1. Use of Color-coded Wristbands to Communicate Alerts
Illinois Hospital Association
METROPOLITAN CHICAGO
HEALTHCARE COUNCIL
Use of Color-coded Wristbands to Communicate Alerts
in Illinois Hospitals

2. Objectives
Provide historical perspective on use of color to communicate alerts to caregivers
Provide overview of practice in Illinois
Describe rationale for colors selected to alert caregivers
Provide recommendations for adoption and the Work Plan to implement adoption
Identify resources to support standardization of color-coded wristbands
Objectives as specified. 2

3. Historical Perspective3

4. Why do hospitals use color-coded wristbands?
Color-coded wristbands are used in healthcare settings to quickly communicate a certain healthcare status, condition, or an “alert” that a patient may have. The wristband is used so every staff member can provide the best care possible, even if they do not know the patient.*
*New Jersey Department of Health and Senior Services FAQs 4 4

5. The case for standardization
In 2005, clinicians in Pennsylvania failed to rescue a patient who had a cardiopulmonary arrest because the patient had been incorrectly identified with a “DNR” status.
The source of confusion was traced to a nurse who had incorrectly placed a yellow wristband on the patient (which meant DNR at that hospital)
In a nearby hospital where this same nurse also worked, yellow meant “restricted extremity,” which was her intent as an alert
In December 2005, a patient safety advisory was issued from the Pennsylvania Patient Safety Reporting System that received national attention. This advisory brought to the surface an incident that occurred in a hospital in which clinicians nearly failed to rescue a patient who had a cardiopulmonary arrest because the patient had been incorrectly designated as “DNR” (Do Not Resuscitate).
The incorrect designation of this patient as a “DNR” was traced to a nurse who had incorrectly placed a yellow wristband on the patient. In that hospital, a yellow wristband meant DNR. In a nearby hospital, where the nurse also worked, yellow meant “restricted extremity” which was what she wanted to alert staff about. Fortunately in this case, another nurse recognized the mistake and the patient was resuscitated. 5

6. Could this happen again?
In response to this near miss, the Pennsylvania Patient Safety Reporting System (PA-PSRS) surveyed Pennsylvania hospitals and found:
78% of the facilities used color-coded patient wristbands
45% used text on the wristbands
Wide variation existed among the facilities regarding the colors used to communicate information via wristbands
Only 33% of responding facilities required patients to remove the popular non-medical wristbands commonly used to show support for charitable endeavors 6 6

7. An alert was issued
In December 2005, the Pennsylvania Patient Safety Reporting System (PA-PSRS) released a patient safety advisory making hospitals aware of the inherent risks associated with the use of patient colored wristbands, commonly used by hospital staff to convey significant clinical information. 7 7

8. Limit the number and colors Standardize the meaning of colors
Pennsylvania Patient Safety Reporting System Identified Risk Reduction Strategies
Limit the number and colors
Standardize the meaning of colors
Use brief, pre-printed text on the bands
No handwriting on bands
Educate patient/families re: bands
Remove “social cause” bands
Develop policies and procedures defining wristband usage-authority/responsibility/maintenance
In the advisory, the Pennsylvania Patient Safety Reporting System identified these seven risk reduction strategies…. 8 8

9. Recommendations for Pennsylvania Hospitals
August 2006
Initiated the recommendations via distribution of the “Color of Safety” manual
Follow-up Survey 2007
80% of hospitals reviewed “Color of Safety” manual
50% of hospitals initiated the recommended changes
In August of 2006, the Pennsylvania Patient Safety Reporting System initiated the recommendations for the risk reduction strategies via the distribution to all Pennsylvania hospital of the “Color of Safety” manual which recommended the statewide standardization of colors on patient “alert” wristbands.
In 2007, a follow-up survey of all PA hospitals revealed that 80% of hospitals reviewed the “Color of Safety” manual and 50% of all PA Hospitals voluntarily initiated the recommended changes. 9 9

