The LAST word on safety: an iterative quality improvement study of local anaesthetic documentation

The use of local anaesthetics is widespread in peri-operative care and guidance recommends calculating and documenting the maximum safe dose and recording drug concentration in mg.ml^-1. We conducted a single-centre quality improvement project to improve documentation of local anaesthetic dosing in 357 adult surgical patients. Six plan-do-study-act cycles were implemented over 10 months, including staff education, a dose-calculation nomogram, a modified WHO sign-in pause and a standardised local anaesthetic documentation sticker. At baseline, no record documented the maximum dose or recorded concentration using mg.ml^-1. After introducing the sign-in pause and documentation sticker, statistical process control charts showed a sustained improvement in documentation, with rates > 95%. These low-cost workflow interventions may support more standardised documentation and shared team awareness.