Preprocedural checklist for regional anesthesia: impact on the incidence of wrong site nerve blockade (an 8-year perspective)

2019 ◽  
Vol 44 (2) ◽  
pp. 201-205 ◽  
Author(s):  
Daryl S Henshaw ◽  
James D Turner ◽  
Sean W Dobson ◽  
Jonathan Douglas Jaffe ◽  
John Wells Reynolds ◽  
...  
Keyword(s):  
Regional Anesthesia ◽  
Invasive Procedure ◽  
Pain Medicine ◽  
Wrong Site Surgery ◽  
Wrong Side ◽  
Anesthesia Providers ◽  
Sentinel Event ◽  
American Society ◽  
Checklist Implementation ◽  
Wrong Site

BackgroundThe term “Wrong-Site Surgery (WSS)” is commonly associated with surgical procedures; however, The Joint Commission (TJC) considers any invasive procedure, not just a surgical procedure, performed on the wrong side, at the wrong site, or on the wrong patient to be a WSS. For anesthesia providers, this means that a wrong-site nerve block (WSNB) also constitutes a WSS and would be considered a sentinel event by TJC. In an attempt to combat WSNB, the American Society of Regional Anesthesia and Pain Medicine published guidelines in 2014 recommending the use of a preprocedural checklist before performing regional blocks. The effectiveness of such a checklist, however, to reduce the occurrence of WSNB has not yet been demonstrated. We hypothesized that the introduction of a preprocedural checklist specific for regional anesthesia would be associated with a lower rate of WSNB procedures.MethodsA retrospective review was performed to compare the incidence of WSNB 2 years before, to 6 years after the implementation of a preprocedural checklist specific to regional anesthesia.ResultsPrior to checklist implementation, 4 WSNB events occurred during 10 123 procedures (3.95 per 10 000 (95% CI 1.26 to 9.53). Following implementation, WSNB events occurred during 35 890 procedures (0 per 10 000 (95% CI 0 to 0.84)); p=0.0023.ConclusionsImplementation of a regional anesthesia specific preprocedural checklist was associated with a significantly lower incidence of WSNB procedures. While prospective controlled studies would be required to demonstrate causation, this study suggests that for regional anesthesia procedures, a preprocedural checklist may positively impact patient safety.

scholarly journals Analysis and outcomes of wrong site thyroid surgery

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gianlorenzo Dionigi ◽  
Marco Raffaelli ◽  
Rocco Bellantone ◽  
Carmela De Crea ◽  
Carlo Enrico Ambrosini ◽  
...  
Keyword(s):  
Thyroid Surgery ◽  
Rare Event ◽  
Lymph Node Excision ◽  
Legal Action ◽  
Preventive Strategies ◽  
Case Presentation ◽  
Wrong Site Surgery ◽  
Wrong Side ◽  
Low Volume ◽  
Wrong Site

Abstract Background In thyroid surgery, wrong-site surgery (WSS) is considered a rare event and seldom reported in the literature. Case presentation This report presents 5 WSS cases following thyroid surgery in a 20-year period. We stratified the subtypes of WSS in wrong target, wrong side, wrong procedure and wrong patient. Only planned and elective thyroid surgeries present WSS cases. The interventions were performed in low-volume hospitals, and subsequently, the patients were referred to our centres. Four cases of wrong-target procedures (thymectomies [n = 3] and lymph node excision [n = 1] performed instead of thyroidectomies) and one case of wrong-side procedure were observed in this study. Two wrong target cases resulting additionally in wrong procedure were noted. Wrong patient cases were not detected in the review. Patients experienced benign, malignant, or suspicious pathology and underwent traditional surgery (no endoscopic or robotic surgery). 40% of WSS led to legal action against the surgeon or a monetary settlement. Conclusion WSS is also observed in thyroid surgery. Considering that reports regarding the serious complications of WSS are not yet available, these complications should be discussed with the surgical community. Etiologic causes, outcomes, preventive strategies of WSS and expert opinion are presented.

