An Audit Cycle Improving Documentation of ‘Stop Before You Block’ Check
Khaku M, Harty E, O’Flaherty D, West S, Kamming D, Ng SC
The Stop Before You Block campaign was born after the Royal College of Anaesthetists’ Safe Anaesthesia Liaison Group (SALG) investigated a series of 67 inadvertent wrong-sided nerve blocks reported over a 15-month period1.
The central recommendation was to perform an identity and laterality check immediately before the block is performed.
In our central London teaching hospital, we incorporated the SALG recommendations into our practice in 2010.
In this audit cycle, we aimed to identify if accurate documentation of the ‘Stop Before You Block’ check was done. We audited before and after implementing a change in practice, completing an audit cycle.
We prospectively audited performance and documentation of “Stop Before You Block’ checks on all nerve blocks taking place over a two week period in the regional anaesthesia block room.
We then introduced a custom made rubber stamp (Figures 1 & 2) to facilitate easy and convenient documentation of the check and performed a re-audit to assess uptake.
The initial audit reviewed 29 blocks over a two week period. Following introduction of the custom made stamp, we audited a further 25 blocks. Documentation of the Stop Before You Block check was done in 0/29 blocks (0%) before the introduction; documentation was done in 23/25 (92%) after the introduction of the stamp.
Anecdotally, the ‘Stop Before You Block’ check had been practised at our institution on peripheral nerve blocks. However, in the absence of formal documentation we cannot know for sure.
Correct medical record keeping is part of out duty of care to the patient and also a legal requirement. Our initiative to address this issue at our institution has lead to the introduction of a documentation stamp.
Our audit after the initiative was introduced clearly shows a positive change leading to a vast improvement of formal recording of the check.
We hope to achieve 100% documentation in the next audit cycle.
Many thanks to Dr Tom Abbott for his assistance with data collection