1. Banding Together for Patient Safety
Wristband Standardization Project
RISNA Cabinet on Nursing Practice
2009

2. Acknowledgements CONP Members who worked on project:
Cathy Duquette - Chair
Denise Bezila
Nancy Lancaster
Jean Taft
Dave Thomas
Sue Thomas

3. Wristband Standardization
The RISNA Cabinet on Nursing Practice is recommending that all Rhode Island healthcare facilities voluntarily agree to use standardized wristband colors
Colors selected are consistent with national direction

4. The Problem
In Pennsylvania a patient was labeled incorrectly as DNR with a yellow wrist band. Clinicians nearly failed to resuscitate the patient until another nurse recognized the mistake.

5. Did You Know?
In some states, acute care settings were using up to 10 different colors to designate 19 different risk factors.
RI is not much different!
The only color standardized in RI is
Purple for Latex Allergy

6. Why Consider Statewide Adoption?
Rhode Island is a small state
Many healthcare professionals work in more than one hospital
Students rotate to many different sites
Having standardized colors decreases potential for error and increases patient safety

7. Review of Standardization Models
RISNA CONP completed a scan of state actions on Standardizing Wristband Colors as of April 2, 2008
CONP scan revealed that most states are using or planning to use
RED for Allergies
YELLOWfor Falls
PURPLE for DNR

8. Review of Standardization Models
Pennsylvania and Arizona were first states to implement wristband standardization
As of July 2008, 35 states have already undertaken standardization projects
28 have adopted the 3 recommended colors, several have adopted 2 additional colors
7 have identified they are waiting for national standardization
RI was not included

9. Review of Standardization Models
In September 2008 the American Hospital Association (AHA) identified
National standardization initiative planned
AHA efforts endorse adoption of:
RED for Allergies
YELLOW for Falls
PURPLE for DNR

10. Recommended Colors Allergy RED DNR PURPLE Fall Risk YELLOW
Latex Allergy
GREEN
Restricted
Extremity
PINK

11. Recommended Process
All colored wristbands will have the precaution pre-printed on the wristband
Colorless/white/clear admission identification bands have not been identified as a cause for concern, and are not included in the recommended colors discussion

12. Allergy
RED for Allergies
Think Stop! Danger!

13. Red for Allergy Do we write the allergies on the wristband too?
No! Allergies should not be written on the wristband for a couple of reasons including:
Legibility
Allergy list may change
Patient chart should be the source for specifics

14. DO NOT RESUSCITATE PURPLE for Do Not Resuscitate
Why not BLUE for a Code Blue?
Potential for confusion – do I code or do I not code?

15. DNR 100% Hospitals in RI use code blue for a medical emergency
Patient safety is about eliminating any potential for confusion
Code Blue = Resuscitate Patient
If used Blue Wristband = Do Not Resuscitate

16. Purple for DNR
If using the purple band, do we still need to look in the chart?
Yes! A chart should always be reviewed even if colored wristbands are used.
Code designation can and does change during a patient’s stay.

17. Fall Risk
YELLOW for Fall Risk
Think Caution! Slow Down!

18. Fall Risk Why yellow for fall risk?
Yellow has an association that implies CAUTION or SLOW DOWN
All healthcare providers want to be alert to fall risks as they can be prevented by anyone.

19. Additional Colors
A number of states have identified standardized colors for other common conditions…

20. Latex Allergy GREEN for Latex Allergy Think Environment
No RI healthcare facility uses green for latex allergies

21. Latex Allergy Why GREEN for latex allergy?
While purple is consistently used for latex allergy in Rhode Island, green is consistent with where the national standardization is headed.

22. Restricted Extremity
PINK for Restricted Extremity
Think

23. Introducing Change Rollout October 2008 RISNA Meeting
Implementation presentation available for all participating Rhode Island facilities
Anticipated implementation date – no later than July 1, 2009

24. Any Barriers to Implementation?
Lessons learned…
States already standardized have noted little staff resistance
Cost has not been noted as a major barrier in either state.
Education has not been noted as a barrier

25. Cabinet Recommendations
Encourage voluntary participation by RI health care facilities
Continue clear or white wristbands for patient identification
Use the wristband colors consistent with national efforts
Color coded wristbands must include pre-printed alert message
Educational emphasis needed for change in PURPLE

26. Cabinet Recommendations
Encourage adoption of facility policy to remove “social cause” wristbands (e.g., ‘Live Strong’) to minimize confusion
Consider refusal form and cover band with white tape if patient refuses to remove
Facilities should adopt policies that require the removal of colored wristbands applied at other facilities

27. Questions Allergy RED DNR PURPLE Fall Risk YELLOW Latex Allergy GREEN
Restricted
Extremity
PINK
For statewide implementation in RI no later than July 1, 2009

28. Current CONP Members Cathy Duquette - Chair Kathy Bergeron
Janice Caianiello
Christine Gadbois
Nancy Lancaster
Nicole Piermont
Christina Sokoloff
Jean Taft