Experience Summary

In this 360-degree video, watch as the anaesthetic team perform the pre-surgical safety checklist and 'Stop Before You Block’.

The pre-surgical anaesthetic checklist is a critical safety protocol designed to ensure patient readiness and procedural safety before the induction of anaesthesia. It functions as a systematic review of key clinical information and environmental factors, helping to minimise errors and enhance communication among the surgical team. One important component of this process is the “Stop Before You Block” (SBYB) initiative, which specifically targets regional anaesthesia procedures to prevent wrong-site blocks.

Clinical Context

Pre-operative checklists are embedded within the broader perioperative safety framework, aligning with the World Health Organization’s (WHO) Surgical Safety Checklist. Anaesthesia-related errors can result from incorrect patient identity, missing documentation, drug preparation issues, or misidentification of the operative site. The checklist aims to eliminate these risks by verifying essential information prior to anaesthetic administration. It is typically completed during the “sign-in” phase, before induction, and involves all members of the anaesthetic team.

The SBYB protocol specifically applies to regional anaesthesia, where the risk of administering a nerve block to the wrong site remains a notable patient safety concern. This initiative encourages a final verbal and visual confirmation of the correct patient, procedure, and side immediately prior to needle insertion. It complements the pre-operative marking of the surgical site and is particularly valuable when time has elapsed between the surgical time-out and the regional anaesthetic procedure.

Procedure

The pre-surgical anaesthetic checklist generally includes:

• Confirmation of patient identity using two identifiers (e.g. name, date of birth).
• Review of the surgical procedure and site, ensuring consistency with the consent form.
• Verification of allergies, fasting status, airway assessment, and anaesthetic plan.
• Confirmation of necessary monitoring, equipment availability, and drug preparation.
• Discussion of anticipated risks and special considerations (e.g. blood loss, positioning).

The “Stop Before You Block” step is incorporated just before regional block administration. It involves:

1. A momentary pause by the anaesthetist.
2. Reconfirmation of the correct patient, procedure, and laterality using documentation and surgical site marking.
3. Team communication to ensure all members are aligned and aware.
4. Only then is the regional block performed.

Learning Outcomes

1. Observe the anaesthetic team performing the pre-surgical checklist.
2. Observe the anaesthetic team performing the “Stop Before You Block” step.

External Resources

• RCoA - Stop Before You Block