View as “PDF version”
Patient Safety Tip of the Week
February 14, 2023
Code Terminology
Still Problematic
In our September 18, 2007 Patient Safety Tip of the Week “Wristbands:
The Color-Coded Conundrum” we noted the lack of standardization of
color-coding of wristbands was problematic. Problems may arise when a
healthcare worker who usually works at another facility is now exposed to a
colored wristband at a new facility that has a different meaning.
The same problem can occur with the nomenclature of
emergency “codes”. In our October 15, 2013 Patient Safety Tip of the Week “Missing
Patients” we noted a good piece of advice from the Minnesota
Hospital Association (MHA
2011). Most of you are aware of the movement to replace
“codes” with plain language for paging emergencies in hospitals (and other
healthcare settings). Again, that is because a “Code Yellow” may mean one thing
at one hospital and a different thing at another hospital.
So, are we doing any better? Apparently not, according to a
new study. Harris et al (Harris 2022) sought to assess the ability of clinical and
non-clinical employees across the State
of Georgia to correctly identify their facility’s emergency codes.
Anonymous electronic
surveys asked 304 employees at 5 facilities to identify the codes for 14 different emergencies. Participants
correctly identified the
emergency codes with only 44.37% accuracy on
average. Codes for fire, infant
abduction, and cardiac arrest
were most commonly identified correctly (≥90%). Codes for hostage situation, internal disaster,
pediatric emergency, and mass casualty incident were incorrectly identified by more than 85% of
participants.
They also sought to identify
significant predictors of
emergency code identification accuracy. Code identification accuracy was significantly higher in participants
who received training at
employee orientation, had knowledge of emergency code activation procedures, and had worked at their current facility for two to five years.
However, accuracy was lower
in employees who had worked at four to
five facilities in their careers,
suggesting that code confusion
becomes particularly pronounced after having more than three healthcare employers.
They also assessed employees’ opinions of emergency alert systems. Most survey participants favored a color-code-based alert system over a plain
language-based alert system, citing
concerns of causing panic in
patients and visitors, and of maintaining confidentiality and discretion. But, obviously, the color-code-based
systems are not cutting it. Most
code systems in the US use color-based codes (e.g., “Code Red” for a fire), predicated
on the idea that
colors are easier to remember and serve as a tool to increase encoding among a target audience.
But individuals often
associate specific colors with specific images that may not be universal.
Harris et al. point out that approximately one in five healthcare workers has at least two jobs, and
each employer may have its own
emergency code designations. Moreover, staffing issues have resulted in
many new or temporary healthcare workers at any facility, particularly since
the COVID-19 era began.
Hospital
associations in more than 25 states in the US have recommended the introduction of a standardized set of
emergency codes and multiple hospital associations have advocated using
“plain language” codes (Wallace 2015).
There is currently
no national standard in the United
States for such warning systems in healthcare
facilities. Harris et al. conclude that transitioning to plain language overhead emergency alerts will better
position employees, as well as
patients and visitors, to effectively respond to emergencies and disasters occurring within a healthcare facility. They note that both the U.S. Federal Emergency Management
Agency (FEMA) and the Department of Health and Human Services
(DHHS) advocate for plain language
communications in all emergency and disaster communications.
The commonly cited reasons against plain language-based alerts are fear of causing panic in patients and visitors, and of maintaining confidentiality and discretion. We’ll
counter that by noting that patients and visitors can play an important role in
resolution of the incident leading to the alert. They might not know what a “Code
Gray” or “Code Pink” means, but they could certainly help identify a wandering
patient or abducted infant if the alert was more specific.
The Harris study showed that both clinical and
non-clinical employees have limited accuracy in identifying their hospital’s emergency codes. Code identification
accuracy was significantly
associated with training at
orientation, knowledge of emergency code activation procedures,
facility experience, and total facilities in the career. The majority of survey participants favored a code-based alert system over a plain
language-based alert system,
citing concerns of causing panic in
patients and visitors and maintaining confidentiality and
discretion. The Harris study and the Wallace study cite several other
studies demonstrating “code confusion”.
Hasn’t the time come for standardization of emergency alerts
in healthcare? While the time-honored use of colors in naming codes could be
standardized, we strongly favor transition to plain language-based alerts.
References:
MHA (Minnesota
Hospital Association). Plain Language Overhead Emergency Paging. Implementation
Toolkit. 2011
http://www.mnhospitals.org/Portals/0/Documents/ptsafety/overhead-paging-toolkit-2011.pdf
Harris C, Zerylnick J, McCarthy K,
et al. Breaking the Code: Considerations for Effectively Disseminating Mass
Notifications in Healthcare Settings. Int J Environ Res Public Health 2022; 19(18):
11802
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9517086/
Wallace SC, Finley E. Standardized Emergency Codes May Minimize “Code Confusion”. Pa
Patient Saf Advis 2015; 12(1):
1-6
http://patientsafety.pa.gov/ADVISORIES/Pages/201503_01.aspx
Print “PDF version”
http://www.patientsafetysolutions.com/