{"id":3356,"date":"2021-06-10T17:46:53","date_gmt":"2021-06-10T14:46:53","guid":{"rendered":"https:\/\/www.esrahellas.gr\/?page_id=3356"},"modified":"2021-07-16T15:01:58","modified_gmt":"2021-07-16T12:01:58","slug":"stop-before-you-block","status":"publish","type":"page","link":"https:\/\/www.esrahellas.gr\/en\/stop-before-you-block\/","title":{"rendered":"Stop Before you Block"},"content":{"rendered":"  <div id=\"page-header-2002699449\" class=\"page-header-wrapper\">\n  <div class=\"page-title dark featured-title\">\n\n    \n    <div class=\"page-title-inner container align-center flex-row medium-flex-wrap\" >\n              <div class=\"title-wrapper flex-col text-left medium-text-center\">\n          <h1 class=\"entry-title mb-0\">\n            Stop Before you Block          <\/h1>\n        <\/div>\n                    <div class=\"title-content flex-col flex-right text-right medium-text-center\">\n        <div class=\"title-share pt-half pb-half\"><div class=\"social-icons share-icons share-row relative icon-style-fill\" ><a href=\"https:\/\/www.facebook.com\/sharer.php?u=https:\/\/www.esrahellas.gr\/en\/stop-before-you-block\/\" data-label=\"Facebook\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip facebook\" title=\"Share on Facebook\" aria-label=\"Share on Facebook\" rel=\"noopener nofollow\"><i class=\"icon-facebook\" aria-hidden=\"true\"><\/i><\/a><a href=\"https:\/\/twitter.com\/share?url=https:\/\/www.esrahellas.gr\/en\/stop-before-you-block\/\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip twitter\" title=\"Share on Twitter\" aria-label=\"Share on Twitter\" rel=\"noopener nofollow\"><i class=\"icon-twitter\" aria-hidden=\"true\"><\/i><\/a><a href=\"mailto:?subject=Stop%20Before%20you%20Block&body=Check%20this%20out%3A%20https%3A%2F%2Fwww.esrahellas.gr%2Fen%2Fstop-before-you-block%2F\" class=\"icon primary button circle tooltip email\" title=\"Email to a Friend\" aria-label=\"Email to a Friend\" rel=\"nofollow\"><i class=\"icon-envelop\" aria-hidden=\"true\"><\/i><\/a><a href=\"https:\/\/www.linkedin.com\/shareArticle?mini=true&url=https:\/\/www.esrahellas.gr\/en\/stop-before-you-block\/&title=Stop%20Before%20you%20Block\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip linkedin\" title=\"Share on LinkedIn\" aria-label=\"Share on LinkedIn\" rel=\"noopener nofollow\"><i class=\"icon-linkedin\" aria-hidden=\"true\"><\/i><\/a><\/div><\/div>      <\/div>\n    <\/div>\n\n     \n<style>\n#page-header-2002699449 {\n  margin-bottom: 20px;\n}\n<\/style>\n  <\/div>\n    <\/div>\n  \n<div class=\"row align-middle\"  id=\"row-276804712\">\n\n\t<div id=\"col-1727962310\" class=\"col medium-4 small-12 large-4\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n\t<div class=\"img has-hover x md-x lg-x y md-y lg-y\" id=\"image_1718943792\">\n\t\t\t\t\t\t\t\t<div class=\"img-inner dark\" >\n\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"960\" height=\"988\" src=\"https:\/\/www.esrahellas.gr\/wp-content\/uploads\/2021\/06\/stop-bfore-you-block.jpg\" class=\"attachment-large size-large\" alt=\"\" \/>\t\t\t\t\t\t\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\n<style>\n#image_1718943792 {\n  width: 100%;\n}\n<\/style>\n\t<\/div>\n\t\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n\n\t<div id=\"col-1002269072\" class=\"col medium-8 small-12 large-8\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n<h3>Joint \u0391dvisory Release from Safe Anaesthesia Liaison Group &#8211; SALG &#038; Regional Anaesthesia UK &#8211; RA UK<\/h3>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n<\/div>\n<div class=\"row\"  id=\"row-130713286\">\n\n\t<div id=\"col-1204475997\" class=\"col small-12 large-12\"  >\n\t\t\t\t<div class=\"col-inner text-left\"  >\n\t\t\t\n\t\t\t\n<p><em>With many thanks to Nottingham University Hospitals NHS Trust<\/em><\/p>\n<p><strong>STOP BEFORE YOU BLOCK CAMPAIGN<\/strong><\/p>\n<p>We introduce a\u00a0<u>\u039dational Patient Safety Initiative<\/u>\u00a0called\u00a0<em><strong>Stop Before You Block<\/strong><\/em>. The campaign is aimed at reducing the incidence of inadvertent wrong &#8211; sided nerve block during regional anaesthesia.