Anesthesia site marking
After confirming the patient's identity, the attending anesthesiol-
ogist (not a trainee) will use a standardized mark that is distinct from
the one used for the surgical site to mark the perioperative nerve
block site. Place the mark close to the injection site to ensure it is visi-
ble in the prepped and draped field. Repeat the marking process when
there are multiple injection sites.
Time out
Secure a block team consisting of at least 2 people with inde-
pendent roles (attending anesthesiologist and pre-op or holding area
nurse or circulating nurse). The anesthesiologist should initiate or ask
for the time out. Conduct a time out before sedating the patient (when
possible), before inserting the needle (or as close to the procedure as
possible) and before each nerve block.
Already on it
One facility that already is taking steps to help to ensure blocks are
being performed at the correct site is Memorial Healthcare System in
Hollywood, Fla. They have patients wear a green wristband on the
side of the block. They also have their patients read from a script dur-
ing the time out, using questions that confirm important information
related to the site and the procedure.
Wrong-site blocks occur more often that you might imagine. They
occurred 10 times more often than wrong-site surgery at the University
of Pittsburgh Medical Center from 2009 to 2012, according to a study
published in the British Journal of Anaesthesia. More than one-fourth
(26%) of all wrong-site procedures reported to the Pennsylvania Patient
Safety Authority from 2004 to 2017 were wrong-site blocks. Follow
these tips and together we can watch those numbers dwindle.
OSM
Dr. Martin (dem8778@gmail.com) is past president of the Pennsylvania
Society of Anesthesiologists.
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