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NurseWeek
Banding Together for Patient Safety
By Donna Hemmila
November 06, 2006
State hospital associations consider standardizing wristband colors to cut down on misinterpretation of patient conditions.
After a nurse in a Pennsylvania hospital gave a patient the wrong medical-alert wristband, he nearly died. That incident has fueled a movement to standardize the colors of condition-alert bands in hospitals throughout the west.
The Arizona Hospital and Healthcare Association is kicking off a “Safe and Sound” campaign to urge all hospitals in the state to use the same colored bands to signify the same patient conditions. Through the Western Region Alliance for Patient Safety (WRAPS), the Arizona group hopes to spread the standardization to neighboring states and eventually to hospitals throughout the country.
“Our overall goal is for this to be used on a national level,” says Beneka Brown, a quality management analyst for the Maricopa Integrated Health System in Phoenix. “Our main concern is patient safety. That’s one of the things we’re trying to work on in Arizona.
After conducting surveys to determine what colors Arizona hospitals are using, the hospital association is focusing on three conditions and three colors: A red wristband will signify allergies, yellow will identify a patient as a fall risk, and purple will signify “do not resuscitate (DNR).
The hospitals will study the outcomes for these three colors before considering additional colors for other conditions, Brown says.
The hospital association is introducing the wristband recommendations at a day-long event at the Phoenix Zoo this month. Hospital representatives can pick up “toolkits” with staff education materials and strategies for promoting the colored bands. Since using the recommended color scheme is voluntary, all health care facilities may not adopt the same color codes. In some of the state’s skilled nursing facilities, Brown says, caregivers don’t think the color standardization is needed because their staffs are smaller. Staffs at skilled nursing facilities also work with the same patients for longer periods, so they know their alert conditions.
However, when patients arrive at a hospital wearing an identification band from another facility, the possibility of misinterpretation increases. To complicate matters, a patient could be wearing a non-medical wristband, like the popular Lance Armstrong yellow bands that are sold to raise money for cancer survivors.
Colorconfusion
Hospitals around the country use a rainbow of colors to indicate various conditions. Among the customers of The St. John Companies, a major supplier of patient identification products to national health care group purchasing organizations, seven different colors are used to designate DNR patients, and seven colors are used to indicate that a patient has an allergy. Five colors — pink, red, blue, orange, and green — are used for both DNR and allergy bands. So a nurse may usually work one day in one hospital where red means “allergies” and the next day in a facility where the same-colored wristband means “do not resuscitate.” The potential for making a possibly deadly mistake is high.
That’s exactly what happened in Pennsylvania, according to a report from the state’s Patient Safety Authority last year. The safety monitoring agency found that a nurse strapped a yellow wristband on a male patient to signify that the man should not have blood drawn nor an IV inserted in the arm wearing the band; that is what the yellow band meant in another medical facility the nurse worked in. But in the hospital where the patient was admitted, yellow meant “do not resuscitate.” Clinicians nearly lost the patient when he went into cardiac arrest. Fortunately, the mistake was discovered in time to avoid a fatality.
That incident prompted hospitals in Pennsylvania to form a task force to explore the standardization of wristband colors.
The potential risks to patients from the lack of standardized bands are raising even more concerns in Western states. The critical nursing shortage in the region means some nurses often work in multiple medical facilities, and hospitals often rely on travel nurses.
“In this day and age with our nursing shortage, when we have nurses traveling from hospital to hospital and from one state to another, it’s a situation fraught with hazards,” says Jo Gott, RN, MS, NP, director of patient safety for Banner Desert Medical Center in Mesa, Ariz. “If we can get more things standardized, patient safety will benefit.”
Gott compares the need for wristband standardization to the changes manufacturers made to distinguish IV tubing from epidural-infusion tubing. The epidural tubing has yellow stripes so that caregivers won’t confuse it with the IV tubing and mistakenly administer the wrong medications. There’s no reason why wristbands can’t be standardized the same way, she says.
Gott says she has never heard of a wristband problem in Arizona causing a scare like the incident in Pennsylvania, but that doesn’t mean it hasn’t happened.
“If it has happened other places, it’s happened here,” she says.
Hospitals in Arizona are taking the lead on standardizing wristbands, says Adam Preisach, marketing manager for wristbands and patient safety at The St. John Companies. The manufacturer is sponsoring the zoo kickoff event and providing the toolkits.
The Valencia, Calif.-based company is recommending that hospitals use the standardized color bands and that the bands have the words “allergies,” “fall risk,” and “DNR” printed on them. That printed information reinforces the color code, he says, and makes the meaning accessible to people with color blindness.
His company has also developed a clear band to which small triangle-shaped plastic tabs can be clipped. Each tab can represent a different alert condition. That allows the hospital to use just one band on a patient’s arm rather than multiple bands that can become hidden under a patient’s clothing.
Good Neighbors
With Arizona taking the lead on wristband standardization, hospitals in neighboring states are exploring the issue, as well.
“As more staff work in more than one place, it has become a safety issue,” says Debby Rodgers, RN, MSN, vice president of quality and emergency services for the California Hospital Association (CHA).
The association has been working with the Association of California Nurse Leaders (ACNL) and the Hospital Council of Northern and Central California to study the wristband issue. A survey of California hospitals found that 54% already use a color-coded system, and 88% support standardizing those colors. That indicates that hospitals will be willing to consider the concept, Rodgers says.
“I think standardization in general is really an important issue for hospitals because there is so much variation,” says Caryn Relkin, projects manager for the New Mexico Hospitals and Health Systems Association, a member of WRAPS. Her group represents 43 acute care hospitals and specialty medical facilities. New Mexico is in the “infancy stage” of developing statewide patient safety initiatives, she says. She sees standardizing patient information systems as a way to reduce stress in an emergency, which would give nurses and physicians one less thing to worry about.
“This isn’t a short-term issue,” Relkin says. “The whole movement of patient safety is that we identify the things that we can improve on for better patient outcomes.”
Donna Hemmila is a freelance writer for NurseWeek. To comment on this story, send e-mail to editormtw@nurseweek.com.
Images courtesy of the St. John Companies, Inc.
Donna Hemmila (11/06/06). Banding Together for Patient Safety. Nurseweek.
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