The Color of SafetyThe Color of SafetyColor-coded Alert

Standardfor Patient Wristbands

1

Impetus for Standardization

• National– Pennsylvania – wrong color Do Not Resuscitate band applied

by nurse who works in two different hospitals with two different protocols

• Wisconsin– Young man transferred from a hospital in Dodgeville to a

Madison hospital for advanced heart care– Upon arrival at the Madison hospital, a nurse commented on his

Do Not Resuscitate (DNR) wristband– The blue patient name-band applied at Dodgeville was the same

blue color as the Madison hospital’s wristband for DNR status– This mix up was immediately clarified and the wristband

removed – This real life scenario could happen in any Wisconsin hospitals

• What is meant to be a patient safety communication may have fatal consequences

2

Findings Across Wisconsin

• Safety is a key priority for WI health care organizations– Near misses have been reported nationally & in WI– Many WI systems/regions are interested in standardizing

communication about patient information and risks• Not all WI hospitals use color as a safety alert• For hospitals that do use color as a safety alert, there is variation

– Safety conditions (DNR, falls, allergies, limb restriction, blood, etc.) – Type of alert product (wristband, plaque by room, chart stickers, etc.)– Colors use for each alert (purple, blue, red, pink, dots, pictures, etc.)– Number of alerts (3-29?)

• Several states have already adopted color standards including Minnesota (Michigan, Illinois, and Indiana currently evaluating)

3

4

WI Hospital Assoc Board Resolution

The Wisconsin Hospital Association recommends that all hospitals evaluate methods to effectively communicate patient information and risks. In the interim, if an organization uses color-coded alerts to communicate patient information or risks, the association encourages Wisconsin hospitals to use the following colors:

• Patient identification – White or clear• DNR – Purple• Allergy – Red• Fall – Yellow

DCMH – Intent of Specific Color Codes

5

Band Color Communicates (“Reminder”)

RED Allergy (STOP!)

YellowYellow Fall RiskFall Risk (Use Caution)(Use Caution)

Green Blood Band (Transfusion)

Purple DNR (Cyanosis)

GRAY Multiple Victim (Code Black)

Authority for Application of the Band

• During initial and reassessment procedures, risk factors associated with falls, allergies, DNR or restricted extremity may be identified by the nurse.

• The appropriately colored wrist band is applied by the nurse on the same arm as the ID band(s), except in the case of restricted extremity.

• Application of the band(s) is documented in the chart according to hospital policy.

6

Hand-Off Communication

• The nurse will re-confirm colored bands before invasive procedures, at transfer and during changes in level of care with patient/family, other caregivers and the patient’s chart.

• Errors and/or omissions are corrected immediately.

7

Re-application of Bands

8

• In the event that any colored band(s) have to be removed for the treatment of the patient, the nurse will:

1. Remove the band(s)2. Reconfirm the risks3. Retrieve new band(s)4. Place the band(s) on another

extremity and document the action.

Patient/Family Education

9

• When admitted, the pt./family is:1. Educated regarding the band(s)

message and importance.2. Advised to contact the nurse if the

band falls off or is removed and not reapplied immediately.

• Patient education is documented in the patient record per hospital policy.

Use of Community “Social Cause” Bands

10

If the patient is wearing a band:

• The nurse will explain the risks associated with the band and he/she will be asked to remove the band.

• If the patient refuses, the nurse will cover the band with medical tape.

Blood Transfusion ID Bands

11

If the patient requires a blood transfusion, a GREEN transfusion band with a specific ID number will be attached to the wrist.

• The Transfusion band, formally red in color, has been changed so not to be confused with an Allergy wristband.

• Utilize the GREEN transfusion band just as you did the red band in the past.

Purple - DNRFor patients who have expressed an end-of-life wish, we will use the color of

PURPLE for the Do Not Resuscitate designation that will assist us in honoring that

wish.

Q. Should we use wristbands for DNR designation?

A. While there is much discussion regarding the issue of “to band or not to band,” a literature review to

date has not conclusively identified a better intervention in an emergency situation. One may say, “In

the good old days we just looked at the chart and didn’t band patients at all.” However, those days

consisted of a work-force that was largely employed by the hospital. Today, an increasing number of

healthcare providers working in hospitals are not hospital-based staff or work for more than one facility.

