wristband standardization presentation to nhonl – rachel rowe, associate executive director...
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WRISTBAND STANDARDIZATION
Presentation to NHONL –
Rachel Rowe, Associate Executive Director
November 6, 2007
Rationale for Standardization in AZ…
A survey conducted in March 2006 showed that 8 different colors/methods were being used to convey DNR
60% - No Band 2% - White13% - Blue 2% - Yellow
13% - Orange 2% - Green
6% - Purple 2% - Red
Rationale for Standardization in PA…
In 2005, clinicians failed to rescue a patient who had a cardiopulmonary arrest because the patient had been incorrectly designated as “DNR”.
Source of confusion was a nurse that had incorrectly placed a yellow wristband on the patient (which meant DNR at that hospital)
In a nearby hospital where she also works, yellow meant “restricted extremity” which was her intent as an alert
Arizona Process…
Wristband Standardization Workgroup: Address DNR, Allergy, Fall Risk Workgroup included nurses, pharmacists, patient
safety officers, physicians, QI staff, and educators Deliverables:
Standardize color-coded wristbands Reach consensus on color definitions Develop a workplan and Implementation Tool Kit
for hospitals to use to adopt the standardization of color-coded wristbands
It was made clear that…
The safety of our patients across the state and success in this effort depends on the participation and adoption of each and every hospital in the state. This will require a willingness to change for the greater good.
DO NOT RESUSCITATE Rationale for banding for DNR:
Increasing number of healthcare providers are not hospital based, current processes need to take this into account. Travelers or non-clinical staff may be unaware of where to look in the medical record if they are new to your hospital
When seconds count, having an alert wristband will serve as ready communication in a crisis situation, evacuation situation, or with patients in transit
Serves as a means to communicate to the family that you are clear about their end of life wishes
Rationale for purple:
Blue? Most hospitals announce a code using “Code Blue” – too much potential for confusion
Orange? Many hospitals use this color to indicate the presence of an Advanced Directive
Green? Due to color blindness, avoid it
ALLERGY
Why red? 75% of hospitals in AZ already use red Red is used in other industries to imply
“extreme concern” The American National Standards Institute
uses red to communicate “Stop!” or “Danger!”
When a caregiver sees a red band, they are prompted to “Stop!” and double check the medication, food, or treatment they are about to receive.
Allergies written on wristband?
NO!Legibility may hinder the correct
interpretationOne may assume the list is
comprehensive and not check the medical record
During the hospitalization, allergies may be discovered and added to the medical record and not always a wristband
FALL RISK
Why Yellow?Other industries use yellow to imply
“caution” ANSI uses yellow to communicate
“Tripping or Falling hazards”Caregivers need to use caution
with a person with a history of previous falls, dizziness or balance problems, or confusion
Why band for Falls?
More than a third of adults over 65 fall each year
Older adults are hospitalized for fall-related injuries 5 times more often than they are for injuries from other causes
Of those who fall, 20%-30% suffer moderate to severe injuries
Total projected cost of all fall injuries by 2020, is $43.8 billion
Risk Reduction Strategies
1. Use wristbands with the alert message pre-printed (such as DNR)
2. Remove any “social causes” wristband (such as Live Strong)
3. Remove wristbands that have been applied by another facility
4. Initiate banding upon admission, changes in condition, or when information is received during the hospital stay
Risk Reduction Strategies…
5. Educate patients and family members regarding purpose and meaning of wristband
6. Coordinate medical record/white board/care plan/door signage/stickers with the same color coding
7. Verify patient color-coded ‘alert’ wristbands upon assessment, hand-off of care and facility transfer communication
Other States…
State Allergy DNR Fall Risk Latex AllergyRestricted Extremity Patient ID Blood Product
ARIZONA
NEW JERSEY In Process of implementing
PENNSYLVANIA
COLORADO In Process of implementing
MISSOURI
OHIOWorking on proposing Purple for DNR white/clear
WEST VIRGINIA
CALIFORNIA
MINNESOTA In Process of implementing
Wristband Standardization Project
Proposed Plan for NH…
Establish small working group of nurse leaders, pharmacist, QI professionals, and physicians to review the Arizona model and toolkit
Reach consensus on the “interest and readiness” to propose a statewide initiative
Recommend adoption of an existing model with NH specific Toolkit
Develop a work plan and timetable for implementation
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