Administration of Local Anaesthetic Blocks SOP
|Publication: 27/10/2016 --|
|Last review: 09/10/2020|
|Next review: 09/10/2023|
|Standard Operating Procedure|
|Approved By: Trust Clinical Guidelines Group|
|Copyright© Leeds Teaching Hospitals NHS Trust 2020|
This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
Administration of local anaesthetic blocks SOP
- Roles and Responsibilities
- Process for Monitoring Compliance/Effectiveness
- Arrangements for review of the SOP
Analysis by the Royal College of Anaesthetists showed a total of 67 incidences of wrong site local anaesthetic blocks in the 15 months to November 2010. Reports gave a number of reasons as to why this had occurred including distraction of the anaesthetist, lack of mark specific to the block, lack of anaesthetic time-out, and discrepancy between the operating list and mark or consent form. Wrong sided block has been classified as a Never Event since 2015 by NHS England. https://improvement.nhs.uk/documents/2899/Never_Events_list_2018_FINAL_v7.pdf
The SOP attempts to address the key issues above and is intended to supplement the LTHT Safer Surgery Checklist to minimise the risk and therefore incidence of administration of wrong site local anaesthetic block before surgery.
This SOP applies to all LTHT staff involved in the administration of local anaesthetic blocks before surgery, namely anaesthetists and anaesthetic practitioners. This SOP does not apply to spinal or epidural nerve blocks nor does it apply to surgeon-delivered local anaesthesia.
To minimise the risk and therefore incidence of administration of wrong site local anaesthetic block before surgery
THE PROCEDURE FOR THE ADMINISTRATION OF LOCAL ANAESTHETIC BLOCKS IS FOUND IN APPENDIX A
The terms ‘Local blockade’, ‘Local block’ and ‘Regional blockade’ are commonly used to describe the technique of local anaesthetic blocks. For the purpose of clarity the term ’local anaesthetic block’ will be used through this document.
The designation ‘Administering anaesthetist’ will be used to describe the anaesthetist responsible for administering the local anaesthetic block.
In addition to the roles and responsibilities set out in the Procedure for administration of local anaesthetic blocks detailed in Appendix A, both the administering anaesthetist and anaesthetic practitioner must follow the responsibilities as defined below:
- Participation in the pre-operative Team Briefing
- Conducting, along with the anaesthetic practitioner the Sign In procedure in the anaesthetic room.
- Participation in the Time Out and Verification procedure.
- Participation in the Sign Out procedure
- Participation in the post-operative debriefing
Where the Administering anaesthetist is teaching a procedure, they should give consideration on each occasion as to whether they are competent to do so whilst also safely administering the local anaesthetic block.
This SOP was implemented on 27 October 2016. Anaesthetists and anaesthetic practitioners will require training prior to implementation. This will be jointly developed and delivered by the Theatres Education Team and Anaesthetic Department.
- Annual Audit Post Implementation performed by the department of anaesthesia across a selection of theatres where blocks occur.
This SOP will be reviewed 3 yearly.
General principles for the administration of local anaesthetic blocks
- To STOP before You Block as a last minute double check of site and side of surgery prior to block insertion
- It is this crucial step that is often missed when a wrong site block occurs. The anaesthetic practitioner assisting the procedure as well as the anaesthetist both have responsibility to ensure this STOP takes place.
- To minimise the risk of distraction
- No one should unnecessarily enter or exit1 the anaesthetic room between the time the patient is “signed in” and the completion of all anaesthetic procedures.
- Consideration should be given to the number of students and other non-essential personnel present in the anaesthetic room.
- It is common practice for an assistant to inject the Local Anaesthetic whilst the Anaesthetist holds the needle in place. If the Local Anaesthetic is being injected by another practitioner under the supervision of the Anaesthetist, a verbal check of the drug and patient details/ allergy status is required prior to administration. This is covered in more detail in LTHT Injectable Medicines Code (Version 2.3; October 2015)
1 Without valid reason. E.g. an individual or item of equipment is required for a life or limb threatening emergency that cannot be obtained elsewhere or the surgeon needs to do a procedure prior to block insertion.
Procedure for the administration of local anaesthetic blocks
Whether the patient is to have a regional block alone or in combination with sedation / general anaesthesia the team briefing must include the anaesthetist and assisting practitioner and the operating surgeon.
All of the following steps must include the surgeon if they are to perform the block.
The administering anaesthetist & anaesthetic practitioner/assisting anaesthetist confirm the site of the proposed local anaesthetic block with the patient in the anaesthetic room prior to the administration of any sedating medication.
Prior to handling the block needle the anaesthetist initiates the “stop before you block (SBYB)” Pause.
If not the ODP/assistant verbally challenges the anaesthetist to confirm the correct site prior to assisting in the block.
This essential stop pause is to allow the anaesthetic practitioner (or assisting anaesthetist) to verbally confirm with the anaesthetist (and the patient who is awake). The pause must include
The patient’s consent form (check with the arm band and the patient (for awake blocks)
Site and laterality of the anaesthetic block (surgical site mark, consent and awake patient)
*It is strongly recommended to recheck with the ODP - local anaesthetic agent syringes, concentration and dose after the above checks before starting the block
The above are mandatory to be completed prior to opening the regional block needle and preparation of block site.
Documentation that a SBYB check was performed and the local anaesthetic block administered is documented in patient’s anaesthetic record.
|Target patient group:|
|Target professional group(s):||Allied Health Professional (Primary Care)
Secondary Care Doctors
- Wrong Site Block Signal from NPSA 29th October 2010
- Wrong Site Blocks during Surgery. Guidelines from the Safety In Anaesthesia Liaison Group (SALG) of the Royal College of Anaesthetists (RCOA) November 2010.
- Foresight training resource pack 1 introduction to foresight.
Trust Clinical Guidelines Group
LHP version 2.0
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