety checklist was successfully introduced into the workflow of the block room. Compliance with the checklist rose from 31% in the six-month pre-intervention phase to over 90% in the six-month post-intervention phase. This was achieved without any negative effect on block efficacy, theatre efficiency, complication rates or patient satisfaction. The high rate of checklist utilisation was associated with an increased rate of ultrasound video documentation. This suggests that there may be collateral benefit to using a pre-block safety checklist in addition to merely reducing the risk of wrong-side block.

Insurance Claims for Wrong-Side, Wrong-Organ, Wrong-Procedure, or Wrong-Person Surgical Errors: A Retrospective Study for 10 Years

“…Wrong-side errors in LRA seemed to be rare in our series, but they are probably underreported. They do not systematically lead to a surgical error, 15,16 and they could be reduced by the introduction of a checklist carried out before the LRA ("stop before you block" 17 ), by warnings (posters, stickers), by physical barriers (reminder on the ultrasound apparatus), or by behaviors (simulation, "mock before you block") 18 actively involving the patient. In our series, 80% of the side error due to LRA led to a surgical error.…”

Are checklists a valuable tool to prevent wrong-side blocks?

“…We read with interest the audit published by McLellan et al 1 assessing the introduction of a mandatory preblock safety checklist. Wrong-side blocks are uncommon, may cause morbidity and should be regarded as 'never' events 2 .…”

In reply

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We thank Dr Glick and Dr Machlin for their thoughtful comments about our audit. 1 The aim of the Stop Before You Block (SB4YB) campaign is to reduce the incidence of wrong-side block. 2 For the SB4YB campaign to be considered a success, we believe two criteria must be met.

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