Safer local anaesthetic practices through multidisciplinary engagement: A pre-post intervention study

A fatal cardiac arrest in 2022 caused by a local anaesthetic overdose highlighted significant gaps in local anaesthetic safety, including inconsistent documentation, variable dosing practices, and inadequate communication. This quality improvement project aimed to improve local anaesthetic safety through standardised documentation, ideal body weight-based dosing, and structured multidisciplinary communication.

A pre-post intervention study was conducted at a district general hospital in South East England. Baseline data were collected using structured questionnaires completed by Operating Department Practitioners during surgical cases. Interventions, informed by national anaesthetic safety guidance, included standardised local anaesthetic documentation, mandatory ideal body weight-based dose calculation, surgeon-led vial checks, and routine discussion of local anaesthetic use during preoperative briefings. Post-intervention data were collected using the same methodology across cases.

Documentation of local anaesthetic administration in the anaesthetic chart increased from 68% (19/28) pre-intervention to 91% (29/32) post-intervention. The use of ideal body weight-based dosing increased from 29% (8/28) to 94% (30/32). Discussion of local anaesthetic during the preoperative brief improved from 82% (23/28) to 100% (32/32). The number of local anaesthetic overdoses decreased from two cases pre-intervention to one case post-intervention, with no associated patient harm.

Targeted multidisciplinary interventions, including standardised documentation, structured communication, and ideal body weight-based dosing, resulted in substantial improvements in local anaesthetic safety. These findings support the adoption of simple, scalable safety measures to reduce dosing errors and enhance perioperative patient safety.