<\/p>\n<p><strong>BACKGROUND<\/strong><\/p>\n<p>Inadvertent wrong-sided peripheral nerve blocks are uncommon, but can have serious consequences, including complications from the unnecessary block, such as nerve injury and local anaesthetic toxicity. Hospital discharge may also be delayed, due to reduced mobility or dexterity. At worst, a wrong-sided nerve block may lead the team to continue to wrong-site surgery.\u00a0<\/p>\n<p>The National Patient Safety Agency (NPSA) describe a\u00a0<u>&#8220;Never Event&#8221;<\/u>\u00a0as a serious, largely preventable patient safety incident that should not occur if the available preventative measures have been implemented [1]. Whilst inadvertent wrong-sided nerve blocks are not yet classified by the NPSA as\u00a0<u>&#8220;Never Events&#8221;<\/u>, they are certainly unacceptable and preventative measures are required to help reduce their incidence.<\/p>\n\t<div class=\"img has-hover middle-img x md-x lg-x y md-y lg-y\" id=\"image_609930474\">\n\t\t\t\t\t\t\t\t<div class=\"img-inner dark\" >\n\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"292\" height=\"218\" src=\"https:\/\/www.esrahellas.gr\/wp-content\/uploads\/2021\/06\/rsz_factors1.gif\" class=\"attachment-original size-original\" alt=\"\" \/>\t\t\t\t\t\t\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\n<style>\n#image_609930474 {\n  width: 40%;\n}\n<\/style>\n\t<\/div>\n\t\n<p>In November 2010, the Safe Anaesthesia Liaison Group (SALG) published an alert highlighting details and learning points from 67 inadvertent wrong-sided nerve blocks reported via the National Reporting and Learning Service (NRLS) over a 15-month period [2]. The recommendation from this alert was to check that the surgical site had been marked by the surgical team before performing a peripheral nerve block, as per the World Health Organisation (WHO) checklist [3].<\/p>\n<p>At Nottingham University Hospitals NHS Trust a local investigation was conducted in response to 5 reported wrong-sided blocks during a 12-month period. Analysis revealed that in ALL of these cases the surgical site had been marked appropriately and the WHO check list sign had been performed correctly. Several important factors contributing to the performance of the wrong-sided nerve blocks were identified that were common in most cases. These included:<\/p>\n<ul>\n<li>Distraction in the anaesthetic room<\/li>\n<li>Time delay between the WHO sign and performance of the nerve block (e.g. a femoral block performed after a difficult and time-consuming spinal anaesthetic)<\/li>\n<li>Covering-up of the surgical mark with blankets in an attempt to keep the patient warm<\/li>\n<\/ul>\n<p><u>These factors were also found to be recurring themes throughout the 67 incident reports received by the NRLS.<\/u><\/p>\n<p>It was felt that the initial advice from the SALG, whilst important, needed to be bolder and therefore introduced\u00a0<strong>a local STOP BEFORE YOU BLOCK campaign<\/strong>.\u00a0 Anaesthetists and operating department personnel were requested to conduct an additional \u00ebstop moment\u00ed; in addition to the WHO checklist, immediately before needle insertion when performing a peripheral nerve block. The conduct of the\u00a0<strong>STOP BEFORE YOU BLOCK process<\/strong>\u00a0is described below.<\/p>\n<p><strong>The Stop Before You Block Process<\/strong><\/p>\n<p><strong>1.