Banding Together for Patient Safety

Wristband Standardization ProjectRISNA Cabinet on Nursing Practice2009

Acknowledgements

CONP Members who worked on project:Cathy Duquette - ChairDenise BezilaNancy LancasterJean TaftDave Thomas Sue Thomas

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

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.

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

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

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

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

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

Recommended Colors

Allergy RED

DNR PURPLE

Fall Risk YELLOWYELLOW

Latex Allergy GREEN

RestrictedExtremity

PINK

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

Allergy

RED for Allergies Think Stop! Danger!

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

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?

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

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.

Fall Risk

YELLOWYELLOW for Fall Risk Think Caution! Slow Down!

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.

Additional Colors

A number of states have identified standardized colors for other common conditions…

Latex Allergy

GREEN for Latex Allergy Think Environment No RI healthcare facility uses green for latex

allergies

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

Restricted Extremity

PINK for Restricted Extremity Think

Introducing Change

Rollout October 2008 RISNA MeetingImplementation presentation available

for all participating Rhode Island facilitiesAnticipated implementation date – no

later than July 1, 2009

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

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

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

Questions

Allergy RED

DNR PURPLE

Fall Risk YELLOWYELLOW

Latex Allergy GREEN

RestrictedExtremity

PINK

For statewide implementation in RI no later than July 1, 2009

Current CONP Members

Cathy Duquette - ChairKathy BergeronJanice Caianiello Christine GadboisNancy Lancaster Nicole PiermontChristina SokoloffJean Taft