LAST Double Check – A Comprehensive Pre-Regional Checklist for the Busy Institution

Abstract

The LAST Double Check is a more comprehensive checklist with the aim of preventing errors associated with wrong site blocks, anticoagulation administration, and care team coordination. This checklist covers areas of the patient history that are routinely reviewed prior to regional anesthesia administration and did not contribute to delay in arrival to the operating room.

Registration and Management of “Never Events” in Swiss Hospitals—The Perspective of Clinical Risk Managers

“… 11 We also included 2 serious adverse events that have been discussed as never events but are not included currently on existing never event lists. 16 , 17 These events were “serious injury or death due to failure to respond to a deteriorating patient on a general care ward” and “serious injury or death due to spinal hematoma after elective epidural or spinal anesthesia with insufficient hemostasis.” Survey participants were asked 4 specific questions after each of the 8 events: whether they could give a count on how frequently such an event occurred in their hospital in the past year; if a count would be available, whether they had confidence in the correctness of this figure; whether the event is a reportable or editable event in their hospital; and whether they had been informed about the occurrence of such an event at least once during their current employment at their hospital. We chose the approach to target these questions to specific events rather than the entity of “never events” to make the situation as explicit and precise as possible.…”

Why don’t clinicians use checklists?

“…Hence, the term "never event" was created, with the task of eliminating its incidence. 9 Wrong-sided blocks (WSBs) constitute the most common wrong-side procedure in the perioperative setting, with an incidence in the range of 0.52 to 5.07 WSBs per 10,000 blocks. 10,11 Various factors contribute to errors in regional blocks, such as time pressure, case volume, production demand, inadequate supervision, personnel changes, cognitive error, reliance on memory, incompetence, fatigue, lack of understanding of safety protocol, delays, interruptions, teaching, and intervening procedure.…”

“…Wrong-site surgery is considered by the Joint Commission to be a sentinel event, and its occurrence is never acceptable or justifiable. Hence, the term “never event” was created, with the task of eliminating its incidence 9 . Wrong-sided blocks (WSBs) constitute the most common wrong-side procedure in the perioperative setting, with an incidence in the range of 0.52 to 5.07 WSBs per 10,000 blocks 10,11 …”

Providing Comprehensive Perioperative Care for Patients Undergoing Regional Blocks

“…The perioperative nurse should verify that proper supplies (eg, ultrasound machine), personal protective equipment (eg, mask, sterile gloves), and medications are available at the bedside before the anesthesia professional begins the block procedure 10 . Additional safety measures include using a pre–regional block checklist intended to guide clinicians through the safety and quality requirements associated with regional blocks 21,22 . The checklist is based on information from The Joint Commission 5 and the World Health Organization 23 and includes some elements of the time‐out process (eg, proper identification of the patient with two unique identifiers, site marking for block placement) as well as maintenance of aseptic technique and required monitoring 22 .…”

“…Active participation and clear communication among all team members is another key to using the checklist successfully 22 . Perioperative personnel and anesthesia professionals should incorporate the time out and a pre–regional block checklist into the regional block process rather than treating it as an additional time‐consuming exercise 13,21 …”