The Color of Safety

Problem PA-PSRS received a report in which clinicians nearly failed to resuscitate a patient who was incorrectly designated as a DNR. A nurse incorrectly placed a yellow wristband on the patient. In that hospital, the yellow band meant DNR. The nurse also worked in another hospital in which yellow meant that there was a “restricted extremity” that was not be used for phlebotomy or IV access.

Safety First PA-PSRS surveyed PSO’s of Pa. Hospitals and found that of those responding: 78% of the facilities used color-coded patient wristbands There were no standard meanings among healthcare facilities.

Risk Reduction Strategies: Limit the number and colors Standardize the meaning of colors Use brief, pre-printed text on the bands Educate patient/families re: bands Remove community “charity” bands Develop P/P defining wristband usage- authority/responsibility/maintenance

Color Code- Intent of Specific Colors Band Color Communicates (“Reminder”) RedAllergy (Stop!) YellowFall Risk (Use Caution) GreenLatex Allergy (Environment) PurpleDNR (Cyanosis) Pink Restricted Extremity ( Breast Ca/lymphedema)

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. These bands have not been identified as a cause for concern in the Color of Safety initiative, and therefore, are not included for discussion.

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 wrist band is applied by the nurse on the same arm as the ID band(s), except in the case of restricted extremity. Application of the band(s) is documented in the chart according to hospital policy.

Band Confirmation & 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 hand- writing on the bands. Per specific hospital policy “alert” labels/stickers may be used as an ancillary means of communicating the risk factors (used on the 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.

Patient Education When admitted, the pt./family is: 1. Educated regarding the band(s) message and importance. 2. Advised to contact the nurse if the band falls off or is removed and not reapplied immediately. Patient education is documented in the patient record per hospital policy.

Use of Community “Charity” Bands If the patient is wearing a band: The nurse will explain the risks associated with the band and he/she will be asked to remove the band. If the patient refuses, the nurse will cover the band with medical tape and have the patient sign a refusal form acknowledging the risks associated with the community band. To avoid confusion, colored charity wrist bands are not allowed to be worn by staff, students, volunteers or patients on hospital grounds.

Patient Refusal or is Incapable to Comply with Policy If patient is capable and refuses the band: Reinforce the safety risks with the pt/family Refusal will be documented in the medical record He/she will be asked to sign a release If patient is incapable, combative or refuses: A photo ID will be taken and affixed to the photo ID form Colored alert bands or labels are affixed to the photo ID form to alert staff to the safety risks.

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 wrist bands.

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 Safety risks will be be assessed and the appropriate color band applied. After the band is applied you need to be sure to document the application in the patient’s record. Frequently check the band and “hand-off” the information to other staff. Educate the patient/family re: the band and document. Take a picture if the patient is incapable of wearing or refuses a band, getting a release signed. You don’t D/C the bands when patient is discharged.