1 HOSPITAL/HEALTH SYSTEM LOGO HERE February 2009 HOSPITAL/HEALTH SYSTEM LOGO HERE

2 Why Standardize? In Pennsylvania, an error occurred when a nurse placed a yellow wristband on a patient to designate "restricted extremity;" however, in that hospital, yellow designated "do- not-resuscitate." When the patient experienced an arrest, resuscitation was delayed until another staff member identified the discrepancy and revived the patient. The nurse who applied the wristband worked at another hospital in the same community where yellow designated "restricted extremity.“ Michigan hospitals currently use eight different colors of alert wristbands to denote "do-not-resuscitate.“

3 What has Happened as a Result? The Michigan Health & Hospital Association (MHA) Patient Safety Organization (PSO), headquartered in Lansing, is pursuing its own initiative to consistently communicate patient alerts to health care providers if a patient has an allergy, is a fall risk, and/or carries a do-not-resuscitate (DNR) order. At the close of 2008, more than 25 states had standardized color-coded patient alert wristbands. This endeavor is not meant to encourage hospitals to begin using color-coded patient alert wristbands if they currently do not use them. The MHA PSO’s goal is 100 percent standardization from those that use wristbands by June 2009.

Hospital Survey Results 112 Michigan hospitals use color-coded alert wristbands 23 Michigan hospitals do not use color-coded alert wristbands 9 hospitals did not respond to the survey 72 hospitals plan to standardize by June 1, hospitals will standardize at a later date

5 Voluntary Statewide Initiative The MHA PSO is encouraging all Michigan community hospitals that use color-coded patient alert wristbands to voluntarily implement standardized wristbands by June A public announcement of the effort is scheduled to take place in February 2009.

6 Standardized Wristband Colors Allergy = RED –“ALLERGY” should be printed or embossed on wristband Fall Risk = YELLOW –“FALL RISK” should be printed or embossed on wristband Do Not Resuscitate (DNR) = PURPLE –“DO NOT RESUSCITATE” or “DNR” should be printed or embossed on wristband

7 Implementation Work Plan Key Processes: Organizational Approval Supply Assessment and Purchase Documentation Staff Education and Training Patient Education Community Awareness Implementation

8 Organizational Approval HOSPITAL/HEALTH SYSTEM NAME obtained organizational approval to proceed with the standardization on DATE. HOSPITAL/HEALTH SYSTEM NAME has set the date of DATE for full standardization. Stakeholders including STAFF CONTINGENT, KEY GOVERNING COMMITTEES and OTHER were consulted in these deliberations.

9 Supply Assessment and Purchase HOSPITAL/HEALTH SYSTEM NAME materials managers provided input from the outset. The new wristbands will replace the formerly used colors of COLOR and COLOR with COLOR and COLOR, designating ALERT and ALERT, respectively. HOSPITAL/HEALTH SYSTEM NAME is not changing its vendor (VENDOR NAME), just the wristband product.

10 Documentation The new color-coded patient alert wristband policy should be reviewed by all pertinent staff. All respective forms should be reviewed for possible modifications (patient education assessments, etc.). If a patient refuses to wear an alert wristband, there should be written documentation of refusal, which is located at LOCATION. Make certain to coordinate with risk management staff and individual hospital administrators.

11 Staff Education and Training Apply registration/admission bands in accordance with hospital policy. This includes: Colorless or clear admission identification (ID) bands Temporary colorless or clear emergency room ID bands

12 Staff Education and Training (cont.) Authority for color-coded alert wristband application: During initial and reassessment procedures, review risk factors associated with falls, allergies or DNR. The appropriately colored wristband is applied by the nurse on the same arm as the ID band(s). Application of the wristband(s) is documented in the chart according to hospital policy.

13 Staff Education and Training (cont.) Wristband confirmation and use of supporting documentation: To reduce misinterpretation of the wristbands, they will be embossed with printed text to ensure readability. Handwriting on the wristbands should be avoided. Per specific hospital policy, “alert” labels/stickers may be used as an ancillary means of communicating the risk factors and will have a corresponding color and text.

14 Staff Education and Training (cont.) “Hand-off” communication: The nurse will re-confirm color-coded patient alert wristbands 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. Hand-off communication must be documented.

