‘Prep, stop, block’: refreshing ‘stop before you block’ with new national guidance

Incidents relating to paediatric regional anaesthesia in the first 8000 cases reported to webAIRS

“…Specific to regional anaesthesia, a ‘stop-before-you-block’ process is recommended by expert groups and anaesthesia training bodies for all unilateral techniques. 32 This final check is completed with the anaesthetist, their assistant and other available theatre staff. This is performed alongside consent documentation, with visualisation of the surgical site marking just before needle meets skin.…”

New Prep, Stop, Block guidance for blocks close to the midline

“…Stop Before You Block (SBYB), introduced by Regional Anaesthesia‐UK (RA‐UK) and the Safe Anaesthesia Liaison Group (SALG), was a national patient safety initiative designed to prevent wrong site nerve blocks [2]. Following an investigation by the Healthcare Safety Investigation Branch, SALG and RA‐UK recently updated the SBYB initiative, refreshing it with the new Prep, Stop, Block (PSB) framework [3, 4]. Wrong site block is listed by NHS Improvement as an intervention that ‘is considered to be surgical’ and, although the list refers specifically to wrong site surgery, the examples given are of wrong side surgery: ‘wrong knee, eye, limb’[1].…”

“…“I am performing a block close to the midline (e.g., an erector spinae block): how does the assistant confirm the side of my proposed injection (especially if there is anatomical abnormality of the spine)?” [4].…”

“…The new PSB Standard Operating Procedure (SOP) stresses the vital role of the assistant in the SBYB process. Our case, which occurred prior to publication of the new SOP, led to the addition of an associated `frequently asked question´to the newly published PSB SOP: ``I am performing a block close to the midline (e.g., an erector spinae block): how does the assistant confirm the side of my proposed injection (especially if there is anatomical abnormality of the spine)?´´ [4]. This is one situation where marking the surface anatomy of the midline will be essential to ensure that the assistant can confirm the block is on the correct side, as reconciled with the surgical site mark.…”

Guidelines and evidence-based recommendations in anaesthesia: where do we stand?

“…Anaesthesia 2021: ‘Prep, stop, block’: refreshing ‘stop before you block’ with new national guidance’. 32 Quality standards Document that defines high-priority areas for quality improvement in a defined care or service area Standardised and detailed development process, Clear and easily accessible, Derived from NICE guidelines, Consultation sought on topics Not always evidenced based, No defined updating procedures, Medico-legal implications NICE, 2021: Quality standard on venous thromboembolism in adults. 33 …”