10. Practice in Illinois
Most of us can imagine the type of near miss that occurred in Pennsylvania occurring in any Illinois institution. Consider these statistics regarding hospital staff in Illinois hospitals:
In 2007, hospitals in Illinois reported an average RN vacancy rate of 6.9% (funded but unfilled positions).
The same survey reports a mean turnover rate for RNs providing direct patient care of 14.9%.
Most hospitals in the state are using registry or traveler RNs to staff vacant positions. 10

11. Illinois caregivers request guidance on the standardization of color-coded wristbands
Illinois Critical Access Hospital Network (ICAHN)
Regional meeting of suburban Chicago hospitals
Chicago area hospitals surveyed on the use of color-coded wristbands by Metropolitan Chicago Healthcare Council (MCHC)
Illinois hospitals surveyed on the use of color-coded wristbands by Illinois Hospital Association (IHA)
Adjacent states favor standardization across borders
Due to the large number of inquiries from hospitals across the state, as well as an inquiry from the Illinois Critical Access Hospital Network (ICAHN), the Metropolitan Chicago Healthcare Council (MCHC) and the Illinois Hospital Association (IHA) decided to assess if there was a potential for confusion in Illinois. Illinois hospitals participated in a survey asking questions related to color-coded wristbands. The results were as suspected with wide variation across hospitals in the use and meaning of wristbands, specifically those used to alert caregivers to DNR, Allergies, and Risk to Fall. 11

12. 2007 Survey of Illinois Hospitals Use of color-coded wristbands
Among Illinois hospitals responding to survey:
57 % use color-coded wristband to indicate Do Not Resuscitate
Six different colors
Most frequent color - blue
58 % use color-coded wristband to indicate an Allergy
Most frequent color - red
65 % use color-coded wristband to indicate Risk to Fall
Most frequent color – orange
The findings of the 2007 Survey of Illinois hospitals include…. (read slide)
IL Survey Data, 2007 12

13. 2007 Survey of Illinois Hospitals Results for Do Not Resuscitate
Six different colors/methods are used by Illinois hospitals to convey Do Not Resuscitate.
11% - Red
32% - Blue
3% - Yellow
5% - Purple
3% - Orange & Other
45% - Do not use color-coding for Do Not Resuscitate 13

14. 2007 Survey of Illinois Hospitals Do Not Resuscitate
Should Illinois hospitals use a standard color on wristbands to alert caregivers that a patient is not to be resuscitated?
74 % YES
26 % NO
This question was posed in the 2007 Survey of Illinois hospitals….
IL Survey Data, 2007 14

15. 2007 Survey of Illinois Hospitals Results for Allergies
Seven different colors/methods are used by Illinois hospitals to convey Allergies.
32% - Red
14% - Green
2% - Blue
4% - Yellow
2% - Purple
2% - Orange and others
44% - Do not use color-coding for Allergies 15

16. 2007 Survey of Illinois Hospitals Allergies
Should Illinois hospitals use a standard color on wristbands to alert caregivers that a patient has allergies?
78 % YES
22 % NO
This question was posed to hospitals in the 2007 Survey of Illinois hospitals….
IL Survey Data, 2007 16

17. 2007 Survey of Illinois Hospitals Results for Risk to Fall
Seven different colors/methods are being used by Illinois hospitals to convey Risk to Fall.
7% - Red
10% - Green
7% - Blue
15% - Yellow
2% - Pink
20% - Orange and Others
39% - Do no use color-coding for Risk to Fall 17

18. 2007 Survey of Illinois Hospitals Risk to Fall
Should Illinois hospitals use a standard color on wristbands to alert caregivers that a patient is at risk to fall?
78 % YES
22 % NO
Illinois hospitals were asked this question in the 2007 Survey of Illinois hospitals….
IL Survey Data, 2007 18

