Green may be the color of money and red the color of love, but both take on an entirely new meaning when used on patient wristbands in hospitals. For a group of hospitals in Pennsylvania, that reality hit home a little over a year ago.
For years, news reports have warned about problems with color-coded wristbands in hospitals, whether those bands are issued by the hospitals themselves or brought in by patients to show support for causes like breast cancer awareness. But the dangers of color-coded wristbands reached a sense of urgency in Pennsylvania when the state’s patient safety authority released an advisory in December 2005 cautioning hospitals about wristband-associated risks.
The report found that a color meaning one thing in one facility meant something else entirely somewhere else. While a hospital might use a green wristband to mean a "restricted extremity" (one that should not be used for phlebotomy or IV access), for instance, that same colored band in a skilled nursing facility where the patient might be transferred could designate an allergy to latex.
That lack of standardization, the report found, could lead to near misses. In one instance, clinicians at a hospital nearly failed to resuscitate a patient who was wearing a yellow wristband. That color wristband meant "do not resuscitate" (DNR) at that particular hospital “and had been placed incorrectly on the patient’s wrist by a nurse who had worked at another hospital where yellow indicated restricted extremity.
The scope of the problem
While Moses Taylor Hospital had not experienced any problems with color-coded wristbands, the 200-bed acute care facility in Scranton, Pa., found the report troubling enough to join forces with four other area hospitals to find common ground. The group was initially brought together a year ago by a nearby rehabilitation hospital that saw some of the confusion that the variety of color-coded wristbands was causing.
When nurses would put a wristband on a patient, they were to document that in a checkbox in the patient’s chart. If stickers were used in the record, sticker colors were supposed to correspond with bands. Nurses were also instructed to reconfirm color-coded wristbands before invasive procedures, at transfer and during changes in level of care. They were to make that confirmation by talking to patients, their family members and other caregivers, and by checking the patient’s chart.
Ms. Fumanti also notes that the committee created another rule: If bands are removed at any time during a hospital stay “a DNR band is cut off prior to surgery, for instance “it should be reapplied by a registered nurse after reassessment.
The bands are supposed to remain on patients’ wrists throughout their hospital stay, even when they are transferred. If patients are going to the rehabilitation hospital, Ms. Fumanti explains, "Everyone already knows what those bands signify."
Getting the word out
Local ambulance personnel needed some education about the meaning “and importance “of the wristbands. (A "Color of Safety" implementation manual can be found online at the Pennsylvania Patient Safety Authority’s Web site.) http://www.psa.state.pa.us/psa/site/default.asp
And when the wristband initiative was introduced at Moses Taylor last November, the hospital’s three full-time hospitalists and several part-time hospitalists were brought up to speed on a one-to-one basis, according to Carmen Brutico Jr., MD, MBA, the hospital’s chief medical officer.
According to Dr. Brutico, the hospitalists helped get the word out about the new initiative to other physicians in the hospital. Sometimes the other physicians "can be difficult to get on board with a lot of these initiatives," Dr. Brutico says, but hospitalists can act as educators for these new policies.
It’s still too early to measure the impact the wristbands are having in improving patient safety, but they appear to be making a difference. In the past, for example, some physicians had been reluctant to give a DNR designation to patients. "It was in the chart," Dr. Brutico says, "but it could not be communicated in an emergency."
After noting a case in which a patient designated as DNR was resuscitated because a good process wasn’t in place, physicians saw the problem and agreed that a more visible symbol like the wristband was one solution.
And while patients can decline to wear a wristband, no one has done so. The hospitals have said that if a patient does refuse, staff must take a photo of the patient and attach colored bands or alert stickers to the photo. That photo will then be placed in the patient chart.
To date, patients have complained only that the wristbands sometimes feel rough on their skin, an issue the hospitals are trying to address with their supplier, Ms. Fumanti says.
Overall, the process of standardizing the patient wristbands moved very quickly because the hospitals focused on the main goal: "Patient safety," Ms. Fumanti explains. "That’s the main thing."
Janice Simmons is a freelance health care writer based in Alexandria, Va.