Wrong-sided nerve block is a never event that keeps happening, and it happens to careful people. The mechanism is almost always the same: the side was confirmed at some earlier point, and by the time the needle is in hand nobody rechecks because everybody assumes somebody already did.
Build in a stop immediately before needle insertion, after the probe is on the skin and the drug is drawn up, in which the operator and one other person look together at the consent form, the mark on the limb and the patient's own answer if they are awake. Do it every time, including for the second block on the same patient, and including when you personally did the first one.
Mark the limb yourself if the surgical mark is not visible under the drapes, and never rely on the patient having been marked in a different room by a different person. If any of the three sources disagree, stop and resolve it before anything is drawn up - not after.
- Pause immediately before needle insertion, not at an earlier point in the pathway.
- Check consent, the limb mark and the patient's answer together with a second person.
- Repeat the check for every block, including the second one on the same patient.
- Mark the limb yourself if the surgical mark is hidden by drapes or positioning.
- Any disagreement between the three sources stops the procedure until it is resolved.
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