JUNE 2008 Pennsylvania’s Color-Coded Alert Wristband Standardization Project

Background  The Pennsylvania Patient Safety Authority received a near miss report related to use of color-coded alert wristbands.  The Authority decided to investigate the use of color- coded alert wristbands in Pennsylvania hospitals through use of a survey.  Results published in supplementary advisory in December 2005.

Safety First  PA-PSRS surveyed Patient Safety Officers of Pennsylvania hospitals and found that of those responding: 78% of the facilities used color-coded patient wristbands. There were no standard meanings among health care facilities.

What’s Happened as a Result?  Pennsylvania’s Color of Safety Task Force created consensus around colors.  The Pennsylvania Patient Safety Authority made available a toolkit developed by this Pennsylvania Task Force.  Task Force work receives national attention.

Voluntary Statewide Initiative The Pennsylvania Safety Authority and The Hospital & Healthsystem Association of Pennsylvania (HAP) are encouraging all hospitals to voluntarily implement standardized color-coded alert wristbands.

Color Recommendations Medical Alert Condition Color AllergyRED Latex AllergyGREEN Fall RiskYELLOW Restricted ExtremityPINK DNRPURPLE  Original recommendation in PA for DNR was changed from BLUE to PURPLE.  PA color scheme matches that selected in other states.  Not all states have adopted all five colors.

Registration/Admission Bands Colorless or clear admission identification bands and temporary clear or temporary yellow emergency room ID bands are applied in accordance with specific hospital policy.

Authority for Application of the Band  During initial and reassessment procedures, risk factors associated with falls, allergies, DNR, or restricted extremity may be identified by the nurse.  The appropriately colored wristband is applied by the nurse on the same arm as the ID band(s), except in case of restricted extremity.  Application of the band(s) is documented in the chart according to hospital policy.

Band Confirmation and Use of Supporting Documentation  To reduce misinterpretation of the bands they will be embossed to be read easily.  Except in emergencies, there will be no handwriting on the bands.  Per specific hospital policy “alert” labels/stickers may be used as an ancillary means of communicating the risk factors (used on Kardex, MAR, chart front, etc.) and will have a corresponding color and text.

“Hand-off” Communication  The nurse will re-confirm colored bands before invasive procedures, at transfer, and during changes in level of care with patient/family, other caregivers, and the patient’s chart.  Errors and/or omissions are corrected immediately.

Re-application of Band  In the event that any colored band(s) have to be removed for the treatment of the patient, the nurse will: 1. Remove the band(s) 2. Reconfirm the risks 3. Retrieve new band(s) 4. Place the band(s) on another extremity and document the action.

RECOMMENDATIONS FOR ADOPTION

ALLERGY Recommendation: Pennsylvania hospitals should adopt the color RED for the ALLERGY ALERT designation with the words printed or embossed on the wristband, “ALLERGY” FINDING: 78% of PA hospitals using color-coded wristbands indicated that they already used RED to signify that the patient had an allergy. FINDING: 78% of PA hospitals using color-coded wristbands indicated that they already used RED to signify that the patient had an allergy.

LATEX ALLERGY Recommendation: Pennsylvania hospitals should adopt the color GREEN for the LATEX ALLERGY ALERT designation with the words printed or embossed on the wristband, “LATEX ALLERGY” TIP: Pennsylvania hospitals may elect to use RED to signify that the patient has a latex allergy rather than using RED and GREEN color-coded bands. TIP: Pennsylvania hospitals may elect to use RED to signify that the patient has a latex allergy rather than using RED and GREEN color-coded bands.

FALL RISK Recommendation: Pennsylvania hospitals should adopt the color YELLOW for the FALL RISK ALERT designation with the words printed or embossed on the wristband, “FALL RISK” FACT: Falls account for more than 70% of the total injury- related health costs among persons 60 years and older. FACT: Falls account for more than 70% of the total injury- related health costs among persons 60 years and older.

RESTRICTED EXTREMITY Recommendation: Pennsylvania hospitals should adopt the color PINK for the RESTRICTED EXTREMITY designation with the words printed or embossed on the wristband, “RESTRICTED EXTREMITY” NOTE: Place this color-coded wristband on the affected extremity NOTE: Place this color-coded wristband on the affected extremity

DO NOT RESUSCITATE Recommendation: Pennsylvania hospitals should adopt the color PURPLE for the DO NOT RESUSCITATE designation with the words printed or embossed on the wristband, “DNR”

IMPLEMENTATION WORK PLAN

Key Processes  Organizational Approval  Supply Assessment and Purchase  Documentation  Staff Education and Training  Patient Education  Community Awareness

Risk Reduction Strategies  Use wristbands that are pre-printed with text that clearly identifies the alert.  Remove wristbands that have been applied from another facility.  Remove any “social cause” or other non-facility colored wristbands.

Risk Reduction Strategies  Make sure that the wristbands reflect the current medical condition or status of the patient.  Color-coded wristbands should only serve as a visual cue to caregivers.  They should not replace verification of information in the patient’s medical record.

Risk Reduction Strategies  Limit use of color-coded wristbands to high alert medical condition concerns.  Educate patients/residents and their families about the purpose and the meaning of the color-coded wristbands.  Educate health care workers on the purpose and meaning of the color-coded wristbands, including how to ensure good communication about patient status during “hand- off.”

Discharge/Transfer of Patient Color-coded bands are not removed at discharge:  For home discharges, the patient is advised to remove the band when he/she is off hospital property.  For discharges or transfer to another facility, the bands are left intact as a safety alert for “hand-off” communication.  If a photo ID with safety alert form was used, it should be photocopied and attached to the transfer in lieu of the use of safety wristbands.

In addition:  DNR status and all other risk assessments are determined by individual hospital policy, procedure, and/or physician order written within and acknowledged within that care setting only.  The receiving hospital is responsible for re- assessment and subsequent band-removal, reconfirmation and application.

Conclusion S afety risks will be assessed and the appropriate color band applied. A fter the band is applied you need to be sure to document that application in the patient’s record. F requently check the band and “hand-off” the information to other staff. E ducation the patient/family re: the band and document. T ake a picture if the patient is incapable of wearing or refuses a band, getting the release signed. Y ou don’t D/C the bands when the patient is discharged.