Travel staff may not be as familiar with how to access information (as in the use of computerized

medical records) or may not be familiar with where to find information in the medical record. When

seconds count, as in a code situation, having a wristband on the patient is one way to

improve communication and reduce the risk of an error.

12

Red - Allergy

If a patient has an allergy to anything – food, medicine, dust, grass, pet hair, ANYTHING -the color of RED for the Allergy designation will be the alert to all staff.

Q. Do we write the allergies on the alert too?

A. It is recommended that allergies be written in the medical record according to your hospital’s policy and

procedure and should not be written on the alert for several reasons:

– Legibility may hinder the correct interpretation of the allergy listed.

– By writing allergies on the alert someone may assume the list is comprehensive. However, space is

limited on an alert and some patients have multiple allergies. The risk is that some allergies would be

inadvertently omitted—leading to confusion or missing an allergy. By having one source of information

to refer to, such as the medical record, staff of all disciplines will know where to find a complete list of

allergies.

– Throughout a hospitalization, allergies may be discovered by clinicians such as dieticians, radiologists,

pharmacists, etc. This information is typically added to the medical record and not always to the alert.

By having one source of information to refer to, such as the medical record, staff of all disciplines will

know where to add newly discovered allergies.

13

Yellow - Fall RiskYellow - Fall Risk

We want to prevent falls at all times. When a patient may need to be assisted when walking or they may fall the color of YELLOW for the Fall Risk designation will be used.

Q. Why did you select Yellow?

A. Research of other industries tells us that yellow has an association that implies “Caution!” Think of traffic lights: yellow

lights mean proceed with caution or stop altogether. The American National Standards Institute (ANSI) has designated

certain colors with very specific warnings. ANSI uses yellow to communicate “Tripping or Falling hazards.” This fits well in

healthcare when associated with a Fall Risk. Caregivers want to know to be on alert and use caution with a person who

has history of previous falls, dizziness or balance problems, fatigability, or confusion about their current surroundings.

Q. Why even use an alert for Fall Risk?

A. According to the Centers for Disease Control and Prevention (CDC), falls are an area of great concern in the aging

population.

– More than a third of adults age 65 years or older fall each year.

– Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes.

– Of those who fall, 20% to 30% suffer moderate to severe injuries that reduce mobility and independence, and increase the risk of

premature death.

14

Gray – Multiple Victim

Patient Tracking System

Wisconsin is implementing a Patient Tracking system that will allow hospitals and other

authorized persons to determine the hospital(s) to which a person, involved in a multiple victim

incident (defined as five or more patients being transferred to one or more hospitals), has been

transported. This will assist hospitals with family reunification.

Q. Who applies the multiple victim ID band?

A. The gray multiple victim wristband will be applied by EMS in the field when there is a multiple victim incident.

The gray multiple victim wristband may also be applied to the patient by the hospital if the patient presents

and the hospital is able to identify that the person was involved in a multiple victim incident.

Q. What should we do if we need to remove the multiple victim ID band during the hospitalization?

A. The hospital may remove the gray multiple victim wristband if there is a medical or treatment reason to do

so. However, the Patient Tracking policy requests that the wristband remain on the patient until admission to

a secondary hospital, i.e. secondary is the second hospital to which the patient may be transferred.

15

Other Considerations• For patients with a state DNR wristband

– State DNR wristband applies to community and emergency services only

– Evaluate DNR status upon admission – Cover but do not remove the State of Wisconsin DNR wristband

• Multiple victim ID band (applied by EMS) – Gray band with bar coding– Do not remove unless required to do so for medical purposes

• Color coded bands are not removed at discharge: - For home discharges, the patient is advised to remove the band when he/she is off hospital property.– For discharges or transfer to another facility, the bands are left

intact as a safety alert for hand off communication.

16

Safety risks will be assessed and the appropriate color band applied.After the band is applied you need to be sure to document the application in the patient’s record.Frequently check the band and “hand-off” the information to other staff.Educate the patient/family re: the band and document.Tape over any colored “social cause” wristbands if a patient will not removed them.You don’t D/C the bands when patient is discharged.

17

Conclusion