19. Next Steps
Survey results presented to IHA Patient Safety Task Force (PSTF), the Board of IHA, and MCHC’s Clinical, Administrative, Professional, & Emergency Services (CAPES) Patient Safety & Nursing Subcommittees
Formation of diverse workgroup:
IHA Patient Safety Task Force
MCHC
ICAHN
Chicago Patient Safety Forum
Individual hospitals
The results of the 2007 survey of Illinois hospitals were presented to the IHA Patient Safety Task Force, the Board of IHA, and MCHC’s Clinical, Administrative, Professional, and Emergency Services’ Patient Safety and Nursing Subcommittees. Based on the baseline data, the decision was made to form a joint workgroup to address the voluntary standardization of color-coded wristbands in Illinois. The workgroup was made up of several representatives of the following groups: the IHA Patient Safety Task Force; MCHC’s Nursing & Patient Safety Subcommittees; the ICAHN; the Chicago Patient Safety Forum; and several individual hospitals, ranging from critical access hospitals to academic medical centers. 19

20. Charge to IHA / MCHC Workgroup
Explore standardization of color-coded alerts
Voluntary initiative
Acknowledge risks and benefits
Explore downstream effects among early adopters
Select alerts and associated color
Formulate recommendation
Develop toolkit for implementation
The workgroup focused on three condition alerts:
Do Not Resuscitate
Allergies
Risk to Fall
The Charge to this diverse workgroup was…….(read slide). 20

21. Workgroup approach
Reviewed current standardization models in use in other states
Reached consensus on color definitions and wristbands
Formulated recommendation for statewide voluntary standardization of color-coded wristbands
The workgroup reviewed current standardization models in use in other states including Arizona, Pennsylvania, Colorado, Ohio, Missouri, and others. Following this review as well as a conference call with representatives of other states’ hospital associations, the group reached a consensus on the alerts and colors of wristbands for the same. 21

22. Recommendations for standardization
ALLERGY
FALL RISK
DNR
The following slides were developed by the Arizona Hospital and Healthcare Association as part of the Arizona toolkit for statewide implementation of color-coded wristbands. Arizona has the most extensive toolkit of all states reviewed and has been duplicated in many other states. The following slides have been modified for Illinois with the permission of the Arizona Hospital and Healthcare Association.
The following slides were developed as part of the Arizona toolkit (copyright © 2007 Arizona Hospital and Healthcare Association), and have been modified with the permission of the Arizona Hospital and Healthcare Association. 22

23. Color-coded Wristband Standardization in Illinois Do Not Resuscitate
CALLING CODE BLUE!
Used by many Illinois hospitals to summon assistance for a patient without adequate pulse or respirations.
If Illinois selected the color blue for the DNR wristband, the potential for confusion exists.
“Does ‘blue’ mean I code or I do not code?”
Recommendation:
DNR - Purple
It is recommended that hospitals adopt the color PURPLE for the “Do Not Resuscitate” designation with the words embossed / pre-printed on the wristband, “DNR”
Recommendation: Purple for the Do Not Resuscitate designation
While there is much discussion regarding the issue of “to band or not to band”, to date a comprehensive peer-reviewed literature search has not identified better interventions. One may say, “In the good old days, we just looked at the chart and didn’t band patients at all”, however, those days consisted of a workforce base that was largely core staff employed by the hospital. Now, an increasing number of health care providers are not hospital based staff, so it is imperative that current processes take this into consideration.
Wristbands are used in many Illinois hospitals to communicate an alert. Registry staff, travelers, non-clinical staff, nursing students, and medical healthcare providers, etc would most likely be unaware of where to look in the medical record. By having a wristband on, a quick warning is communicated so anyone could know about this alert.
Additionally, it is also a means to communicate to the family and significant others that we are clear about their end of life wishes. By not having a band on, errors of omission could potentially be created.
When seconds count, as in a code situation, we believe having an alert wristband on the patient will serve as a great tool. Similar to a second identifier, it will serve as a ready communication in a crisis situation, an evacuation situation, or in a transit situation. 23

