50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Improving Time Out Compliance and Safety in Regional Nerve Blocks:

A Quality Improvement Initiative

Introduction

•Wrong site procedures occur at a rate of 0.5-5.1 per 10,000 blocks

o Our practice reveals a rate of 0.003 per 10,000

•Recent near misses and a wrong sided nerve block highlighted gaps in our current time out process

•We conducted a quality improvement initiative to enhance our time out process

Our goal is to standardize the time out procedure, improve communication amongst multidisciplinary teams, and increase adherence to best practices for patient safety

Current guidelines

•Guidelines from The Joint Commission Universal Protocol, Anesthesia Patient Safety Foundation, ASRA Task Force Pre-block Safety Checklist, and the World Health Organization Surgical Safety Checklist were reviewed

•3 core principles were identified

o pre-procedure verification

o site marking

o time out

A review of practices at other institutions demonstrated clear patient markings and RN involvement

Intervention proposals

•Dual marking by the surgeon and regional team on block site

•Visual confirmation with colored bracelets on the correct side corresponding to block laterality

•Inclusion of RN in time out

•Printed time out forms

•Patient led and directed time out

Weekly RCA meetings identified the root cause of the wrong sided block and assessed the feasibility of above proposals with feedback from nursing, anesthesia, and QI leadership

Results

•A standard workflow was created

o Updated regional block time out posters

o Preoperative RN included in the time out

o EMR time out checklist for real time documentation

•Zero near misses or wrong sided nerve blocks since implementation

Conclusions

Implementing a standardized, enhanced time out process for regional blocks across our institution is essential for ensuring patient safety. This effort is supported by strict compliance, continuous auditing, and ongoing education.

50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

IMPROVING TIME-OUT COMPLIANCE AND SAFETY IN REGIONAL ANESTHESIA: A QUALITY IMPROVEMENT INITIATIVE

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