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.

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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).

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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%).

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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.

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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;

 

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