24. Color-coded Wristband Standardization in Illinois Purple - Do Not Resuscitate
Recommendation - PURPLE for Do Not Resuscitate
Why not blue?
Should not be the same color that is used for calling a code
Registry, turnover, travelers, etc
Why not orange?
Pre-hospital confusion with Advance Directives
Why not green?
Color blind
“Go ahead” confusion
If we adopt purple, do we still need to look in the chart?
Yes!
Code designation can and does change during a patients stay
Recommendation: Purple for the Do Not Resuscitate designation
1. Why not use Blue?
The work group considered the work in Pennsylvania, where blue was used to standardize DNR (although Pennsylvania recently changed from blue to purple) and Arizona and the additional states that have subsequently adopted purple to standardize DNR, and the rationale behind their decisions. It also took into consideration that the standard, usual hospital emergency code utilizes a call of “code blue” to summon the resuscitation team. By also having the DNR wristband as “no code,” there was potential for confusion. “Does blue mean we code or do not code?” To avoid creating any second-guessing in this situation, the decision was made to adopt the same guideline as in the majority of states — purple to designate DNR.
2.. Why not use Green?
We considered this color as well, however, due to color blindness concerns it was decided to avoid it altogether. Also, in other industries, the color green often has a “Go Ahead” connotation, such as traffic lights. We again want to avoid any possibility of sending “mixed messages” in a critical moment.
3. If we adopt the purple DNR wristband do we still need to look in the chart?
Yes. Some hospitals do not use wristbands for DNRs because they want the chart to be reviewed first for the most current code designation. However, that practice should be the practice in all cases - whether a wristband is being used or not. Code status can change throughout a hospitalization. It is important to know the current status so the patients’ and families’ wishes can be honored. 24

25. Color-coded Wristband Standardization in Illinois Allergy
Quick Adoption
According to survey results, more Illinois hospitals use red to alert caregivers to allergies than any other color.
Recommendation: Allergy - Red
It is recommended that hospitals adopt the color RED for the ALLERGY ALERT designation with the words embossed / pre-printed on the wristband, “ALLERGY”
Recommendation: RED for the Allergy Alert designation
Allergies 25

26. Color-coded Wristband Standardization in Illinois Allergy
Recommendation - RED for the Allergy Alert
Why Red?
Currently associated with allergies by 55% of Illinois hospitals that use color-coded wristbands
Any other reasons?
Associated with other messages such as STOP! DANGER! due to traffic lights and ambulance/police lights
Do we write the allergies on the wristband too?
No because that may create new errors due to:
Legibility issues
Allergy list may change
Patient chart should be the source for the specifics
Recommendation: RED for the Allergy Alert designation
1. Why did you select red?
Red was selected due to the 2007 survey conducted with Illinois hospitals that indicated 56% of hospitals already use the color red. It just made sense to continue with an established color that has such overwhelming use.
2. Are there any other reasons for using red?
Yes there are. Our research of other industries tells us that red has an association that implies extreme concern. The American National Standards Institute (ANSI) has designated certain colors with very specific warnings. ANSI uses red to communicate “Stop!” or “Danger!”. We think that message should hold true for communicating an allergy status. When a care giver sees a red allergy alert band they are prompted to “STOP!” and double check if the patient is allergic to the medication, food, or treatment they are about to receive.
3. Do we write the allergies on the wristband too?
It is our recommendation that allergies be written in the medical record according to your hospital’s policy and procedure. We suggest allergies not be written on the wristband for several reasons:
Legibility make hinder the correct interpretation of the allergy listed;
By writing allergies on the wristband someone may assume the list is comprehensive. However, space is limited on a wristband and some patients have in excess of 12 or more allergies. The risk is some allergies would be inadvertently omitted.
Throughout a hospitalization, allergies may be discovered by other care-givers, such as dieticians, radiologists, pharmacists, etc. This information is typically added to the medical record and not always a wristband. By having one source of information t refer to, such as the medical record, staff of all disciplines will know where to add newly discovered allergies. 26

27. Color-coded Wristband Standardization in Illinois Fall Risk
Allergies
Falls account for more than 70 percent of the total injury-related health costs among people 60 years of age and older.
Recommendation:
Fall Risk - Yellow
It is recommended that hospitals adopt the color YELLOW for the Fall Risk Alert designation with the words embossed / pre-printed on the wristband, “Fall Risk”
Recommendation: YELLOW for the Fall Risk designation
Why even use an alert band for Fall Risk?
According to the Centers for Disease Control and Prevention (CDC), falls are an area of great concern in the aging population. According to the CDC,
More than a third of adults aged 65 years or older fall each year.
Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes.  
Of those who fall, 20% to 30% suffer moderate to severe injuries that reduce mobility and independence, and increase the risk of premature death.
The total cost of all fall injuries for people age 65 or older in 1994 was $27.3 billion (in current dollars).
By 2020, the cost of fall injuries is expected to reach $43.8 billion (in current dollars). Hospital admissions for hip fractures among people over age 65 have steadily increased, from 230,000 admissions in 1988 to 338,000 admissions in 1999.
The number of hip fractures is expected to exceed 500,000 by the year 2040. 27

