#StopBeforeYouBlock - Twitter Hashtag

5 months ago

🛑 𝐖𝐑𝐎𝐍𝐆-𝐒𝐈𝐃𝐄𝐃 𝐁𝐋𝐎𝐂𝐊: 𝐃𝐨𝐧’𝐭 𝐉𝐮𝐬𝐭 𝐌𝐚𝐧𝐚𝐠𝐞 𝐈𝐭 - 𝐂𝐨𝐧𝐭𝐚𝐢𝐧, 𝐃𝐢𝐬𝐜𝐥𝐨𝐬𝐞, 𝐋𝐞𝐚𝐫𝐧 #WrongSidedBlock #NeverEvent #RegionalAnesthesia #PatientSafety #StopBeforeYouBlock #HumanFactors #EDRA #SafetyFirst #ThinkBeforeYouBlock #GrayZonesInRA #GrayAreasInRA 𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄𝐒 𝐢𝐧 𝐑𝐀: 1️⃣ 🎯 𝐖𝐡𝐲 𝐈𝐭𝐬 𝐚 𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄? ⚠️ The event = black & white (wrong side → error) 🧠 The response = decision-making under uncertainty ⚖️ Proceed vs postpone surgery? 💉 Can you safely perform the correct-side block (dose limits)? 🫀 Risk of LAST after cumulative dosing? 🔄 Switch to GA or modify technique? 📊 Patient-specific factors (age, comorbidities, block type) 👉 No single guideline gives a fixed answer → requires clinical judgment 2️⃣⚡ 𝐈𝐌𝐌𝐄𝐃𝐈𝐀𝐓𝐄 𝐑𝐄𝐒𝐏𝐎𝐍𝐒𝐄: “𝐒𝐭𝐨𝐩 𝐭𝐡𝐞 𝐂𝐡𝐚𝐢𝐧” 🛑 Stop further injection immediately if wrong side/site is recognized during the block. 📣 Call for senior help and inform the surgical, anesthesia, & nursing team. 🧾 Document exactly what was injected: drug, dose, concentration, volume, time, side, block type, & patient status. 👁️ Monitor closely for LAST, excessive bilateral block effects, respiratory compromise, motor weakness, or evolving neurological symptoms. 🚫 Do not proceed casually with the correct-sided block; reassess cumulative LA dose, urgency of surgery, patient risk, & alternative anaesthetic plan. 3️⃣ 🧠 𝐂𝐋𝐈𝐍𝐈𝐂𝐀𝐋 𝐃𝐄𝐂𝐈𝐒𝐈𝐎𝐍: 𝐏𝐫𝐨𝐜𝐞𝐞𝐝, 𝐌𝐨𝐝𝐢𝐟𝐲, 𝐨𝐫 𝐀𝐛𝐚𝐧𝐝𝐨𝐧 ⚖️ Recalculate the remaining safe LA dose before any further block. 🔄 Modify the plan if needed: lower dose, different technique, catheter strategy, GA, local infiltration, or surgical postponement. 🧪 Treat it as a safety event, not just a technical error. 🫀 Ensure lipid rescue and resuscitation equipment are immediately available if further LA is considered. 4️⃣ 💬 𝐃𝐈𝐒𝐂𝐋𝐎𝐒𝐔𝐑𝐄: 𝐇𝐨𝐧𝐞𝐬𝐭, 𝐄𝐚𝐫𝐥𝐲, 𝐂𝐨𝐦𝐩𝐚𝐬𝐬𝐢𝐨𝐧𝐚𝐭𝐞 🤝 Inform the patient once clinically safe. 🗣️ Explain clearly: what happened, what was given, expected effects, monitoring plan, and impact on surgery. 🙏 Offer apology without blame-shifting. 📌 Escalate according to institutional duty of candour / incident reporting pathways. 5️⃣ 🧩 𝐂𝐀𝐔𝐒𝐄𝐒: 𝐓𝐡𝐞 𝐔𝐬𝐮𝐚𝐥 𝐓𝐫𝐚𝐩𝐬 👉 Wrong-sided nerve block is rare but serious and is classified as a “𝐍𝐄𝐕𝐄𝐑 𝐄𝐕𝐄𝐍𝐓”. 👉 Published estimates range from 𝟎.𝟓𝟐 𝐭𝐨 𝟓.𝟎𝟕 per 10,000 blocks. 👉 It may increase risk of nerve injury, LA toxicity, & even wrong-site surgery. 🌀 Distraction during block performance ⏱️ Time pressure and list changes 🔁 Patient repositioning 👥 More than one block 👁️ Surgical mark absent, hidden, or not rechecked 🧠 “Checklist done earlier” illusion 🔇 Poor team culture where people hesitate to speak up 6️⃣ 🛡️ 𝐏𝐑𝐄𝐕𝐄𝐍𝐓𝐈𝐎𝐍: 𝐌𝐚𝐤𝐞 𝐭𝐡𝐞 𝐋𝐚𝐬𝐭 𝐂𝐡𝐞𝐜𝐤 𝐭𝐡𝐞 𝐑𝐞𝐚𝐥 𝐂𝐡𝐞𝐜𝐤 🛑 Stop Before You Block must occur immediately before every new needle insertion, not at consent, not at WHO sign-in, not five minutes earlier. 👀 Visualize the surgical arrow/site mark immediately before needle insertion. 🗣️ Ask the conscious patient to confirm the operative side; if unconscious, recheck consent & operative documentation. 🔁 Repeat the check if the patient is repositioned or if more than one block is performed. 🧑‍🤝‍🧑 Use a two-person stop moment. 🧪 Consider “𝐌𝐎𝐂𝐊 𝐁𝐄𝐅𝐎𝐑𝐄 𝐁𝐋𝐎𝐂𝐊": touch the intended side with an empty syringe & confirm aloud with the team. 🎯 𝐊𝐄𝐘 𝐓𝐀𝐊𝐄𝐀𝐖𝐀𝐘𝐒 🛑 Wrong side? Stop the block. Right response? Stop the harm. 👁️ The mark must be seen - not assumed. 🧠 The checklist is not the safety step; the behaviour is. ⚖️ After a wrong-sided block, the next injection is a new risk decision. 🔥 Stop Before You Block is not a slogan - it is the last 𝐂𝐎𝐆𝐍𝐈𝐓𝐈𝐕𝐄 𝐁𝐑𝐀𝐊𝐄 before harm. 👉 Wrong-sided block is a “NEVER event”… but what you do next is a “𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄 𝐝𝐞𝐜𝐢𝐬𝐢𝐨𝐧.”

