Wrong sided nerve block Flashcards
(7 cards)
What are the implications for the patient of a wrong-sided peripheral nerve block?
The potential adverse effects of an unnecessary nerve block, such as bleeding, infection, nerve or visceral damage
That bilateral blocks may be contraindicated (e.g. interscalene blocks), meaning that surgery may have to be cancelled or undertaken with suboptimal analgesia, also the consequent side effects of any alternative analgesia used
The safe dose of local anaesthetic might be exceeded by performing a subsequent correct-sided block
Could result in further error, i.e. wrong-sided surgery.
Could lead to delayed discharge due to, for example, immobility if nerve blocks are subsequently undertaken on both legs
Loss of trust in healthcare professionals
Why was the “stop before you block” campaign refreshed with the “Prep, Stop Block” approach
Due to the failure of the original campaign to reduce the incidence of wrong-sided nerve blocks
Due to local flexibility in the application of the “stop before you block” advice contributing to it’s lack of success
What are the recomendations of the “Prep Stop Block” approach
Preparation:
The blocker prepares the equipment and gives it to their assistant, then positions the patient, scans, cleans the site, and dons sterile gloves.
Stop:
Just before the block the blocker announces “stop before you block” and with the assistant checks with the assistant checks the mark on the patient and the consent form, also with the patient if they are conscious and have capacity
Block:
The assistant hands the equipment to the blocker so that the block may be performed immediately after the “stop”
Restart:
The process should be restarted in the event of any delay to the block being performed OR if multiple blocks are required.
Apart from failure to engage with the “Stop before you block” / “Prep Stop Block” approaches what factors have been identified as contributing to the performance of a wrong sided block.
A prolonged ammount of time between the WHO sign in and the block being attempted
The patient being in the prone or lateral position
A busy anaesthetic room or a distracted anaesthetist
In lower limb blocks the arrow to make the operating side may not be readily visible due to being covered up to maintain the patient’s warmth and/or dignity
The anesthetist performing the block does not regularly do so
The surgical mark is absent (or obscured)
An increasing distance between the block and the surgical site
More than one block being performed
Changes to the list
Inadequate supervision
Time pressure
Poor working culture
Wrong information from the patient
Define the term “never” event
A serious incident that is wholly preventable, because of guidance or safety recommendations that have been raised, implemented, and are available at a national level by all healthcare providers, providing a strong, systemic, protective barrier
List drug related never events as listed by NHS improvement
Mis-selection of the wrong strength of strong potassium-containing solution
Wrong route administration of medication
Overdose of insulin due to abbreviations or an incorrect device
Overdose of methotrexate for non-cancer treatment
Mis-selection of high-strength midazolam during conscious sedation
Unintentional connection of a patient requiring oxygen to an air flowmeter
List the non-drug never events as listed by NHS Improvement
Wrong site / Wrong Block surgery
Wrong implant or prosthesis
Retained foreign body/object post-operation
Failure to install functional collapsible shower or curtain rails
Falls from poorly restricted windows
Chest or Neck entrapment in bedrails
Transfusion OR Transplantation of ABO-incompatible blood components or organs
Misplaced naso/orogastric tube
Scalding of patients
