Reg Howard

🛑 𝐖𝐑𝐎𝐍𝐆-𝐒𝐈𝐃𝐄𝐃 𝐁𝐋𝐎𝐂𝐊: 𝐃𝐨𝐧’𝐭 𝐉𝐮𝐬𝐭 𝐌𝐚𝐧𝐚𝐠𝐞 𝐈𝐭 - 𝐂𝐨𝐧𝐭𝐚𝐢𝐧, 𝐃𝐢𝐬𝐜𝐥𝐨𝐬𝐞, 𝐋𝐞𝐚𝐫𝐧 #WrongSidedBlock #NeverEvent #RegionalAnesthesia #PatientSafety #StopBeforeYouBlock #HumanFactors #EDRA #SafetyFirst #ThinkBeforeYouBlock #GrayZonesInRA #GrayAreasInRA 𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄𝐒 𝐢𝐧 𝐑𝐀: 1️⃣ 🎯 𝐖𝐡𝐲 𝐈𝐭𝐬 𝐚 𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄? ⚠️ The event = black & white (wrong side → error) 🧠 The response = decision-making under uncertainty ⚖️ Proceed vs postpone surgery? 💉 Can you safely perform the correct-side block (dose limits)? 🫀 Risk of LAST after cumulative dosing? 🔄 Switch to GA or modify technique? 📊 Patient-specific factors (age, comorbidities, block type) 👉 No single guideline gives a fixed answer → requires clinical judgment 2️⃣⚡ 𝐈𝐌𝐌𝐄𝐃𝐈𝐀𝐓𝐄 𝐑𝐄𝐒𝐏𝐎𝐍𝐒𝐄: “𝐒𝐭𝐨𝐩 𝐭𝐡𝐞 𝐂𝐡𝐚𝐢𝐧” 🛑 Stop further injection immediately if wrong side/site is recognized during the block. 📣 Call for senior help and inform the surgical, anesthesia, & nursing team. 🧾 Document exactly what was injected: drug, dose, concentration, volume, time, side, block type, & patient status. 👁️ Monitor closely for LAST, excessive bilateral block effects, respiratory compromise, motor weakness, or evolving neurological symptoms. 🚫 Do not proceed casually with the correct-sided block; reassess cumulative LA dose, urgency of surgery, patient risk, & alternative anaesthetic plan. 3️⃣ 🧠 𝐂𝐋𝐈𝐍𝐈𝐂𝐀𝐋 𝐃𝐄𝐂𝐈𝐒𝐈𝐎𝐍: 𝐏𝐫𝐨𝐜𝐞𝐞𝐝, 𝐌𝐨𝐝𝐢𝐟𝐲, 𝐨𝐫 𝐀𝐛𝐚𝐧𝐝𝐨𝐧 ⚖️ Recalculate the remaining safe LA dose before any further block. 🔄 Modify the plan if needed: lower dose, different technique, catheter strategy, GA, local infiltration, or surgical postponement. 🧪 Treat it as a safety event, not just a technical error. 🫀 Ensure lipid rescue and resuscitation equipment are immediately available if further LA is considered. 4️⃣ 💬 𝐃𝐈𝐒𝐂𝐋𝐎𝐒𝐔𝐑𝐄: 𝐇𝐨𝐧𝐞𝐬𝐭, 𝐄𝐚𝐫𝐥𝐲, 𝐂𝐨𝐦𝐩𝐚𝐬𝐬𝐢𝐨𝐧𝐚𝐭𝐞 🤝 Inform the patient once clinically safe. 🗣️ Explain clearly: what happened, what was given, expected effects, monitoring plan, and impact on surgery. 🙏 Offer apology without blame-shifting. 📌 Escalate according to institutional duty of candour / incident reporting pathways. 5️⃣ 🧩 𝐂𝐀𝐔𝐒𝐄𝐒: 𝐓𝐡𝐞 𝐔𝐬𝐮𝐚𝐥 𝐓𝐫𝐚𝐩𝐬 👉 Wrong-sided nerve block is rare but serious and is classified as a “𝐍𝐄𝐕𝐄𝐑 𝐄𝐕𝐄𝐍𝐓”. 👉 Published estimates range from 𝟎.𝟓𝟐 𝐭𝐨 𝟓.𝟎𝟕 per 10,000 blocks. 👉 It may increase risk of nerve injury, LA toxicity, & even wrong-site surgery. 🌀 Distraction during block performance ⏱️ Time pressure and list changes 🔁 Patient repositioning 👥 More than one block 👁️ Surgical mark absent, hidden, or not rechecked 🧠 “Checklist done earlier” illusion 🔇 Poor team culture where people hesitate to speak up 6️⃣ 🛡️ 𝐏𝐑𝐄𝐕𝐄𝐍𝐓𝐈𝐎𝐍: 𝐌𝐚𝐤𝐞 𝐭𝐡𝐞 𝐋𝐚𝐬𝐭 𝐂𝐡𝐞𝐜𝐤 𝐭𝐡𝐞 𝐑𝐞𝐚𝐥 𝐂𝐡𝐞𝐜𝐤 🛑 Stop Before You Block must occur immediately before every new needle insertion, not at consent, not at WHO sign-in, not five minutes earlier. 👀 Visualize the surgical arrow/site mark immediately before needle insertion. 🗣️ Ask the conscious patient to confirm the operative side; if unconscious, recheck consent & operative documentation. 🔁 Repeat the check if the patient is repositioned or if more than one block is performed. 🧑‍🤝‍🧑 Use a two-person stop moment. 🧪 Consider “𝐌𝐎𝐂𝐊 𝐁𝐄𝐅𝐎𝐑𝐄 𝐁𝐋𝐎𝐂𝐊": touch the intended side with an empty syringe & confirm aloud with the team. 🎯 𝐊𝐄𝐘 𝐓𝐀𝐊𝐄𝐀𝐖𝐀𝐘𝐒 🛑 Wrong side? Stop the block. Right response? Stop the harm. 👁️ The mark must be seen - not assumed. 🧠 The checklist is not the safety step; the behaviour is. ⚖️ After a wrong-sided block, the next injection is a new risk decision. 🔥 Stop Before You Block is not a slogan - it is the last 𝐂𝐎𝐆𝐍𝐈𝐓𝐈𝐕𝐄 𝐁𝐑𝐀𝐊𝐄 before harm. 👉 Wrong-sided block is a “NEVER event”… but what you do next is a “𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄 𝐝𝐞𝐜𝐢𝐬𝐢𝐨𝐧.”

