Stop Before You Block

Stop Before You Block
RCoA/AAGBI/NPSA 2010
Sixty-seven incidents over fifteen months
Various reasons given, including:

distraction of the anaesthetist
lack of mark specific to the block
lack of anaesthetic time-out
discrepancy between the operating list and mark or consent form
mark site covered or obscured
surgical mark distant from block site
WHO Safer Surgery
The SALG report highlighted the WHO Surgical Safety Checklist supporting documentation:

Page 4: ‘The team will operate on the correct patient at the correct site.’
Page 12: ‘Regional blocks – the overall responsibility for the site marking should remain with the operating surgeon. The anaesthetist should only proceed with a regional block when he/she has confirmed that the site for surgery has been marked.’
The SBYB Campaign
Instigate a further STOP moment before the insertion of the block needle to check:

the surgical site marking
the site and side of the block

After two years of this campaign, how are we performing?
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How are we doing?
Audit of our documentation of SBYB:

Forty orthopaedic cases from one week (excluding carpal tunnel decompressions and spinal injections)
Anaesthetic chart review to identify blocks
Was a STOP procedure documented?
Was the side of the operation documented along with the block (as a proxy for SBYB)?
Results
Recommendations
We need to improve our compliance with SBYB

Step One: Improve the audit trail
Changes to the perioperative pathway and/or anaesthetic charts to include SBYB?

Step Two: Better control for human factors
Introduce a policy of marking needle-entry points for all/sided blocks?