1076 Stop Before You Bier's Block- a Major Trauma Centre's Experience of Improving Intravenous Regional Anaesthesia Safety

Aim Intravenous regional anaesthesia (IVRA) offers a safe and cost-effective means to perform short procedures on an extremity. Local anaesthetic systemic toxicity may occur if the anaesthetic is infiltrated prior to inflating a tourniquet. This project aims to improve Bier’s block safety in the Orthopaedic department at a major trauma centre. Method Root cause analysis performed after a patient safety incident involving the Bier’s block indicated a knowledge gap among Orthopaedic junior doctors, breakdown in communication between the Plaster room team and need for training in managing adverse outcomes. A survey assessing block providers’ understanding of the indications, associated risks and competence in undertaking the procedure was conducted. A poster with an aide memoire highlighting the key steps of the procedure was created and a demonstration was provided. The widely successful “STOP before you BLOCK” approach was applied to encourage a 2-person check of tourniquet inflation and local anaesthetic before proceeding. Results The post session survey demonstrated an increase in self-reported confidence levels in performing the block from 3 to 5 on a 5-point scale with 88% reporting a better understanding of the signs and symptoms of local anaesthetic toxicity and its management. 70% responders attributed their increased confidence to the poster intervention and 84% to the “STOP before you BLOCK approach.” The Plaster room technicians reported improved communication among the team with better involvement of individual members. Conclusions Procedural competency in IVRA can be improved through adequate training, induction, use of visual cues and effective communication.