Fiona Stanley Fremantle Hospitals Group

PrepCheck is a pre-block time-out process – a simple but highly effective safety check which prevents wrong side nerve blocks. It confirms the correct side and site to be blocked at the moment sterile prep is applied for the block.

An alternative to the ‘Stop Before You Block’ process, it addresses human factors in busy clinical environments where the risk of human error is high.

PrepCheck was developed by regional anaesthesia specialists at Fiona Stanley Fremantle Hospitals Group, part of the broader South Metropolitan Health Service (external site) based in Perth, Western Australia.

Following a successful pilot, PrepCheck is already being used across multiple Perth public hospitals.

PrepCheck supports patient safety

PrepCheck was developed in response to a series of wrong side blocks, where wrong side skin prep, distractions and forgetting to do a formal block check were implicated.

Previous processes delayed the formal block check until final needle insertion (needle-in-hand) which:

enabled wrong side skin prep
risked task fixation
timed the block check at a moment of high cognitive load (after ultrasound scanning).

The simple and intuitive PrepCheck process:

ensures the correct site/side is checked from the start
improves communication, teamwork and wider staff engagement
is compatible with existing theatre checklists, causing minimal disruption to workflow.

How to perform PrepCheck

The three-step process links the actions of skin PREP and block CHECK.

It should involve at least two members of the clinical team, typically an:

anaesthetist (referred to as the Blocker)
assistant, such as an anaesthetic technician or nurse.

Application of sterile skin prep for the block prompts the Blocker to lead a two-person check of site and side.

Linking these two actions builds the block check into the workflow, making it difficult to skip this essential step.

PrepCheck at a glance

Step	Actions	How it supports safety
Step 1 Hold the PREP	Blocker holds skin prep, assigns an Assistant, and says, “Let’s do a PrepCheck”.	Creates a momentary pause, prompting communication and teamwork. Acts as an obvious visual and verbal clue to the wider team.
Step 2 Block CHECK	Blocker and Assistant (and patient if awake) check: patient and ID band surgical consent surgical mark. Blocker maintains responsibility for leading process and applying skin prep throughout.	Acts as the formal two-person check of block site/side against sources of truth.
Step 3 PREP the skin Complete block	Blocker applies sterile skin prep to the block site/side and completes nerve block. Repeat PrepCheck if: there is a delay completing the block a distraction away from the block area there is a new block or patient position changes.	Acts as a physical and mental commitment to specific block site/side. Blocker unlikely to insert block needle elsewhere.

Step

Actions

How it supports safety