KartikBSonawane's tweet photo. 🛑 𝐖𝐑𝐎𝐍𝐆-𝐒𝐈𝐃𝐄𝐃 𝐁𝐋𝐎𝐂𝐊: 𝐃𝐨𝐧’𝐭 𝐉𝐮𝐬𝐭 𝐌𝐚𝐧𝐚𝐠𝐞 𝐈𝐭 - 𝐂𝐨𝐧𝐭𝐚𝐢𝐧, 𝐃𝐢𝐬𝐜𝐥𝐨𝐬𝐞, 𝐋𝐞𝐚𝐫𝐧

#WrongSidedBlock #NeverEvent #RegionalAnesthesia #PatientSafety #StopBeforeYouBlock #HumanFactors #EDRA #SafetyFirst #ThinkBeforeYouBlock
#GrayZonesInRA #GrayAreasInRA

𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄𝐒 𝐢𝐧 𝐑𝐀:

1️⃣ 🎯 𝐖𝐡𝐲 𝐈𝐭𝐬 𝐚 𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄?

⚠️ The event = black & white (wrong side → error)
🧠 The response = decision-making under uncertainty

⚖️ Proceed vs postpone surgery?
💉 Can you safely perform the correct-side block (dose limits)?
🫀 Risk of LAST after cumulative dosing?
🔄 Switch to GA or modify technique?
📊 Patient-specific factors (age, comorbidities, block type)

👉 No single guideline gives a fixed answer → requires clinical judgment

2️⃣⚡ 𝐈𝐌𝐌𝐄𝐃𝐈𝐀𝐓𝐄 𝐑𝐄𝐒𝐏𝐎𝐍𝐒𝐄: “𝐒𝐭𝐨𝐩 𝐭𝐡𝐞 𝐂𝐡𝐚𝐢𝐧”

🛑 Stop further injection immediately if wrong side/site is recognized during the block.

📣 Call for senior help and inform the surgical, anesthesia, & nursing team.

🧾 Document exactly what was injected: drug, dose, concentration, volume, time, side, block type, & patient status.

👁️ Monitor closely for LAST, excessive bilateral block effects, respiratory compromise, motor weakness, or evolving neurological symptoms.