15 Staff Education and Training (cont.) 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.”

16 Staff Education and Training (cont.) Risk Reduction Strategies (cont.) : Remove wristbands that have been applied by staff in another facility. Remove any “social cause” or other non-facility colored wristbands. Use wristbands that are pre-printed with text that clearly identifies the alert. Make sure that the wristbands reflect the current medical condition or status of the patient.

17 Risk Reduction Strategies (cont.) : REMEMBER: Color-coded alert wristbands should only serve as a visual cue to caregivers; they should not replace verification of information in the patient’s medical record. Staff Education and Training (cont.)

18 Staff Education and Training (cont.) Relocation of wristbands for treatment: In the event that any color-coded wristband(s) must be removed for the treatment of the patient, the nurse will: 1.Retrieve new wristband(s) from LOCATION. 2.Place the new wristband(s) on another extremity (if necessary) and document the action.

19 Staff Education and Training (cont.) Re-application of wristbands, if applicable: In the event that any color-coded wristband(s) must be removed and then re-applied, the nurse will: 1.Reconfirm the risks. 2.Retrieve new wristband(s) from LOCATION. 3.Re-apply the wristband(s).

20 Staff Education and Training (cont.) Color-coded wristbands are not removed at discharge: For home discharges, the patient is advised to remove the wristband when he/she is off hospital property. For discharges or transfer to another facility, the wristbands are left intact as a safety alert for “hand-off” communication. 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/health care facility is responsible for re-assessment and subsequent wristband-removal, reconfirmation and application.

21 Patient Education Educate the patient and their family members: about the meanings of the alert wristbands and the medical condition associated with each wristband. about the risks associated with wearing “social cause” wristbands and why these bands should be removed. when a new wristband is applied and the reason. using a patient/family education brochure that explains this information, which is located at LOCATION.

22 Implementation: “Go Live” Date INSERT HOSPITAL/HEALTH SYSTEM “GO LIVE” DATE Awareness efforts leading up to the day will include EXAMPLES (publications, announcements, reminders, etc.). Removal of old stock of nonstandardized color-coded alert wristbands and replace with new, standardized color-coded alert wristbands will occur on DATE. Designated staff will review medical charts before and after standardization. Signage posted at nursing stations by STAFF on DATE. Materials management staff should be kept informed of wristband needs. Follow-up with staff to obtain feedback will occur via a survey on DATE.

23 Community Awareness Stakeholders are being informed of the effort: Local charitable organizations (particularly those using “social cause” wristbands) Local print and television media Local ambulance services Local nursing homes Local medical society Dialysis centers Imaging centers Wound centers Ambulatory surgical facilities Home health services Hospice providers Radiation oncology centers Staffing agencies Local physician offices Affiliated education organizations Services for which the hospital contracts

24 Conclusion Safety risks will be assessed and the appropriate color-coded wristband applied. After the wristband is applied, caregivers must document that application in the patient’s record. Frequently check the wristband and “hand-off” the information to other staff. Educate patient/family about the wristband and document the information provided. Take appropriate steps if the patient is incapable of wearing or refuses a wristband, such as explaining the potential risks to the patient and requesting the patient sign a refusal form. You do not remove the bands when the patient is discharged.

25 Resources To access the online version of the standardization toolkit: –visit the MHA PSO Web site at –click on “Patient Safety Initiatives,” then click “Patient Alert Wristband Standardization” Questions? For more information, contact HOSPITAL/HEALTH SYSTEM CONTACT NAME at PHONE or ADDRESS.

26 MHA PSO Background The Michigan Health & Hospital Association (MHA) has created the state’s first Patient Safety Organization (PSO). The role of the MHA PSO: –Collect data on the National Quality Forum’s 28 serious adverse events –Work with providers to analyze the sources of those errors –Encourage a culture of patient safety –Recommend and disseminate methods and tools for error prevention The MHA is uniquely positioned as a PSO because: –Since 2003, MHA has led the nation in improving patient safety and quality through its groundbreaking MHA Keystone Center –MHA has collected health care data from Michigan hospitals for more than 25 years This standardization is the first initiative of the MHA PSO and began with a member hospital survey in 2008.