Pa Patient Saf Advis 2018 Sep;15(3).
Principles for Reliable Performance of Correct-Site Nerve Blocks
Anesthesiology, Nursing, Surgery
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‚ÄčEditor's Note

The American Society of Regional Anesthesia and Pain Medicine's August 2018 newsletter, ASRA News, includes an article addressing principles to promote correct-site nerve blocks. The article, abstracted below, discusses a partnership initiative between the Pennsylvania Patient Safety Authority and the Pennsylvania Society of Anesthesiologists to assess the frequency of wrong-site nerve blocks and present Pennsylvania anesthesia providers and healthcare facilities with practices to prevent them.


Analysis of wrong-site procedure events reported through the Pennsylvania Patient Safety Reporting System (PA-PSRS) from July 2004 through September 2017 found that wrong-site nerve blocks comprised nearly 26% of these events.* Beginning in 2015, the Authority and the Society partnered to address a perceived slower adoption of prevention practices by anesthesiologists in perioperative or pain services than that of surgical teams.

A systematic review of English-language world literature conducted by the partnership team identified five themes contributing to wrong-site nerve blocks: time pressure, personnel factors, site mark not visible, distraction, and inadequate communication. The partnership team used the literature review results, as well as interviews conducted of a task force of anesthesiologists, surgeons, nurses, and patient representatives from Pennsylvania healthcare facilities, to identify more than 60 prevention practices. Subsequent review and consensus sought from task force members about the practices resulted in 21 principles, which address process of care (n = 12) and healthcare facility structure and culture of safety (n = 9).

The partnership team notes that these principles are unique from previous recommendations of professional organizations. The principles were informed by actual events reported in Pennsylvania and perspectives of a multidisciplinary task force. Other factors of the principles include using data sources, such as patients, to verify the surgical site and considering the environment and culture associated with performance of nerve blocks. Anesthesiologists are encouraged to familiarize themselves with the principles and endeavor to integrate them in their healthcare facilities.

* According to an article in the March 2018 issue of the Pennsylvania Patient Safety Advisory, from July 2004 through September 2017, there were 779 wrong-site perioperative events, including wrong-site nerve blocks, reported through PA-PSRS.


Arnold TV, Martin DE. Peer-driven principles promote correct-site nerve blocks. ASRA News. 2018 Aug:26-9. Also available:

Additional Resources

A complete list of Principles for Reliable Performance of Correct-Site Nerve Blocks is available from the Authority website as part of a broad set of resources addressing the patient safety topic of wrong-site surgery.


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