28. Color-coded Wristband Standardization in Illinois Fall Risk
Allergies
Recommendation - YELLOW for Fall Risk
Why Yellow?
Associated with “Caution” or “Slow Down”
Stop lights
School buses
Hazardous intersections
American National Standards Institute (ANSI) uses yellow to communicate tripping or falling hazards
All health care providers want to be alert to fall risks as they can be prevented by anyone
Recommendation: YELLOW for the Fall Risk Alert designation
1. Why did you select yellow?
Our research of other industries tells us that yellow has an association that implies “Caution!”. Think of the traffic lights; proceed with caution or slow down is the message with yellow lights. The American National Standards Institute (ANSI) has designated certain colors with very specific warnings. ANSI uses yellow to communicate “Tripping or Falling hazards.” It fits well in healthcare too when associated with a Fall Risk. Care givers would want to know to be on alert and use caution with a person who has history of previous falls, dizziness or balance problems, fatigability, or confusion about their current surroundings. 28

29. *Plus one or two additional colors *Adopted late in 2008
According to AHA survey dated 7/22/2008, twenty-six states have standardized color-coded wristbands associated with Allergies (red), Fall Risk (yellow) and DNR (purple)
Alabama Arkansas Arizona
California Colorado* Florida
Illinois Iowa Kansas
Michigan Minnesota* Missouri*
Nebraska Nevada New Hampshire
New Jersey* New Mexico Ohio*
Oregon* Pennsylvania* Texas
Utah Virginia Washington
West Virginia Wisconsin Louisiana*
*Plus one or two additional colors *Adopted late in 2008
According to the American Hospital Association (AHA) survey dated July 22, 2008, twenty–six states have standardized color-coded wristbands associated with Allergies (red), Fall Risk (yellow), and DNR (purple). The state of Louisiana adopted the standardization of color-coded wristbands in late 2008 (following the collection of data by the AHA). 29 29

30. American Hospital Association (AHA) Position
“America’s Hospitals are committed to delivering safe care. To alert caregivers to certain patient risks, many facilities use color-coded patient wristbands…. Standardizing the colors of the wristbands used in hospitals is the sensible approach to improving patient safety, and many state hospital associations have already engaged their hospitals in this effort. As the national advocate for America’s hospitals, the AHA is asking all hospitals to consider using three standardized colors for alert wristbands. The colors, which have been adopted as a consensus in numerous states, are: red for patient allergies; yellow for a fall risk; and purple for do-not-resuscitate patient preferences.”*
* American Hospital Association Quality Advisory, September 4, 2008
In September 2008, the American Hospital Association published a Quality Advisory entitled, Implementing Standardized Colors for Patient Alert Wristbands. 30 30

31. Work Plan 31

32. Suggested Work Plan for facility preparation, staff education, and patient education includes:
Organizational approval
Supplies assessment and purchase
Hospital-specific documentation
Staff and patient education materials and training
Following the work plan is a task chart for each element that provides cues for methodical and successful implementation. 32

33. Sample Work Plan Document
This document has been designed to assist you in considering the stakeholders and the
depth of a system-wide implementation. There may be more steps than these – or
less, depending on your organizations infrastructure. Use this as a tool and add to it as
necessary. 33

34. Sample Task Chart
This document has been designed to assist you in very specific tasks that need to be
considered when launching a change like this. There may be more steps than these – or
less, depending on your organizations infrastructure. Use this as a tool and add to it as
necessary. 34

