AHA Urges Standard Colors for Wristbands
By Debra Wood, RN, contributor
In an effort to improve patient safety, the American Hospital Association (AHA) is recommending that all member hospitals standardize colors of their alert wristbands: red for allergy, yellow for fall risk and purple for do not resuscitate.
The Arizona Hospital and Healthcare Association was one of the pioneers leading the effort to standardize wristband colors. Photo source: Arizona Hospital and Healthcare Association
"Many physicians and nurses practice in more than one hospital," said Beth Feldpush, senior associate director for policy at the AHA. "If a practitioner is working in more than one hospital, [he or she] could have difficulty responding to the alerts patients are wearing if in the multiple hospitals different colors have different meanings. Standardizing the color takes away the confusion and provides one alert with a common meaning."
Feldpush indicated the AHA Quality Center followed the lead of state associations that pioneered the concept of standardized colors. Concerns originated in Pennsylvania, where a nurse who worked at more than one facility placed a do-not-resuscitate (DNR) alert wristband on a patient, thinking it meant do not draw blood from this arm. When the woman suffered a cardiac arrest, nurses quickly tried to verify the order in the chart and not finding a DNR order started resuscitation. The Pennsylvania Patient Safety Authority discovered the error and looked into the situation.
Research indicated hospitals designated a variety of colors to mean different things. They learned one in seven Pennsylvania hospitals used wristbands to denote DNR orders, but they had picked differing colors.
Fran Charney, RN, MS, CPSP. CPHRM, CPHQ, FAHRM, director of risk management and patient safety officer at Holy Spirit Hospital in Camp Hill, Pennsylvania, served as part of the original statewide effort in 2006 to standardize wristband colors. The team developed a tool kit to help fellow hospitals revise policies and assess wristband competencies.
"We live in an area with other entities, and we share staff," Charney said. "It makes sense that we be uniform."
Along with the Pennsylvania Patient Safety Authority, the Arizona Hospital and Healthcare Association was one of the first state organizations to promote color standardization, starting in 2006. Now 96 percent of Arizona’s hospitals follow the standards.
Scottsdale Healthcare adopted the standardized colors about a year ago, making some slight modifications to the program at the suggestion of its physicians and nurses. Debbie Weller, RN, MPH, manager for patient safety and regulatory for Scottsdale Health, said the modifications have resulted in a better program.
For instance, Scottsdale Health puts a red wristband on everyone and indicates what the allergies are or "NKA," meaning no known allergies. That way the staff knows the allergy issue was addressed with the patient. The hospital also added a purple clasp to the red band for patients with a do-not-resuscitate order, rather than having the patient wear a purple band, easily seen by everyone.
"Jewels" attached to a white wristband can be used for the alerts. Photo source: Arizona Hospital and Healthcare Association
"Now the staff is pleased with it," Weller said. "It has made the hospital much more standardized, especially for staff that work at another hospital or for registry people."
Continuum Health Partners network, operating Beth Israel Medical Center, St. Luke’s and Roosevelt Hospitals, Long Island College Hospital in Brooklyn and the New York Eye and Ear Infirmary, have adopted the new standard color wristbands, plus two more: pink for limb alert and green for no blood transfusions.
"This entire project, the colors of safety initiative, across all hospitals was initiated by nurses," said Carmen Schmidt, RN, MSN, director of nursing education and research at Beth Israel Medical Center, St. Luke’s and Roosevelt Hospitals.
Carmen Schmidt, RN, MSN, has helped the nurse-led wristband safety initiative at Continuum Health Partners standardize colors throughout the health system.
Continuum Health began the project about a year and a half ago, after the Continuing Care Leadership Coalition and the Greater New York Hospital Association began promoting standardization of colors. The Continuum Health nursing standards and practice council researched the issue and decided to standardize colors throughout the health system. At the time, some facilities within the health system were not consistently using wristbands and others chose different colors for fall risk.
The implementation process included updating the electronic medical record system, revising policies and procedures, and educating the nursing staff.
The AHA reminds members that the wristbands should serve only as an alert, not a care directive. Caregivers should return to the medical record to confirm orders.
"A bracelet is only as good as the individual putting it on," Charney said. "There’s a potential for error, and the chart and patient are the most reliable. Communication is key to safe patient care."
The national association advises hospitals that are currently using wristbands with different color meanings than the new standard to discontinue all wristband use for about six months. This will allow the staff to adjust to the colors when they are reintroduced and avoid the potential for errors.
In addition to the color standardization, the AHA Quality Center recommends several wristband risk-reduction strategies. For instance, the alert wristbands should be placed on the same arm as the patient’s ID band. Hospitals should use preprinted or embossed wristbands, and no one should write on the wristbands. To avoid confusion, nurses should ask the patient to remove a "social cause" wristband, and if the person refuses, to have him or her sign a form acknowledging the risks.
Nurses should not remove the wristband at discharge, so it remains intact during transfers. Patients can remove the device one they arrive home.
The AHA is sponsoring education programs to help hospitals transition to the new colors. Training should include all employees. A red wristband could alert dietary staff to a food allergy as well as nurse to a medication. The association suggests employing formal and informal education at department meetings, in-services and online modules, and following up while annually evaluating competencies.
Nurses must also inform patients and their families about the meaning of the bands.
"We’re happy to be on the forefront," Schmidt said. "Most hospitals will eventually adopt this. I take a great deal of comfort knowing we are all doing it the same way."
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