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201 ‘Stop before you block’: re-audit of compliance and breaking down barriers to implementation
  1. K Malone,
  2. A Newman-Marks and
  3. M Molyneux
  1. University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK


Background and Aims Stop Before You Block (SBYB)1 is an established initiative to prevent wrong-sided regional anaesthesia (RA). Despite this, compliance with SBYB has been poor in our institution and a recent wrong-sided block (‘A Never Event’) prompted a re-audit of local processes.

Methods We prospectively examined all unilateral RA performed in a six-week period starting in May 2021. Data on SBYB compliance and risk factors for failing to SBYB were sought. An anonymous online survey was sent out to all anaesthetists regarding SBYB to collect qualitative opinion and suggestions for improved SBYB compliance. Local audit committee authorised and registered this work as not needing ethics committee approval.

Results Twenty-eight regional nerve blocks were observed. Risk factors present included surgical site marking not being visible, repositioning of patients and additional distractions (table 1). Although SBYB compliance improved to 82%, in two cases without SBYB there were no risk factors present. Of the 29 survey results received, all agreed a physical reminder needed to be introduced, with posters on ultrasound machines achieving the most favourable response followed by a physical barrier on the syringe.

Abstract 201 Table 1

SBYB compliance and risk factors for failing to SBYB

Conclusions We identified improved compliance in our re-audit, but nearly a fifth of blocks occurred without SBYB. With risk factors for failing to SBYB prevalent including distraction, we suggest a non-user dependent step is needed to improve compliance. We believe this could be achieved if needle manufacturers incorporate a pre-packaged fail-safe barrier into their syringe design or RA needle sheaths.

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