35. Tools for Staff Education
Poster announcing the training meeting dates/times
Staff sign-in sheet
Staff competency checklist
Tri-fold staff education brochure about this initiative
FAQs handout for staff
Tri-fold patient education brochure about color-coded wristbands
PowerPoint presentation
These tools are included in the tool kit. They are designed to help you. Use them as
you see fit. 35

36. Tri-fold staff education brochure includes:
How this all got started…the Pennsylvania story
Why this is recommended in Illinois
The national picture
What the colors are for: Allergy, Fall Risk, and DNR
Script for any staff person talking to a patient or family about the wristbands
“Quick Reference Card” cutout that lists seven other risk reduction strategies (more on the following slides)
This brochure was designed to be reprinted for all staff training. 36

37. Color-coded “Alert” Wristbands/Risk Reduction Strategies : A Quick Reference Card ____________________________________ 1. Use wristbands with the alert message pre- printed (such as “DNR). 2. Remove any “social cause” colored wristbands (such as the yellow Lance Armstrong “LIVESTRONG” wristband). 3. Remove wristbands that have been applied from another facility.
The Quick Reference Card: The following information takes each risk reduction strategy and provides further
detail and / or explanation of that strategy.
1. Use wristbands that are pre-printed with text that tells what the band means.
This can reinforce the color coding system for new clinicians, help caregivers
interpret the meaning of the band in dim light, and also help those who
may be color blind.
Eliminates the chance of confusing colors with alert messages.
2. Remove any “social cause” (such as Live Strong, Cancer, etc.) colored wristbands.
Be sure this is addressed in your hospital policy and during patient education.
Goal is for the patient and family to understand that the removal of
wristbands is solely done to enhance patient safety processes.
If that can't be done, you can cover the band with a bandage or medical tape,
but removal altogether is best.
3. Remove wristbands that have been applied from another facility.
This should be done during the entrance to facility process and/or admission.
Be sure this is addressed in your hospital policy. 37

38. ____________________________________
Color-coded “Alert” Wristbands/Risk Reduction Strategies : A Quick Reference Card (cont.)
____________________________________
4. Initiate banding upon admission, changes in condition, or when information is received during hospital stay.
5. Educate patients and family members regarding the wristbands.
6. Coordinate chart/white board/care plan/door signage information/stickers with same color coding.
7. Educate staff to verify patient color-coded “alert” wristbands upon assessment, hand-off care, and facility-to-facility transfer communication.
The following information takes each risk reduction strategy and provides further detail and / or
explanation of that strategy.
4. Initiate banding upon admission, changes in condition, or information received during
hospital stay.
5. Educate patients and family members regarding purpose and meaning of the wristbands.
Including the family in this is a safe guard for you and the patient.
Remind them that color coding provides another opportunity to prevent errors.
Use the Patient / Family Education brochure located in the tool kit.
6. Coordinate chart/ white board/care plan/door signage information/stickers with same color
coding.
For allergies, fall prevention and DNR status.
7. Educate staff to verify patient color coded “alert” wristbands upon assessment, hand- off of
care and facility transfer communication.
Remember, the wristband is a tool to communicate an alert status. Other points to make include
Educate staff to utilize the patient, medical record information (physician order for DNR) as additional
resource for verification process for allergies, fall risk, and advance directives.
When possible, limit the use of colored arm bands.
Such as, for other categories of care (i.e. latex, MRSA, tape)
If your facility uses pediatric wristbands that correspond to the Broselow color coding system for
pediatric resuscitation, take steps to reduce any confusion between these Broselow colors and
the colors on the wristbands used elsewhere in the facility. 38

39. Why have a script for staff?
We know how we say something is as important as what we say. This provides a script sheet so staff can work on the “how” as well as the “what.”
Serves as an aid to help staff be comfortable when discussing the topic of a DNR wristband.
Promotes patient/family involvement and reminds the patient/family to alert staff if information is not correct.
By following a script, patients and families receive a consistent message – which helps with retention of the information.
The Patient Education brochure also is available for staff to hand out.
Teaching Patients - The Patient Education brochure is a companion document to the staff brochure.
We know that how we say something is just as important as what we say. Patients and their loved ones are scared, vulnerable and unfamiliar with hospital ways. We need to communicate to them in a respectful and simple way without being condescending. The following text was written to serve as a “script” for staff so all could be delivering the same information to patients and families. By having a consistent message, we reinforce the information – this helps patients and families retain the information. Another benefit of having a consistent message is patients and families experience a sense of confidence in the health care system since we are all echoing each other. The text box below (on the next slide) is taken directly from the staff brochure. This is the time to mention to staff there is a patient / family brochure that can be handed out (if your unit intends on doing that). Tell staff you will hand out the brochure to them (when you are finished presenting the material) so they can see what the patients will be given. 39