🚫 Do not proceed casually with the correct-sided block; reassess cumulative LA dose, urgency of surgery, patient risk, & alternative anaesthetic plan.

3️⃣ 🧠 𝐂𝐋𝐈𝐍𝐈𝐂𝐀𝐋 𝐃𝐄𝐂𝐈𝐒𝐈𝐎𝐍: 𝐏𝐫𝐨𝐜𝐞𝐞𝐝, 𝐌𝐨𝐝𝐢𝐟𝐲, 𝐨𝐫 𝐀𝐛𝐚𝐧𝐝𝐨𝐧

⚖️ Recalculate the remaining safe LA dose before any further block.

🔄 Modify the plan if needed: lower dose, different technique, catheter strategy, GA, local infiltration, or surgical postponement.

🧪 Treat it as a safety event, not just a technical error.

🫀 Ensure lipid rescue and resuscitation equipment are immediately available if further LA is considered.

4️⃣ 💬 𝐃𝐈𝐒𝐂𝐋𝐎𝐒𝐔𝐑𝐄: 𝐇𝐨𝐧𝐞𝐬𝐭, 𝐄𝐚𝐫𝐥𝐲, 𝐂𝐨𝐦𝐩𝐚𝐬𝐬𝐢𝐨𝐧𝐚𝐭𝐞

🤝 Inform the patient once clinically safe.

🗣️ Explain clearly: what happened, what was given, expected effects, monitoring plan, and impact on surgery.

🙏 Offer apology without blame-shifting.

📌 Escalate according to institutional duty of candour / incident reporting pathways.

5️⃣ 🧩 𝐂𝐀𝐔𝐒𝐄𝐒: 𝐓𝐡𝐞 𝐔𝐬𝐮𝐚𝐥 𝐓𝐫𝐚𝐩𝐬

👉 Wrong-sided nerve block is rare but serious and is classified as a “𝐍𝐄𝐕𝐄𝐑 𝐄𝐕𝐄𝐍𝐓”.
👉 Published estimates range from 𝟎.𝟓𝟐 𝐭𝐨 𝟓.𝟎𝟕 per 10,000 blocks.
👉 It may increase risk of nerve injury, LA toxicity, & even wrong-site surgery.

🌀 Distraction during block performance
⏱️ Time pressure and list changes
🔁 Patient repositioning
👥 More than one block
👁️ Surgical mark absent, hidden, or not rechecked
🧠 “Checklist done earlier” illusion
🔇 Poor team culture where people hesitate to speak up

6️⃣ 🛡️ 𝐏𝐑𝐄𝐕𝐄𝐍𝐓𝐈𝐎𝐍: 𝐌𝐚𝐤𝐞 𝐭𝐡𝐞 𝐋𝐚𝐬𝐭 𝐂𝐡𝐞𝐜𝐤 𝐭𝐡𝐞 𝐑𝐞𝐚𝐥 𝐂𝐡𝐞𝐜𝐤

🛑 Stop Before You Block must occur immediately before every new needle insertion, not at consent, not at WHO sign-in, not five minutes earlier.

👀 Visualize the surgical arrow/site mark immediately before needle insertion.

🗣️ Ask the conscious patient to confirm the operative side; if unconscious, recheck consent & operative documentation.

🔁 Repeat the check if the patient is repositioned or if more than one block is performed.

🧑‍🤝‍🧑 Use a two-person stop moment.

🧪 Consider “𝐌𝐎𝐂𝐊 𝐁𝐄𝐅𝐎𝐑𝐄 𝐁𝐋𝐎𝐂𝐊": touch the intended side with an empty syringe & confirm aloud with the team.

🎯 𝐊𝐄𝐘 𝐓𝐀𝐊𝐄𝐀𝐖𝐀𝐘𝐒

🛑 Wrong side? Stop the block. Right response? Stop the harm.
👁️ The mark must be seen - not assumed.
🧠 The checklist is not the safety step; the behaviour is.
⚖️ After a wrong-sided block, the next injection is a new risk decision.
🔥 Stop Before You Block is not a slogan - it is the last 𝐂𝐎𝐆𝐍𝐈𝐓𝐈𝐕𝐄 𝐁𝐑𝐀𝐊𝐄 before harm.
👉 Wrong-sided block is a “NEVER event”… but what you do next is a “𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄 𝐝𝐞𝐜𝐢𝐬𝐢𝐨𝐧.”

