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Background and Aims In 2022, a patient suffered a fatal cardiac arrest following a ropivacaine overdose, attributed to inconsistent documentation. This tragedy exposed critical safety gaps in local anaesthetic (LA) administration, highlighting the need for standardised practices to prevent errors and improve patient safety. This project aimed to enhance LA safety at Medway Maritime Hospital by assessing LA types, dosing methods, and surgical team roles; standardising documentation and weight-based dosing; and improving communication through pre-surgical briefings.Methods A two-cycle Plan-Do-Study-Act (PDSA) approach was used, beginning with a baseline audit via questionnaires (n=60). Interventions, aligned with the Royal College of Anaesthetists’ guidelines, included standardised notation by recording LA as ‘volume (ml) of solution (mg/ml) of named LA’; implementation of ideal body weight (IBW)-based dosing calculations; enhanced documentation to ensure LA administration was recorded in the care plan; and improved verification and communication through surgeon vial checks and mandatory pre-surgical brief discussions.Results LA documentation in care plans improved from 36% to 91% (+55%, p<0.001). IBW-based dosing compliance increased from 39% to 91% (+52%, p<0.001). Pre-surgical LA discussions rose from 83% to 100% (+17%, p=0.02). Across the two cycles, LA overdoses decreased from two to one, with no clinical impact identified.Conclusions Statistical analysis confirmed significant improvements in LA safety, with p-values <0.05. The interventions effectively reduced documentation errors, dosing inconsistencies, and communication gaps, emphasising the importance of ongoing monitoring and training. Future efforts will focus on embedding these practices into routine workflows to ensure sustained improvements and safeguard patient safety across surgical units.