Patient Safety
Stop Before You Block
Wrong-site regional anaesthesia is a preventable Never Event. A deliberate, structured pause immediately before needle insertion — combined with a thorough pre-block check — is the single most effective safeguard against blocking the wrong patient, the wrong site, or the wrong side. This page sets out the checks to complete before every block.
The "Stop Before You Block" Moment
Right before the needle touches the patient — after prep, after draping, with the ultrasound on the skin — stop. Pause as a team and out loud confirm against the visible site mark:
1
Stop
Halt before insertion. No needle advances until the check is complete.
2
Look at the mark
Find the indelible site arrow and confirm it is on the side you are about to block.
3
Confirm out loud
Operator and assistant verbally agree patient, site and side before proceeding.
Key principle
The site mark must remain visible after the sterile drapes are applied. If you cannot see the mark at the moment of blocking, stop and re-establish it — do not proceed from memory.Why It Matters
- Wrong-site nerve blocks are classified as a Never Event — serious, largely preventable patient safety incidents.
- Most wrong-site blocks involve a failure of final verification, not a lack of knowledge.
- Contributing factors include time pressure, distraction, list changes, bilateral pathology and reliance on memory rather than the mark.
- A consistent, spoken pause that the whole team expects makes it socially acceptable to stop the process at any point.
Patient & Consent
- Correct patient confirmed against wristband and notes
- Valid, documented consent for the specific block
- Indication for the block reviewed and still appropriate
- Allergies checked — especially local anaesthetic and chlorhexidine
Site & Side
- Correct side and site confirmed and visibly marked with an indelible arrow
- Mark made by the operator, visible after draping and skin prep
- Imaging (if relevant) matches the marked side
- Block site cross-checked with the surgical/procedure site
Drugs & Dose
- Local anaesthetic agent, concentration and volume confirmed
- Maximum safe dose calculated for the patient’s weight
- Running total of LA kept if multiple injections/sites
- Adjuvants and their doses confirmed if used
Safety Net
- IV access in place and patent
- Full monitoring applied (SpO2, ECG, NIBP)
- Resuscitation equipment immediately available
- 20% Intralipid stocked, in date and its location known
- Trained operator with a competent assistant present
Human Factors
- Minimise distractions and interruptions during the pre-block check — treat it like a sterile cockpit.
- Empower every team member to halt the procedure if any check is incomplete or in doubt.
- Re-run the pause if the operator changes, the patient is repositioned, or there is any interruption.
- Be especially deliberate with bilateral pathology, regional lists, and last-minute order changes.
After the Block — Document
- Record the block performed, side, approach and needle used.
- Document the local anaesthetic agent, concentration, volume and total dose given.
- Note that the Stop Before You Block check and site verification were completed.
- Record any complications, and that Intralipid availability was confirmed.