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Dr Nav Sidhu @DrNavSidhu

over 2 years ago

Wishing the #RAUK24 peeps all the best. Sorry I can’t be there in person. #StopBeforeYouBlock #RegionalAnesthesia

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Sarah Everett 💙 @SarahE_NHS

about 3 years ago · East

The Natssips8 easy to understand flow chart. Which now includes #stopbeforeyoublock as well as implant, lens verification #surgicalsafety #patientsafety #safetyculture

Patient Safety Learning @ptsafetylearn

about 3 years ago

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 NatSSIPs sequential standards with the WHO Surgical Safety Checklist https://t.co/QFF32IZxMW

ptsafetylearn's tweet photo. 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 NatSSIPs sequential standards with the WHO Surgical Safety Checklist https://t.co/QFF32IZxMW https://t.co/PbADs7v3AZ

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Rainbow Trays @RainbowTrays

over 3 years ago

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? 🧵👇

RainbowTrays's tweet photo. 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?
🧵👇 https://t.co/kAjxklCmHl

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Rainbow Trays @RainbowTrays

over 3 years ago

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?

RainbowTrays's tweet photo. 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? https://t.co/ZiUhiGaubi

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Rainbow Trays @RainbowTrays

almost 4 years ago

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

RainbowTrays's tweet photo. 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 https://t.co/sBHUXYze39

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Liana Zucco 🇨🇦🇬🇧🇮🇹🇺🇸 @lianazucco

almost 4 years ago

Excellent title. Absolutely brilliant. #regionalanaesthesia #prepstopblock #stopbeforeyoublock

Lloyd Turbitt @LloydTurbitt

almost 4 years ago

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

LloydTurbitt's tweet photo. Core Basic Nerve Blocks for Paediatric Anaesthesia.

#PaedsPlanAblocks

Editorial in @Anaes_Journal

https://t.co/Oc0vG5Dbqw

@RegionalAnaesUK https://t.co/KIO8mjribs

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Rainbow Trays @RainbowTrays

about 4 years ago

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

RainbowTrays's tweet photo. The new @Rainbowtrays Prep Stop Block trays are now available to support the @RegionalAnaesUK Standard Operating Procedures poster
https://t.co/fK4j3qE7pW
#StopBeforeYouBlock
#PrepStopBlock https://t.co/DfwAFHIQhB

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Mahul Gorecha @DrMGorecha

over 4 years ago

Loving these probe covers! #stopbeforeyoublock @tomhaytack @DEdgar_BBMUK

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Natalie Davies @nhsdavies

over 4 years ago

Also great to see these block trays in use - great idea! #neverevents #stopbeforeyoublock

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AFSRA

@AFSRA10

over 4 years ago

#STOPBEFOREYOUBLOCK as safety measure before doing any nerve block by @BouarroudjN

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BucksUSGRA @BucksUSGRA

over 4 years ago

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

BucksUSGRA's tweet photo. 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 https://t.co/FsrQlXACdI

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Rainbow Trays @RainbowTrays

over 4 years ago

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

RainbowTrays's tweet photo. 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 https://t.co/eJuJfiF3x8

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Dr Amit Pawa💉🎙️ @amit_pawa

over 4 years ago

@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

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Dr Amit Pawa💉🎙️ @amit_pawa

over 7 years ago

@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!

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Digital Futures @ TSDFT @VRLAB_TSD

over 8 years ago

Here's an #equirectangular still from the #StopBeforeYouBlock scenario we captured the other day! #immersivehealth #immersivetraining

VRLAB_TSD's tweet photo. Here's an #equirectangular still from the #StopBeforeYouBlock scenario we captured the other day! #immersivehealth #immersivetraining https://t.co/LIRSGmzewv

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Digital Futures @ TSDFT @VRLAB_TSD

over 8 years ago

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

VRLAB_TSD's tweet photo. 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 https://t.co/OVtspVtxSH

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SCATA ASM @SCATA_ASM

over 8 years ago

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

SCATA_ASM's tweet photo. @c_johnstone1980 presenting a #technological solution promoting #stopbeforeyoublock #patientsafety #anaesthesia @RegionalAnaesUK @scata_uk @SCATA_ASM #scata2018 https://t.co/1BcmAY7Y2g

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MFT Patient Safety & Clinical Governance @MFTPtSafety

over 8 years ago

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