Top Tweets for #StopBeforeYouBlock
๐ ๐๐๐๐๐-๐๐๐๐๐ ๐๐๐๐๐: ๐๐จ๐งโ๐ญ ๐๐ฎ๐ฌ๐ญ ๐๐๐ง๐๐ ๐ ๐๐ญ - ๐๐จ๐ง๐ญ๐๐ข๐ง, ๐๐ข๐ฌ๐๐ฅ๐จ๐ฌ๐, ๐๐๐๐ซ๐ง
#WrongSidedBlock #NeverEvent #RegionalAnesthesia #PatientSafety #StopBeforeYouBlock #HumanFactors #EDRA #SafetyFirst #ThinkBeforeYouBlock
#GrayZonesInRA #GrayAreasInRA
๐๐๐๐ ๐๐๐๐๐ ๐ข๐ง ๐๐:
1๏ธโฃ ๐ฏ ๐๐ก๐ฒ ๐๐ญ๐ฌ ๐ ๐๐๐๐ ๐๐๐๐?
โ ๏ธ The event = black & white (wrong side โ error)
๐ง The response = decision-making under uncertainty
โ๏ธ Proceed vs postpone surgery?
๐ Can you safely perform the correct-side block (dose limits)?
๐ซ Risk of LAST after cumulative dosing?
๐ Switch to GA or modify technique?
๐ Patient-specific factors (age, comorbidities, block type)
๐ No single guideline gives a fixed answer โ requires clinical judgment
2๏ธโฃโก ๐๐๐๐๐๐๐๐๐ ๐๐๐๐๐๐๐๐: โ๐๐ญ๐จ๐ฉ ๐ญ๐ก๐ ๐๐ก๐๐ข๐งโ
๐ Stop further injection immediately if wrong side/site is recognized during the block.
๐ฃ Call for senior help and inform the surgical, anesthesia, & nursing team.
๐งพ Document exactly what was injected: drug, dose, concentration, volume, time, side, block type, & patient status.
๐๏ธ Monitor closely for LAST, excessive bilateral block effects, respiratory compromise, motor weakness, or evolving neurological symptoms.
๐ซ Do not proceed casually with the correct-sided block; reassess cumulative LA dose, urgency of surgery, patient risk, & alternative anaesthetic plan.
3๏ธโฃ ๐ง ๐๐๐๐๐๐๐๐ ๐๐๐๐๐๐๐๐: ๐๐ซ๐จ๐๐๐๐, ๐๐จ๐๐ข๐๐ฒ, ๐จ๐ซ ๐๐๐๐ง๐๐จ๐ง
โ๏ธ Recalculate the remaining safe LA dose before any further block.
๐ Modify the plan if needed: lower dose, different technique, catheter strategy, GA, local infiltration, or surgical postponement.
๐งช Treat it as a safety event, not just a technical error.
๐ซ Ensure lipid rescue and resuscitation equipment are immediately available if further LA is considered.
4๏ธโฃ ๐ฌ ๐๐๐๐๐๐๐๐๐๐: ๐๐จ๐ง๐๐ฌ๐ญ, ๐๐๐ซ๐ฅ๐ฒ, ๐๐จ๐ฆ๐ฉ๐๐ฌ๐ฌ๐ข๐จ๐ง๐๐ญ๐
๐ค Inform the patient once clinically safe.
๐ฃ๏ธ Explain clearly: what happened, what was given, expected effects, monitoring plan, and impact on surgery.
๐ Offer apology without blame-shifting.
๐ Escalate according to institutional duty of candour / incident reporting pathways.
5๏ธโฃ ๐งฉ ๐๐๐๐๐๐: ๐๐ก๐ ๐๐ฌ๐ฎ๐๐ฅ ๐๐ซ๐๐ฉ๐ฌ
๐ Wrong-sided nerve block is rare but serious and is classified as a โ๐๐๐๐๐ ๐๐๐๐๐โ.
๐ Published estimates range from ๐.๐๐ ๐ญ๐จ ๐.๐๐ per 10,000 blocks.
๐ It may increase risk of nerve injury, LA toxicity, & even wrong-site surgery.
๐ Distraction during block performance
โฑ๏ธ Time pressure and list changes
๐ Patient repositioning
๐ฅ More than one block
๐๏ธ Surgical mark absent, hidden, or not rechecked
๐ง โChecklist done earlierโ illusion
๐ Poor team culture where people hesitate to speak up
6๏ธโฃ ๐ก๏ธ ๐๐๐๐๐๐๐๐๐๐: ๐๐๐ค๐ ๐ญ๐ก๐ ๐๐๐ฌ๐ญ ๐๐ก๐๐๐ค ๐ญ๐ก๐ ๐๐๐๐ฅ ๐๐ก๐๐๐ค
๐ Stop Before You Block must occur immediately before every new needle insertion, not at consent, not at WHO sign-in, not five minutes earlier.
๐ Visualize the surgical arrow/site mark immediately before needle insertion.
๐ฃ๏ธ Ask the conscious patient to confirm the operative side; if unconscious, recheck consent & operative documentation.
๐ Repeat the check if the patient is repositioned or if more than one block is performed.
๐งโ๐คโ๐ง Use a two-person stop moment.
๐งช Consider โ๐๐๐๐ ๐๐๐
๐๐๐ ๐๐๐๐๐": touch the intended side with an empty syringe & confirm aloud with the team.
๐ฏ ๐๐๐ ๐๐๐๐๐๐๐๐๐
๐ Wrong side? Stop the block. Right response? Stop the harm.
๐๏ธ The mark must be seen - not assumed.
๐ง The checklist is not the safety step; the behaviour is.
โ๏ธ After a wrong-sided block, the next injection is a new risk decision.
๐ฅ Stop Before You Block is not a slogan - it is the last ๐๐๐๐๐๐๐๐๐ ๐๐๐๐๐ before harm.
๐ Wrong-sided block is a โNEVER eventโโฆ but what you do next is a โ๐๐๐๐ ๐๐๐๐ ๐๐๐๐ข๐ฌ๐ข๐จ๐ง.โ