Interesting. Anyone got data from the UK on this?

Needs more than a revived NHS when grotesque inequalities are why Britain's health is going backwards. Men's healthy life expectancy down to 60.7 years from 62.9 and women's 60.9 from 60.7. UK 20th in 21-country table with only the US worse. theguardian.com/society/2026/a…

🚨News: Politicians have just voted away your online privacy & freedoms Social media will be restricted for under-16s, the Government confirms. This means that every one of us in the UK could soon need to submit to intrusive digital ID checks to access the internet fully. This is a huge step back for free expression in Britain. Worse still, the Government wants to impose this ban while an active consultation is still in progress. Around the world, similar restrictions have failed to keep children safe. It is clear - a social media ban is not about children's wellbeing but a trojan horse for more surveillance and censorship.

@helenvecht @LucyGoBag In my 40 years working in the NHS it evolved from being an incredible idealistic social enterprise that many of us viewed as a political statement and an honour to work in, into a damaging toxic workplace that is harmful to patients and staff The bank of goodwill is rightly empty

For over the last 2 years doctors have been warning that lesser skilled staff are being used to ‘deliver care’ There is NO shortage of doctors Doctors are in fact stopped from working in the NHS, made redundant or just forced out. The public is being sold out by politicians @wesstreeting

Two distinct things can be true: 1. Women's sport must be protected. 2. Parkrun allows people to run with dogs/buggies. It's for everyone. It's not a competition. The suggestion that a trans runner is a threat to anyone's morning fun run is ludicrous. telegraph.co.uk/sport/2026/04/…

Car Parking Charges: • NHS Staff: £70,500,000 per year. • MPs: £0.00 per year. Egregious, in the extreme.

This morning, I asked the @Thirlwall_Inq once again to clarify when it came into possession of a crucial piece of evidence that, by the Crown Prosecution Service's own standards, materially undermined Lucy Letby's conviction. Here's what I put to them: When did the Thirlwall Inquiry come into possession of the email by Dr Jayaram that impeached the evidence he gave under oath? Was it before or after Letby was convicted at retrial – a retrial that, both prosecution and defence agreed in court, hinged on the testimony and credibility of Dr Jayaram? In their response, the Thirlwall Inquiry reiterated what they'd already told me last year: they are not willing to answer these questions for as long as they consider the inquiry to be ongoing. Keep in mind that hearings for the Thirlwall Inquiry have been over for more than a year. Closing remarks took place in March 2025. And, only two days ago, the inquiry put out a statement, announcing that their final report has been postponed indefinitely.

Cheshire police arrested someone yesterday "on suspicion of perverting the course of justice," in relation to their gross negligence manslaughter investigation into Lucy Letby's hospital. chesterstandard.co.uk/news/26046420.…

We’re excited to announce that this year’s Association Conference will be held in the vibrant city of Sheffield! 📅 1–2 October 📍 Sheffield 👉 CPD opportunities 👉 Networking Perfect for AA, MAPs, AHPs, and anaesthetists of all grades. More details coming soon!

New guidance on sterile gown use during spinal anaesthesia aims to reduce unnecessary waste while maintaining high standards of patient safety. Consensus guidelines published in @Anaes_Journal now buff.ly/rvtALwy With @RCoANews, @OAAinfo, @RegionalAnaesUK, CAI, ANZCA

Another excellent column in Private Eye from @drphilhammond. He comments on delays at the @ccrcupdate and the removal of case manager Shaun Edwards from the Letby case. "To remove him only because his words were reported in The Sun hardly screams due diligence or independence."

Heard of Palantir? Because of public pressure, on Thursday 16 April, MPs will debate Palantir’s contract with the NHS. The genocide by Israel against Palestinians in Gaza is ongoing. A company linked to genocide has NO place in our NHS. We need to make ourselves heard NOW. Act now: amn.st/6015B622sv We need as many MPs as possible to attend the debate, raise Palantir’s human rights record and oppose its role in our NHS.

If you half the number of hospital beds it doesn’t require a team of management consultants to work out why patients are stuck in corridors 🤷‍♂️

The UK governments guide to terrorism: Left: Terrorism Right: Not Terrorism

Why Lucy Letby is extremely unlikely to be granted an appeal, no matter how many experts review all the notes and trial records, and find no evidence of deliberate harm. If you couldn’t find the right defence experts first time around, it’s just bad luck. observer.co.uk/opinion-and-id…

Dear Wes, As a Consultant Oncologist it is was no inconvenience to me or my patients. We sorted a fair rota & I was delighted to support our highly indebted and underpaid Resident doctor colleagues. We also got paid tons more than the Residents. Do you see your problem? #NHS

The replies are better than Streeting's initial tweet.

Israel ruthlessly carpet bombed Lebanon today, killing at least 180 people and injuring more than 800. How does the BBC report it? “Israel says it hit more than 100 command centres and military sites in 10 minutes…” This is how war crimes are laundered.