244 responses

1. A Questionnaire on the Prevention of Wrong-sided Nerve Blocks in the North Western Deanery Lie J1 & Naylor K2 1 Specialty Trainee (ST6), 2 Consultant Anaesthetist Insert your Logos/QR Code here BACKGROUND RESULTS PROPOSED GUIDELINE • 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: • Increased risk of nerve damage • Prolonged recovery • Delay in mobilisation • Contribution to wrong sided surgery • Increased anaesthetic induction time and stress 244 responses • 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. 59.8% of respondents were aware of local guideline at their hospitals, with 19.7% weren’t aware & 20.5% were unsure. 58.9% (144) of respondents were consultants, followed by 14.8% (36) ST5-7 & 11.1% (27) ST3-4. What do you usually do to prevent wrong-sided nerve blocks?? (Top 6 responses) *Multiple comments are allowed, so percentages are out of a total of 244 respondents 30.7% of respondents had been involved in wrong-sided nerve blocks or near-misses in the past. OBJECTIVES What do you think will be useful in preventing wrong-sided nerve blocks?? • 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. • To develop a universal guideline for the Deanery. METHODS • 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. CONCLUSIONS Avoid distraction Lock door Education Regular workshops • 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 incidence • The development of the proposed guideline will help improve patient safety in this area REFERENCES Increasing awareness Warning signs5 1 Alert: NPSA/2009/PSA002/U1; WHO Surgical Safety Checklist – 27 January 2009 2 Safe Anaesthesia Liaison Group Report: wrong site blocks during surgery; November 2010 3 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, A773 4 Bierstein K. Preventing wrong-site surgery. ASA Newsletter 2007; 71: 21-23 5 The Royal College of Anaesthestists; Bulletin 70: November 2011