Patient Safety Tip of the Week
September 18, 2007
Wristbands: The Color-Coded Conundrum
In several of our Tips of the Week
we have mentioned issues related to the use of colored-coded labels or
identifiers to alert staff to a number of issues (high alert medications, flag
catheters, flag orders, etc.). Visual cues are a time-honored way of
communicating information of extreme importance. However, lack of
standardization of colors and their meanings can lead to dangerous
circumstances and produce undesired outcomes.
An advisory by the Pennsylvania Patient Safety
Authority in December 2005 was inspired by a near-miss incident in
which a patient incorrectly had a yellow-colored wrist band placed that meant
“Do Not Rescuscitate”. The nurse who placed the yellow wrist band usually
worked in another facility where a yellow wristband meant “restricted
extremity”. The advisory gave several other examples of incidents arising from
color-coded wrist bands and also noted that wristbands are often temporarily
removed for procedures or may be covered up by the patient or a caregiver and
that some patients may come into a hospital wearing a colored wristband that
has nothing to do with their health status (eg. social cause wristbands). The
PSA then did a statewide survey and found that most facilities used color-coded
wrist bands to indicate at least some condition or alert but that lack of
standardization across facilities (for both the colors used and the conditions
for which they are used) was a major problem. They made several
recommendations:
·
Limit the number of different colors used
·
Standardize the meanings of specific colors
across healthcare facilities
·
Use only primary and secondary colors and avoid
different shades of the same color to convey different messages
·
Use brief, pre-printed text on the wristbands
to further clarify and always emboss or prepint text rather than ever using
handwriting
·
Beware of other color-coding schemes that may
be in place at the facility (such as the Broselow system for pediatric
rescuscitation carts, or certain blood bank systems)
They also recommended addressing
the issue of wristbands that patients bring with them on admission, patient/family/staff
education, policies and procedures, etc.
The issue of standardization
remains the most significant barrier to use of color-coded wristbands as a
patient safety tool. Several states and regions have done collaboratives to
adopt standardized practices on this issue. The Missouri Center for Patient
Safety recently put out an excellent toolkit "Banding Together - for patient
safety" Standardization and Implementation Toolkit”.
They adopted most of the
recommendations from the Pennsylvania PSA and recommended only three colored
wrist bands: red to denote allergies, yellow to denote high fall risk, and
purple to denote DNR. They chose red for allergy because red signals “Stop!” in
most industries and other environments. Yellow was chosen for fall prone
patients since it denotes “Caution!”. Purple was chosen to denote that a
patient has “Do Not Rescuscitate” status, largely because blue (currently used
at many hospitals) might lead to confusion. Since “Code Blue” is used by many
hospitals to summon the rescuscitation team, a blue wristband might confuse
people as to whether blue means “do I code or not code here?”. They also
recommend pre-printing text on the bands to help reinforce the color-coding
system for new staff and to help avoid confusion in dim light or for color
blind individuals.
They recommend removal of any
“social cause” or other colored wristbands on admission (with appropriate
education of patients and families of the reasons) and, if that is not
possible, covering those wristbands with bandages or medical tape. And
wristbands from other facilities should be removed.
The Missouri toolkit has excellent resources for implementation, including good tips about development of policy and procedure, a sample workplan, FAQ’s, staff education, patient/family education, community education, brochures, PowerPoint slides, and even references on makers and designs of wristbands.
We highly recommend use of
color-coded wristbands for the above indications, but only when you can be
reasonably sure that all healthcare workers who might be working in your
facility fully understand their meaning and use. That usually means that there
has been a regional or state-wide collaborative to standardize the colors and
their meanings across healthcare sites. We see many such regional organizations
looking for a good project to collaborate on. This is a good one and most of
the leg work has already been done for you!
Addenda:
The Colorado Foundation for Medical
Care also provides a Wristband
Color Standardization Project Implementation Toolkit. They add the color
green to denote latex allergy and the color pink to denote restricted
extremity. They also thoughtfully recommend that the color designation should
apply not only to wristbands but any form of designation of the 5 conditions
(eg. stickers or placards).
The Minnesota Hospital
Association also has a Wristband
Implementation Toolkit. It also
adopts green to denote latex allergy and pink to denote restricted extremity.
They also provide a Power
Point presentation on the color-coded wristbands and a sample
policy.
Update: See October 2008 What’s New
in the Patient Safety World “More
on Color-Coded Wristbands”
http://www.patientsafetysolutions.com
Patient
Safety Tip of the Week Archive
What’s New in the Patient Safety World Archive