Category Archives: Safety

Stop before you block!

(Posted on behalf of Paul Slocombe)

Thank you for your time and effort completing the recent computer survey on survey monkey regarding safety checklists prior to regional anaesthesia.

The survey was sent to all Anaesthetists and trainees at Gold Coast University Hospital and Private Anaesthetists via GCape. The purpose of the survey was to gauge how common wrong sided blocks are (given they are believed to be under reported) and also to gauge opinion around the introduction of the “Stop before you block” checklist.

There were 54 responses, the majority of which were consultants (38 or 70%), with 4 fellows, 6 advanced trainees and 6 basic trainees. There was a variety of level of experience with blocks with the majority reporting they perform blocks weekly.

SBYB 01 SBYB 02

There were 7 respondents that reported they had performed a wrong sided block (13% of respondents). The wrong sided blocks were a range of different types (eye blocks, shoulder, paravertebral, femoral and ankle blocks).

SBYB 03 SBYB 04 SBYB 05

There was no real relationship with wrong-sided blocks and being awake (2), sedated (3) or asleep (2). This is similar to other surveys with a survey from the UK reporting that 40% of wrong-sided blocks were performed on patients that were awake, so having an awake patient does not prevent against wrong-sided block.

There were also 7 respondents that reported “near misses” where they had been stopped from performing a wrong-sided block, 6 by the anaesthetic nurse. The majority of anaesthetists never mark the site of their block (66%).

SBYB 06 SBYB 07

To the question of should a site check be performed the majority (94%) said yes, with 92% in favour of one just prior to needle insertion.

Of the replies, the majority (96%) preferred a quick verbal check and 64% would document it in the anaesthetic record.

SBYB 08

So in summary the survey had a good response from consultants with varying experience with blocks. 7 had performed a wrong-sided block with a further 7 near misses. The majority were in favour of performing a site check, with a quick verbal check preferred.

EDIT:

Stop Before You Block has been introduced to Gold Coast University and Robina Hospitals. Simon Pattullo has provided the following references should you wish to institute Stop Before You Block in your hospital;

 

Anaphylaxis Workshop Saturday 1st Nov 2014

Note: The November workshop is now full, however you can register your interest for workshops in 2015.

Dr Helen Crilly will be running a College recognised Anaphylaxis Workshop at John Flynn on Saturday morning 1st November 2014. Helen, the ANZAAG Coordinator, ran a workshop at the recent ASA NSC however it was quickly booked out. To satisfy demand for an encore, Helen has graciously agreed to repeat the workshop, giving local Anaesthetists the opportunity to attend at no cost.

You are able to claim this course as an “Emergency Response” activity in your college CPD. If you were on your toes and attended the CICO activity earlier this year you could attend Helen’s workshop and satisfy all your emergency response requirements for the triennium before the end of the first year, all for free!

Registration is now open at the GCAPE Anaphylaxis page.

Details
  • Venue: VMO Lounge, First Floor, John Flynn Medical Centre, John Flynn Hospital
  • Time: 830am and 1030am (time for attendance advised by Dr Crilly once booked)
  • NB: A further opportunity to do the workshop will be available in 2015 with date TBA. If you are interested in this workshop please advise by registering and indicating you would like to attend in 2015 in the comments section
  • Cost: Nil
  • Workshop description: This 90 minute interactive workshop utilises case discussion and the anaphylaxis box to develop skill with using the ANZAAG/ANZCA Anaphylaxis management guidelines in the event of anaphylaxis emergency. Although paper-based, each participant will be required to consider their own approach to all questions. There is pre-reading required which can be found on line in the management section of the ANZAAG website – www.anzaag.com/Mgmt Resources.aspx
  • Registration: You can register at the GCAPE Anaphylaxis page.

(Please note that this activity has been recognised as suitable to be claimed in the emergency responses category of the ANZCA CPD program. The course content has not been assessed and this recognition does not represent endorsement by ANZCA.)

Survey – Stop Before You Block

(Posted on behalf of Paul Slocombe)

Hello Gold Coast Anaesthetists!

My name is Paul Slocombe and I am an Anaesthetic Trainee at GCUH and I would appreciate your help in the form of a quick 5 minute survey.

The purpose of the survey is to gauge opinion amongst all anaesthetists on the Gold Coast (Public and Private) about their experiences with blocks and particularly wrong-sided blocks.

In recent times the UK has adopted a quick simple safety checklist prior to unilateral blocks titled “Stop Before You Block” aimed at preventing wrong-sided blocks. This process is to be introduced at GCUH in a little over a month, but we would greatly appreciate your opinion to guide its introduction.

The survey can be reached via this link (anaesthetists / trainees only):

https://www.surveymonkey.com/s/H5ZG9V6

I will be presenting the findings of the survey as part of an educational program during the roll out of the campaign (similar to what was undertaken in the UK). Uptake of the checklist will be audited as part of a formal project that will go toward part of my ANZCA training. I realise your time is valuable and I appreciate your input.

Thank you very much!

ANZCA Safety Alerts

ANZCA publishes safety alerts on their website at http://www.anzca.edu.au/fellows/quality-safety/safety-alerts

Starch solutions

NZ review of safety, basically existing restrictions are appropriate. More info…

Here is the Anesthesia and Analgesia article by Van der LInden evaluating its safety in surgery.

Safety of Starches pdf

Propofol contamination

Restrictions have been lifted, more info…

Theatre lighting

Working in the Dark

Due largely to the rapid growth of endoscopic surgery and the use of mobile imaging, many anaesthetists find themselves confronted with the challenge of working in a darkened or semi-darkened theatre. Most operating rooms, even those built recently with ceiling-mounted endoscopic screens were not designed to cope with this. They lack directed lighting both for the anaesthetist who may be drawing up from hard to read ampoules to the scrub nurse handling ‘sharps’.

The options could be:
• Refusing to accept low lighting with the possible risk of surgical mishaps or increased operating times.
• Retrofitting the OR with directional spot lighting.
• Using personal lighting; headlights, anyone?
• Mounting battery-powered LED lights on our trolleys.

Before the matter is brought to the attention of an OH&S body or a coronial magistrate, I feel that it is incumbent upon anaesthetists and the hospitals to develop an approach to this situation.