40. SCRIPT for any staff person talking to a patient or family:
What is a color-coded “alert” wristband?
Color-coded “alert” wristbands are used in hospitals to quickly communicate a certain health status, condition, or “alert” that a patient may have. This is done so every staff member can provide the best care possible.
What do the colors mean?
There are three different color-coded “alert” wristbands that we are going to discuss because they are the ones most commonly used. 40

41. SCRIPT for any staff person talking to a patient or family (cont.):
RED means ALLERGY ALERT
If a patient has an allergy to anything – food, medicine, dust, grass, pet hair, ANYTHING – we want them to tell the healthcare team. It may not seem important to the patient, but it could be very important in the care the patient receives.
YELLOW means FALL RISK
We want to prevent falls at all times. Nurses assess patients throughout their stay to determine if they need extra attention in order to prevent a fall. Sometimes a person may become weakened during his/her illness or following surgery. When a patient has this color-coded “alert” wristband, the nurse is indicating this person needs to be closely monitored because he/she may fall. 41

42. SCRIPT for any staff person talking to a patient or family (cont.):
PURPLE means “DNR” or Do Not Resuscitate
Some individuals have expressed an end-of-life wish and we, the healthcare team, want to honor it. 42

43. Policy and Procedure 43

44. Policy & Procedure Information
A template policy and procedure has been provided.
Make modifications to it so it fits your organization’s process and culture.
Address how to respond when a patient refuses to wear a wristband.
Always remember that when surveyors or regulatory entities visit your organization, they will survey your performance according to the policies you have implemented.
That being said, be sure that your final policy and procedure for the wristbands is “do-able.”
This template has been provided for your consideration – adopt all of it or none of it…but do review your current policy and update it to reflect your current changes. 44

45. Excerpt from Refusal Form
The above-named patient refuses to (check what applies):
Wear color-coded “alert wristbands.
The benefits of the use of color-coded wristbands have been explained to me by a member of the healthcare team. I understand the risks and benefits of the use of color-coded wristbands, and despite this information, I do not give permission for the use of color-coded wristbands in my care.
Remove “social cause” colored wristbands (like the yellow Lance Armstrong “LIVESTRONG” and others).
The risks of refusing to remove the “social cause” colored wristbands have been explained to me by a member of the healthcare team. I understand that refusing to remove the “social cause” wristbands could cause confusion in my care, and despite this information, I do not give permission for the removal of the “social cause” colored wristbands.
Reason provided (if any):__________________________________
__________________ _________________________________________
Date/Time Signature/Relationship
_____________________ ________________________________________________
Date/Time Witness Signature/Job Title
If a patient refuses to wear a band, how do you document that?
This form facilitates that process of documentation. 45

46. In Closing
The participation of each Illinois hospital in standardization of colors associated with alerts for Allergies, Risk to Fall, and DNR is strictly voluntary. The use of color-coded wristbands as a strategy to communicate Allergies, Risk to Fall, and DNR remains the decision of the individual facility. 46

47. Resources 47

48. Illinois Wristband Toolkit
Available for download: Illinois Hospital Association Metropolitan Chicago Healthcare Council 48

49. Questions? Becky Steward Manager, Patient Safety Collaborative
Illinois Hospital Association
Dawn Niedner
Program Director
Clinical and Emergency Services
Metropolitan Chicago Healthcare Council 49

50. Additional Websites American Hospital Association Quality Center
Arizona Hospital and Healthcare Association
Ohio Patient Safety Institute
Patient Safety Authority (Pennsylvania) 50