<\/strong>\u00a0The WHO checklist is performed as usual. The patient identity, consent form and marking of the correct surgical site are confirmed.<\/p>\n<p><strong>2.<\/strong>\u00a0IMMEDIATELY before needle insertion in the nerve block process the correct site is confirmed again. This involves:<\/p>\n<ul>\n<li>Visualising the surgical arrow indicating site of surgery<\/li>\n<li>Asking the patient to confirm the side of surgery (if conscious)<\/li>\n<li>Double checking the consent form for operative side (if patient unconscious)<\/li>\n<\/ul>\n<p>The Stop Before You Block moment can be instigated by any member of the anaesthetic team (anaesthetist, anaesthetic nurse, operating department practitioner or anaesthetic physician\u00eds assistant). Success of the campaign will rely upon all team members being aware of, and trained in the process.<\/p>\n<p>Posters advertising the campaign accompany this alert and should be printed then displayed in all anaesthetic rooms in your hospital where nerve blocks take place. Local additions to this project are to be encouraged. Suggested adjuncts include block site marking by the anaesthetist at the time of the WHO Checklist \u00ecSign in\u00ee and smaller versions of this poster attached to nerve stimulators and ultrasound machines. Local clinical governance procedures should also be put in place to audit the uptake of the Stop Before You Block process.<strong>\u00a0<\/strong><\/p>\n<p><strong>Times to be Vigilant<\/strong><\/p>\n<p>Long duration of primary anaesthetic &#8211; Prolonged time since WHO Sign in<br \/>After turning the patient &#8211; Block side moved<br \/>Busy anaesthetic room &#8211; Excess distraction<\/p>\n<p>Lower limb nerve blocks\u00f1 Surgical site arrow may not be immediately visible<\/p>\n<p><strong>The Process<\/strong><\/p>\n\t<div class=\"img has-hover middle-img x md-x lg-x y md-y lg-y\" id=\"image_1082940993\">\n\t\t\t\t\t\t\t\t<div class=\"img-inner dark\" >\n\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"214\" src=\"https:\/\/www.esrahellas.gr\/wp-content\/uploads\/2021\/06\/process.gif\" class=\"attachment-original size-original\" alt=\"\" \/>\t\t\t\t\t\t\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\n<style>\n#image_1082940993 {\n  width: 40%;\n}\n<\/style>\n\t<\/div>\n\t\n<p><strong>1.<\/strong>\u00a0WHO Checklist sign in is performed as usual to confirm patient identity and consent form with operation and site of surgery<\/p>\n<p><strong>2.<\/strong>\u00a0Particular vigilance should be taken where:<\/p>\n<ul>\n<li>There is a delay between the Sign in and the performance of the nerve block<\/li>\n<li>After turning the patient, when the block site will have moved relative to the anaesthetist<\/li>\n<li>If there are obvious distractions in the anaesthetic room (such as excess personnel interruptions since \u00ecSign in\u00ee)<\/li>\n<li>Lower limb nerve blocks are performed (as the surgical site arrow may not be immediately visible)<\/li>\n<li>Personnel performing the nerve block less regularly performing regional anaesthesia e.g. trainees or locums<\/li>\n<\/ul>\n<p><strong>3.<\/strong>\u00a0<u>STOP moment occurs IMMEDIATELY before needle insertion in the nerve block process<\/u>\u00a0and the correct site is confirmed again.