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Banding Together for Patient Safety
Wristband Standardization ProjectRISNA Cabinet on Nursing Practice2009
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Acknowledgements
CONP Members who worked on project:Cathy Duquette - ChairDenise BezilaNancy LancasterJean TaftDave Thomas Sue Thomas
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Wristband Standardization
The RISNA Cabinet on Nursing Practice is recommending that all Rhode Island healthcare facilities voluntarily agree to use standardized wristband colors
Colors selected are consistent with national direction
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The Problem
In Pennsylvania a patient was labeled incorrectly as DNR with a yellow wrist band. Clinicians nearly failed to resuscitate the patient until another nurse recognized the mistake.
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Did You Know?
In some states, acute care settings were using up to 10 different colors to designate 19 different risk factors.
RI is not much different!The only color standardized in RI is
Purple for Latex Allergy
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Why Consider Statewide Adoption?
Rhode Island is a small stateMany healthcare professionals work in
more than one hospitalStudents rotate to many different sitesHaving standardized colors decreases
potential for error and increases patient safety
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Review of Standardization Models
RISNA CONP completed a scan of state actions on Standardizing Wristband Colors as of April 2, 2008
CONP scan revealed that most states are using or planning to use RED for Allergies YELLOWYELLOWfor Falls PURPLE for DNR
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Review of Standardization Models
Pennsylvania and Arizona were first states to implement wristband standardization
As of July 2008, 35 states have already undertaken standardization projects 28 have adopted the 3 recommended colors,
several have adopted 2 additional colors 7 have identified they are waiting for national
standardization RI was not included
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Review of Standardization Models
In September 2008 the American Hospital Association (AHA) identifiedNational standardization initiative plannedAHA efforts endorse adoption of:
RED for Allergies
YELLOW YELLOW for Falls
PURPLE for DNR
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Recommended Colors
Allergy RED
DNR PURPLE
Fall Risk YELLOWYELLOW
Latex Allergy GREEN
RestrictedExtremity
PINK
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Recommended Process
All colored wristbands will have the precaution pre-printed on the wristband
Colorless/white/clear admission identification bands have not been identified as a cause for concern, and are not included in the recommended colors discussion
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Allergy
RED for Allergies Think Stop! Danger!
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Red for Allergy
Do we write the allergies on the wristband too? No! Allergies should not be written on the
wristband for a couple of reasons including:LegibilityAllergy list may changePatient chart should be the source for
specifics
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DO NOT RESUSCITATE
PURPLE for Do Not Resuscitate Why not BLUE for a Code Blue?
Potential for confusion – do I code or do I not code?
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DNR
100% Hospitals in RI use code blue for a medical emergency
Patient safety is about eliminating any potential for confusion
Code Blue = Resuscitate Patient If used Blue Wristband = Do Not Resuscitate
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Purple for DNR
If using the purple band, do we still need to look in the chart?
Yes! A chart should always be reviewed even if colored wristbands are used.
Code designation can and does change during a patient’s stay.
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Fall Risk
YELLOWYELLOW for Fall Risk Think Caution! Slow Down!
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Fall Risk
Why yellow for fall risk? Yellow has an association that implies
CAUTION or SLOW DOWN All healthcare providers want to be alert to fall
risks as they can be prevented by anyone.
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Additional Colors
A number of states have identified standardized colors for other common conditions…
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Latex Allergy
GREEN for Latex Allergy Think Environment No RI healthcare facility uses green for latex
allergies
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Why GREEN for latex allergy? While purple is consistently used for latex
allergy in Rhode Island, green is consistent with where the national standardization is headed.
Latex Allergy
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Restricted Extremity
PINK for Restricted Extremity Think
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Introducing Change
Rollout October 2008 RISNA MeetingImplementation presentation available
for all participating Rhode Island facilitiesAnticipated implementation date – no
later than July 1, 2009
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Any Barriers to Implementation?
Lessons learned…States already standardized have noted
little staff resistanceCost has not been noted as a major
barrier in either state.Education has not been noted as a
barrier
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Cabinet Recommendations
Encourage voluntary participation by RI health care facilities
Continue clear or white wristbands for patient identification
Use the wristband colors consistent with national effortsColor coded wristbands must include pre-
printed alert messageEducational emphasis needed for
change in PURPLE
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Cabinet Recommendations
Encourage adoption of facility policy to remove “social cause” wristbands (e.g., ‘Live Strong’) to minimize confusionConsider refusal form and cover band with
white tape if patient refuses to removeFacilities should adopt policies that
require the removal of colored wristbands applied at other facilities
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Questions
Allergy RED
DNR PURPLE
Fall Risk YELLOWYELLOW
Latex Allergy GREEN
RestrictedExtremity
PINK
For statewide implementation in RI no later than July 1, 2009
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Current CONP Members
Cathy Duquette - ChairKathy BergeronJanice Caianiello Christine GadboisNancy Lancaster Nicole PiermontChristina SokoloffJean Taft