Momentum Builds for Standardizing Color-Coded Wristbands

While the transition to electronic medical records (EMR) is likely to play a critical role in improving patient safety, more and more healthcare providers are recognizing that by putting the right processes in place, they can have an immediate impact on reducing risks to patients.

Near-Miss Fatality
That fact was driven home just two years ago when the Pennsylvania Patient Safety Authority issued an alert that a patient had nearly died in cardiac arrest because she had been mistakenly designated as “do not resuscitate (DNR).”  The source of the confusion was the yellow wristband which the nurse had applied to the patient, thinking it signified “restricted extremity” for blood draw, as it did in a nearby hospital where she also worked.  Fortunately, another clinician identified the error and the patient was resuscitated.

Color Confusion
This near-fatal mix-up prompted hospitals in Pennsylvania to form a task force to assess the scope of the problem.  In their research¹, they found that nearly 87 percent of hospitals and 67 percent of ambulatory surgical facilities use color-coded patient wristbands.  Yet, there was little consistency in the colors used to communicate specific clinical information.  For example, while DNR status was most commonly associated with the color blue, the same color was used to designate nine other patient conditions.  Moreover, less than half of the surveyed facilities said they used text on the wristbands as an additional cue to their meaning.

States Banding Together
The lack of standardized bands is creating even more concern in those states where critical nursing shortages prompt nurses to work in multiple medical facilities, traveling from hospital to hospital and one state to another.  Certainly, that’s been the case in the West².

The Arizona Hospital and Healthcare Association has taken the lead to urge hospitals throughout the state to use the same colored wristbands to signify the same patient conditions.  It is also working to spread standardization to neighboring states through the Western Region Alliance for Patient Safety (WRAPS), which includes Arizona, California, Colorado, Nevada, New Mexico, and Utah. 

Standardization and Education
A similar initiative is underway in Ohio where the Ohio Patient Safety Institute is launching its Ohio Bands of Safety campaign.  Spurred on by the Pennsylvania alert and state legislation mandating the wristband color for DNR (white with the DNR logo), the institute is implementing statewide standardization of colored wristbands for Ohio hospitals, nursing homes, ambulatory facilities and emergency medical services before the end of 2007.   The program will reduce the numbers of colors in use from 14 to three, and add printed or embossed text for further clarification. Moreover, the agency is recommending a comprehensive training and education program for healthcare staff, patients and the community.

Though these state-based wristband initiatives vary to some degree to accommodate local customs and requirements, they closely follow the recommendations first issued by the Pennsylvania Patient Safety Authority³:

• Limit the spectrum of color-coded wristbands.
• Standardize the meanings associated with each color.
• Don’t rely solely on color to communicate the meaning.  Add preprinted, embossed text for further clarification.
• Avoid handwriting on the band except in emergency situations.
• Only allow nurses to apply or remove wristbands.
• When labels or stickers are used in the medical record to communicate specific risk factors, the colors and text should correspond with those used on the colored wristbands for the same risk.
• Prohibit wearing of patient wristbands that promote a charity or social cause within the healthcare setting. On admission, have nurses remove them, or cover them when patients do not consent to removal.
• Educate patients and their families on the risks associated with community bands and the meanings of the colored wristbands used in the healthcare setting.

Related Links
Arizona Health and Hospital Association  http://www.azhha.org/public/quality/
Ohio Patient Safety Institute  www.ohiopatientsafety.org

Planning to standardize your wristband program?  Standard Register can provide you with the resources and experience in designing and producing wristbands and labels, as well as in planning and implementing the training and education program that’s essential to your success. Contact us for more information.