Common general surgical never events: analysis of NHS England never event data

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Islam Omar ◽  
Rishi Singhal ◽  
Michael Wilson ◽  
Chetan Parmar ◽  
Omar Khan ◽  
...  
Keyword(s):  
Breast Implants ◽  
Skin Condition ◽  
Chest Drain ◽  
Event Data ◽  
Wrong Site Surgery ◽  
Wrong Side ◽  
Retained Foreign Body ◽  
Never Events ◽  
Never Event ◽  
Wrong Site

Abstract Background There is little available data on common general surgical never events (NEs). Lack of this information may have affected our attempts to reduce the incidence of these potentially serious clinical incidents. Objectives The purpose of this study was to identify common general surgical NEs from the data held by the National Health Service (NHS) England. Methods We analysed the NHS England NE data from April 2012 to February 2020 to identify common general surgical NEs. Results There was a total of 797 general surgical NEs identified under three main categories such as wrong-site surgery (n = 427; 53.58%), retained items post-procedure (n = 355; 44.54%) and wrong implant/prosthesis (n = 15; 1.88%). We identified a total of 56 common general surgical themes—25 each in the wrong-site surgery and retained foreign body categories and six in wrong implants category. Wrong skin condition surgery was the commonest wrong-site surgery (n = 117; 27.4%). There were 18 wrong-side chest drains (4.2%) and 18 (4.2%) wrong-side angioplasty/angiograms. There were seven (1.6%) instances of confusion in pilonidal/perianal/perineal surgeries and six (1.4%) instances of biopsy of the cervix rather than the colon or rectum. Retained surgical swabs were the most common retained items (n = 165; 46.5%). There were 28 (7.9%) laparoscopic retrieval bags with or without the specimen, 26 (7.3%) chest drain guide wires, 26 (7.3%) surgical needles and 9 (2.5%) surgical drains. Wrong stents were the most common (n = 9; 60%) wrong implants followed by wrong breast implants (n = 2; 13.3%). Conclusion This study found 56 common general surgical NEs. This information is not available to surgeons around the world. Increased awareness of these common themes of NEs may allow for the adoption of more effective and specific safeguards and ultimately help reduce their incidence.

Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration

2016 ◽  
Vol 124 (3) ◽  
pp. 535-552 ◽  
Keyword(s):  
Respiratory Depression ◽  
Regional Anesthesia ◽  
Practice Guidelines ◽  
Task Force ◽  
Digital Content ◽  
Pain Medicine ◽  
Practice Parameters ◽  
Opioid Administration ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract The American Society of Anesthesiologists Committee on Standards and Practice Parameters and the Task Force on Neuraxial Opioids and the American Society of Regional Anesthesia and Pain Medicine present an updated report of the Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration. Supplemental Digital Content is available in the text.

Anticoagulation in Regional Anesthesia

2018 ◽  
Author(s):  
Issam A. Mardini ◽  
Jiabin Liu ◽  
Nabil Elkassabany
Keyword(s):  
Elderly Patient ◽  
Regional Anesthesia ◽  
The Elderly ◽  
Orthopedic Procedures ◽  
Pain Medicine ◽  
Cardiovascular Risks ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Risks And Benefits ◽  
American Society

Regional anesthesia and analgesia provide attractive options for patients undergoing major orthopedic procedures. The use of anticoagulation medications in the elderly patient population and in patients with cardiovascular risks is very common. The guidelines from the American Society of Regional Anesthesia and Pain Medicine (ASRA) and other societies have been adopted widely over many years. The guidelines provide a basis for adequate delay intervals between dosing of medications and performing neuraxial or peripheral nerve blocks (PNBs), thus allowing for safer practice of regional anesthesia. Following guidelines never eliminates risk, but it allows balanced clinical practice by physicians in regard to the risks and benefits for individual patients.

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