244 responses

A Questionnaire on the Prevention of Wrong-sided Nerve Blocks in the North Western DeaneryLie J

1 & Naylor K2

1 Specialty Trainee (ST6), 2 Consultant Anaesthetist

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BACKGROUND

•The number of peripheral nerve blocks being performed each year is at an all time high, leading to an increase in wrong-sided nerve blocks

•In 2009 the National Patient Safety Agency (NPSA) published data showing that wrong sided nerve block is commoner than wrong sided surgery

•In the UK 67 wrong site blocks were reported by the Safe Anaesthesia Liaison Group (SALG) & NPSA in a period of 15 months2

•In the USA the American Society of Anaesthesiologists reported an increase in wrong sided block from 2% to 16%4

•There is likely to be significant undereporting3

Complications include5:1.Increased risk of nerve damage2.Prolonged recovery3.Delay in mobilisation4.Contribution to wrong sided surgery5.Increased anaesthetic induction

time and stress

OBJECTIVES

RESULTS

30.7% of respondents had been involved in wrong-sided nerve blocks or near-misses in the past.

1. Pre-procedure Verification (on ward)Pre-anaesthetic assessment .Anaesthetic site marking

-performed by the professional responsible for the planned procedure

- involve the patient in the site marking process

-mark is made near or at the procedure site

-mark is sufficiently permanent to be visible after skin preparation and draping.

A standardised marking system should be agreed either with the use of

sticker, clinicians’ initials or coloured marker pen

Alternatively, a “Wrong Side” sticker or equivalent can be placed on the opposite site with the help of the

patient.

2. WHO sign-in (in anaesthetic room)The person performing the block

confirms:-correct patient, correct surgical site,

correct nerve block-verified with the use of the surgical

consent form-confirmation with the patient

3. Anaesthetic time-out (“Stop before you Block”)

-“time-out” just before commencement of procedure

-designated member of the team starts the time-out

-all team members present -confirm correct patient, correct site &

procedure

Repeat if the same patient is having a second nerve block at a different

place

Document the completion of time-out along with the block details ideally incorporating this into the WHO checklist.

CONCLUSIONS

REFERENCES

METHODS

Nearly 1/3 of our anaesthetists had personal experience of a wrong sided block or near miss. Survey suggests a step-wise process of verification, marking & time-out would be useful in reducing incidenceThe development of the proposed guideline will help improve patient safety in this area

1 Alert: NPSA/2009/PSA002/U1; WHO Surgical Safety Checklist – 27 January 20092 Safe Anaesthesia Liaison Group Report: wrong site blocks during surgery; November 20103 Barach P, Seiden ST & Morley J. Wrong-site anaesthesia adverse events: can they be stopped? Presented at the annual meeting of the American Society of Anaesthesiologists, October 19, 2008, Orlando, Florida, A7734 Bierstein K. Preventing wrong-site surgery. ASA Newsletter 2007; 71: 21-235 The Royal College of Anaesthestists; Bulletin 70: November 2011

PROPOSED GUIDELINE

•An email invite to complete the survey was sent to all anaesthetists of any grade in our deanery. •Their grades, their frequency in performing peripheral nerve blocks, their involvements of any wrong-sided nerve blocks or near-misses and their awareness of any guidelines at their hospitals were recorded.•Free text sections were used for their routine practices in prevention of wrong-sided nerve blocks and suggestions on further improvement.

59.8% of respondents were aware of local guideline at their hospitals, with 19.7% weren’t aware & 20.5% were unsure.What do you usually do to prevent wrong-sided nerve blocks?? (Top 6 responses)

What do you think will be useful in preventing wrong-sided nerve blocks??

Confirm with awake patient verbally (before GA) 113

46.31%

Check surgical site marking by surgeons 89

36.48%

Check consent form 7329.92

%Check again prior to block ("time-out")/Stop before you block 52

21.31%

Check with ODP/anaesthetic assistant 30

12.30%

WHO check list 2711.07

%

*Multiple comments are allowed, so percentages are out of a total of 244 respondents

EducationRegular workshopsIncreasing awarenessWarning signs5

Avoid distractionLock door

58.9% (144) of respondents were consultants, followed by 14.8% (36) ST5-7 & 11.1% (27) ST3-4.

1. To survey the anaesthetists in the North Western Deanery on their experiences of wrong-sided nerve blocks or near-misses and their suggestions on how to prevent them from happening in future.

2. To develop a universal guideline for the Deanery.