Recently, CHPSO received an inquiry about the use of color-coded patient wristbands in California hospitals. To assess whether there is a national movement toward standardized armband color adoption, CHPSO surveyed its more than 485 member hospitals across 21 states.
First, what are color-coded wristbands and why should hospitals and long-term care facilities consider using them?
Patient safety color-coded wristbands are a communication tool for caregivers to quickly provide visual cues about a patient’s status and/or risk. However, the use of these wristbands is complicated by the fact that the color schema has not been standardized across hospitals. Color standardization is critical during inter-facility transfers, when providers work in more than one facility, and especially when temporary staff — e.g., travel nurses — are employed to address staffing demands. As such, wristband use has been the subject of ongoing debate.
In 2005, an advisory from the Pennsylvania Patient Safety Authority (PSA) brought national attention to the use of color-coded wristbands. The advisory highlighted an incident, which could have occurred in any hospital, that involved the incorrect placement of a wristband that almost resulted in “a patient not [being] resuscitated during cardiopulmonary arrest because she was incorrectly designated ‘DNR.’”1
Approximately three years later, the American Hospital Association (AHA) issued a statement proposing that all hospitals follow the practice of using standardized colors. The four recommended colors are:
- Red for allergies
- Yellow for falls
- Pink for restricted extremities
- Purple for do not resuscitate (DNR)
While at least 20 states have adopted AHA’s color-coded recommendations, some resistance to adopting the DNR wristband remains (see Figure 1). The Joint Commission has expressed some caution over the use of DNR bands, citing “concerns about branding patients by their end-of-life choices, or inadvertently broadcasting those choices to family and friends who have not been consulted.”2
Valuable resources that hospitals might find useful when considering the implementation of a color-coded wristband system are available online, including policies and procedures from the University of Connecticut (UConn Health) and the Wisconsin Hospital Association, Inc., as well as an exhaustive toolkit from the state of Texas.
Another model developed by the Color of Safety Task Force, which is led by the Pennsylvania PSA, includes the following best practices from the Patient Safety Update website.
- Limiting the spectrum of color-coded wristbands and standardizing the meanings associated with each color, below.
- Purchasing wristbands with preprinted, embossed text, rather than relying solely on color to communicate the meaning.
- Avoiding handwriting on the band, except in emergent situations.
- Allowing only nurses to apply or remove wristbands.
- Using corresponding colors and text for any labels or stickers used in the medical record to communicate the same risk factors.
- Prohibiting non-health care, “community” wristbands in the health care setting, with nurses removing them (or covering them, when patients do not consent to removal) on admission.
- Educating patients and their families on the risks associated with community bands and on the meanings of the colored wristbands applied in the health care setting.
CHPSO SURVEY QUESTIONS AND RESULTS
1: Does your hospital use color-coded wristbands to identify patients with allergies, DNR, fall risk, etc.?
2: If yes, do you use the standardized colors recommended by California (Red for allergies, Purple for DNR, Yellow for Fall Risk, Green for Latex allergy, Pink for restricted extremity?
3: If you don’t use the standardized colors recommended by AHA, what colors do you use and for what situations? (Aggregate responses)
- Cranberry band to indicate orifice packing in place
- Red for allergies and yellow for fall risk
- Orange band that says, “no blood”
- We have patients wear a “no allergy bracelet” if they have no allergies; a patient with a no allergy band is not treated as if they have no allergy – it causes workers to go the chart to determine
- Orange band to identify the side for surgery
- Universal protocol alternative site-marking process; the procedure/surgery will be handwritten
- Pink for restricted extremity
- Orange for intentionally retained foreign objects; blue for patients administered radioactive isotopes; a teal band that comes with Exparel (non-opioid medication); and a plain band on which the proceduralist/surgeon can initial and write the intended side/site in lieu of initialing the actual site if the patient refuses or if the proceduralist/surgeon cannot initial the site.
- Green for patients at risk for elopement/wandering
- Green for combative patients
- Blue for DNR
- Red for Blood Bank ID
- Orange for physician orders for life-sustaining treatment /advance directive; blue for no blood products; white for Patient ID bands
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