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Jumping on the Wristband Wagon

Standardized program aims for patient safety

Monday April 7, 2008
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New Hampshire is joining other states in adopting a standardized approach to wristbands. A multidisciplinary team with representatives from several New Hampshire hospitals is planning the implementation of a statewide color-coded wristband standardization program with the hopes of launching the initiative Jan. 1, 2009. The program has the support and endorsement of the New Hampshire Organization of Nurse Leaders.

"Standardizing the color on wristbands gives us accurate, recognizable information about the patient," says Roberta Vitale-Nolen, RN, president of the NHONL. "Color-coded wristbands can serve as an important alerting system for all care providers regarding critical patient information, and standardizing color-coding across organizations minimizes the risk of caregivers misinterpreting the meaning of such wristbands."

Vitale-Nolen says the NHONL will assist New Hampshire's Foundation for Healthy Communities in promoting a statewide adaptation of the program. Details regarding the program's promotion and implementation are yet to be determined. The committee is co-chaired by Diane Allen, RN, chief nursing officer at Concord Hospital, and Donna M. Brown, RN, nursing director of medical specialties at Dartmouth-Hitchcock Medical Center.

Allen says color-coded wristbands offer an opportunity to communicate patient safety risks. She says the goal of standardizing the colors is to reduce confusion for people who work in more than one organization and for staff who are temporary or travel to different hospitals. Standardization of wristband colors also has the endorsement of the American Hospital Association.

In a prepared statement, Nancy Foster, AHA's vice president for quality and patient safety, said, "The more we can standardize the way we communicate critical information, the more we reduce the chance of tragic error in care."

While there is no national standardization for wristband colors, several states have implemented their own wristband color standardization programs. Many of them, including New Hampshire, are structuring their programs based on a program developed in Arizona. The Arizona Color-Coded Wristband Standardization Program advocates the use of three colors: purple for DNR, red for allergies, and yellow for fall risk. Some states have included pink for extremity restriction — no blood draws, no IV access — and green for latex allergy. Pennsylvania uses blue for DNR.

" 'Standardize where you can' is one of the primary principles in patient safety," says Barb Averyt, project director for the Arizona Hospital and Healthcare Association's Safe & Sound program. Averyt led the committee that developed and implemented Arizona's Color-Coded Wristband Standardization Program. The committee researched which colors would function best and created a comprehensive toolkit to assist hospitals with implementation of the voluntary program.

Since the program's launch in November 2006, Averyt says, several states have used Arizona's toolkit to launch or plan color-coded wristband standardization programs of their own. Those states include California, Colorado, Nevada, New Mexico, Oregon, Washington, Ohio, Florida, Illinois, Alabama, West Virginia, New Jersey, and Minnesota.

Averyt says the need for wristband color standardization was highlighted by a near fatal mistake that was documented by the Pennsylvania Patient Safety Reporting System. In a 2005 national advisory, it warned of possible miscommunication related to the use of wristband colors. The advisory referred to a case in which a nurse wrongly used a yellow wristband to indicate a restricted extremity. In fact, the yellow wristband indicated a DNR. The nurse was working at two hospitals at the time. One hospital used yellow to indicate DNR, while the other used yellow to indicate restricted extremity. The mistake was caught in time, and the patient was successfully resuscitated.

Before implementing the Color-Coded Wristband Standardization Program, Averyt determined Arizona hospitals were using eight different colors to designate a patient's DNR status. As of December 2007, Averyt says 94% of Arizona hospitals now use the color purple for DNR.

Averyt is quick to state that standardizing wristband colors does not replace checking the chart for information regarding a patient.

"This is a visual cue to say to somebody that we have a message here," says Averyt. "It prompts the caregiver to check the chart and see what that message is."


Rita Marie Barsella, RN, BSN, MSJ is a freelance writer. To comment, e-mail editorNE@nursingspectrum.com.
Living by the Code: Program's Goals

1. Preprint alert message on wristbands (ie: Falls)
2.Remove “social cause” wristbands (ie: Livestrong)
3. Remove wristbands from other facilities
4. Wristband at admission, with changes in condition, with new information
5. Educate patients and family regarding wristbands
6. Coordinate chart, care plan, room signs, stickers with same color coding
7. Educate staff to verify alert wristband color upon admission, hand-off care and transfers

Source: AHA Wristband Standardization Toolkit