<\/p>\n<p>The anaesthetist and anaesthetic assistant must double check:<\/p>\n<ul>\n<li>The surgical site marking<\/li>\n<li>The side of the block<\/li>\n<\/ul>\n<p><strong>Implementation<\/strong><\/p>\n<ul>\n<li>\n<p>Poster copies will be downloadable from\u00a0<a href=\"http:\/\/www.rcoa.ac.uk\/standards-of-clinical-practice\/wrong-site-block\" target=\"_blank\" rel=\"noopener\">RCoA<\/a>\u00a0and\u00a0<a href=\"http:\/\/www.ra-uk.org\/images\/stories\/documents\/CSQ-PS-sbyb-posterA4.pdf\" target=\"_blank\" rel=\"noopener\" target=\"_blank\">RA-UK website<\/a><\/p>\n<\/li>\n<li>\n<p>Display the campaign poster in ALL areas where a nerve block is likely to be performed<\/p>\n<\/li>\n<li>\n<p>Please ensure local governance systems are in place to introduce this advisory message and audit uptake<\/p>\n<\/li>\n<li>Engagement of ALL members of the anaesthetic team (anaesthetists, ODPs, etc) is essential for success of this safety initiative<\/li>\n<\/ul>\n<p><strong>Resources<\/strong><\/p>\n<p>You may download the following resources here:<\/p>\n<ul>\n<li><a href=\"http:\/\/www.ra-uk.org\/images\/stories\/documents\/CSQ-PS-sbyb-posterA4.pdf\" target=\"_blank\" rel=\"noopener\" target=\"_blank\">Poster<\/a><\/li>\n<li><a href=\"http:\/\/www.ra-uk.org\/images\/stories\/documents\/Stop%20before%20you%20block%20supporting%20information%20Final%20Version-1.pdf\" target=\"_blank\" rel=\"noopener\" target=\"_blank\">Suppporting Information<\/a><\/li>\n<\/ul>\n<p><strong>References<\/strong><\/p>\n<p>1. National Patient Safety Agency. Never Events; Framework: Update for 2010\/2011. Mar 2010. Available from:\u00a0<a href=\"http:\/\/www.nrls.npsa.nhs.uk\/resources\/?entryid45=68518\" target=\"_blank\" rel=\"noopener\">http:\/\/www.nrls.npsa.nhs.uk\/resources\/?entryid45=68518<\/a><\/p>\n<p>2. Safe anaesthesia Liaison Group. Wrong Site Blocks During Surgery . Nov 2011.<\/p>\n<p>Available from:\u00a0<a href=\"http:\/\/www.aagbi.org\/foundation\/safety\/SALG_statement_WSB_10_11_10.pdf\" target=\"_blank\" rel=\"noopener\" target=\"_blank\">http:\/\/www.aagbi.org\/foundation\/safety\/SALG_statement_WSB_10_11_10.pdf<\/a><\/p>\n<p>3. National Patient Safety Agency. WHO Surgical Safety Checklist. Jan 2009. Available from:\u00a0<a href=\"http:\/\/www.nrls.npsa.nhs.uk\/resources\/?entryid45=59860\" target=\"_blank\" rel=\"noopener\">http:\/\/www.nrls.npsa.nhs.uk\/resources\/?entryid45=59860<\/a><\/p>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\n\t\n<\/div>\n<div class=\"social-icons share-icons share-row relative full-width text-center\" ><a href=\"https:\/\/www.facebook.com\/sharer.php?u=https:\/\/www.esrahellas.gr\/en\/stop-before-you-block\/\" data-label=\"Facebook\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip facebook\" title=\"Share on Facebook\" aria-label=\"Share on Facebook\" rel=\"noopener nofollow\"><i class=\"icon-facebook\" aria-hidden=\"true\"><\/i><\/a><a href=\"https:\/\/twitter.com\/share?url=https:\/\/www.esrahellas.gr\/en\/stop-before-you-block\/\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip twitter\" title=\"Share on Twitter\" aria-label=\"Share on Twitter\" rel=\"noopener nofollow\"><i class=\"icon-twitter\" aria-hidden=\"true\"><\/i><\/a><a href=\"mailto:?subject=Stop%20Before%20you%20Block&body=Check%20this%20out%3A%20https%3A%2F%2Fwww.esrahellas.gr%2Fen%2Fstop-before-you-block%2F\" class=\"icon primary button circle tooltip email\" title=\"Email to a Friend\" aria-label=\"Email to a Friend\" rel=\"nofollow\"><i class=\"icon-envelop\" aria-hidden=\"true\"><\/i><\/a><a href=\"https:\/\/www.linkedin.com\/shareArticle?mini=true&url=https:\/\/www.esrahellas.gr\/en\/stop-before-you-block\/&title=Stop%20Before%20you%20Block\" onclick=\"window.open(this.href,this.title,'width=500,height=500,top=300px,left=300px'); return false;\" target=\"_blank\" class=\"icon primary button circle tooltip linkedin\" title=\"Share on LinkedIn\" aria-label=\"Share on LinkedIn\" rel=\"noopener nofollow\"><i class=\"icon-linkedin\" aria-hidden=\"true\"><\/i><\/a><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-blank.php","meta":{"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-3356","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - 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