Wishing the #RAUK24 peeps all the best. Sorry I canโt be there in person. #StopBeforeYouBlock #RegionalAnesthesia

The Natssips8 easy to understand flow chart. Which now includes #stopbeforeyoublock as well as implant, lens verification
#surgicalsafety
#patientsafety
#safetyculture
Speaking now at #AfPPConf2023, @1974nigel is discussing his research findings on surgical safety. He is also the author of the flow chart below, available via the hub, which combines the NatSSIPsย sequential standards with the WHO Surgical Safety Checklist https://t.co/QFF32IZxMW

Considering adding a breakable paper sleeve to the #StopBeforeYouBlock trays to force a pause at the stop point in the procedure.
What do you think?
Useful?
Unnecessary?
๐งต๐

Responding to some conversations about the new #StopBeforeYouBlock trays, we have created some additions to reinforce the STOP moment.
1.Sealed lidded tray
2.Paper sleeve to break before administration
3.Basic tray
What do you think?

The new #RainbowTrays #StopBeforeYouBlock tray supporting @RegionalAnaesUK SOPs. @EM_AHSN are exploring the new trays use and evaluation in practice and are keen to hear from interested trusts. An element of funding is available to support this project. Phil Stimpson @EM_AHSN

Core Basic Nerve Blocks for Paediatric Anaesthesia.
#PaedsPlanAblocks
Editorial in @Anaes_Journal
https://t.co/Oc0vG5Dbqw
@RegionalAnaesUK

The new @Rainbowtrays Prep Stop Block trays are now available to support the @RegionalAnaesUK Standard Operating Procedures poster
https://t.co/fK4j3qE7pW
#StopBeforeYouBlock
#PrepStopBlock



A reminder to make sure consent is informed, training is strong and support is available if necessary - safe care equates to constant vigilance #stopbeforeyoublock
Also a great area for future #NAP study @RCoANews @Assoc_Anaes @doctimcook
#regionalanaesthesia #masterUSGRA

Introducing the new Rainbow Trays Stop Before You Block tray aligning directly to the new Standard Operating Procedures poster from SALG & UK-RA for regional anaesthesia blocks. PREP-STOP-BLOCK #Rainbowtrays #stopbeforeyoublock

@lotusgav I hear you and get it.
For me- they key Has to be in the assistant withholding the needle until the stop moment has occurred. This will be tough for me, but am prepared to do it!
#PrepStopBlock #StopBeforeYouBlock @RegionalAnaesUK
@LTHAnaesthesia @RegionalAnaesUK @MindrayUK @LancsHospitals Excellent work by @MindrayUK ensuring the #StopBeforeYouBlock is at the forefront of our minds when it counts - thank you for this #PatientSafety step!
Here's an #equirectangular still from the #StopBeforeYouBlock scenario we captured the other day! #immersivehealth #immersivetraining

Yesterday we had our first of many #threesixty shoots at @TorbaySDevonNHS Producing a short piece for @todguest and #anaesthetists about #stopbeforeyoublock using our app controlled #yi360

@c_johnstone1980 presenting a #technological solution promoting #stopbeforeyoublock #patientsafety #anaesthesia @RegionalAnaesUK @scata_uk @SCATA_ASM #scata2018

Well done to the #Anaesthetists who completed a #clinicalaudit on the #StopBeforeYouBlock practise @MFTnhs
We are proud to have high compliance to this important #patientsafety check, ensuring peripheral nerve blocks are placed correctly

The ortho regs used to call me the โtattooistโ when I was in the ED doing FI blocks for #NOFs #stopbeforeyoublock https://t.co/Rd3DF69ouL
Now that we are doing more ultrasound guided blocks, it is vital to document clearly for subsequent treating teams...

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