Color of Safety Wristbands

Ministry Door County Medical Center

1. The Color of SafetyThe Color of Safety
Color-coded Alert Standard
for Patient Wristbands
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2. Impetus for Standardization
•National
–Pennsylvania – wrong color Do Not Resuscitate band applied by
nurse who works in two different hospitals with two different protocols
•Wisconsin
–Young man transferred from a hospital in Dodgeville to a Madison
hospital for advanced heart care
–Upon arrival at the Madison hospital, a nurse commented on his Do Not
Resuscitate (DNR) wristband
–The blue patient name-band applied at Dodgeville was the same blue
color as the Madison hospital’s wristband for DNR status
–This mix up was immediately clarified and the wristband removed
–This real life scenario could happen in any Wisconsin hospitals
•What is meant to be a patient safety communication may have fatal
consequences
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3. Findings Across Wisconsin
•Safety is a key priority for WI health care organizations
–Near misses have been reported nationally & in WI
–Many WI systems/regions are interested in standardizing
communication about patient information and risks
•Not all WI hospitals use color as a safety alert
•For hospitals that do use color as a safety alert, there is variation
–Safety conditions (DNR, falls, allergies, limb restriction, blood, etc.)
–Type of alert product (wristband, plaque by room, chart stickers, etc.)
–Colors use for each alert (purple, blue, red, pink, dots, pictures, etc.)
–Number of alerts (3-29?)
•Several states have already adopted color standards including
Minnesota (Michigan, Illinois, and Indiana currently evaluating)
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4. 4
WI Hospital Assoc Board
Resolution
The Wisconsin Hospital Association recommends
that all hospitals evaluate methods to effectively
communicate patient information and risks. In the
interim, if an organization uses color-coded alerts to
communicate patient information or risks, the
association encourages Wisconsin hospitals to use
the following colors:
•Patient identification – White or clear
•DNR – Purple
•Allergy – Red
•Fall – Yellow

5. DCMH – Intent of Specific Color
Codes
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Band Color Communicates (“Reminder”)

RED Allergy (STOP!)
YellowYellow Fall RiskFall Risk (Use Caution)(Use Caution)
Green Blood Band (Transfusion)
Purple DNR (Cyanosis)
GRAY Multiple Victim (Code Black)

6. 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.
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7. 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.
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8. Re-application of Bands
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•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.

9. Patient/Family Education
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•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.

10. Use of Community “Social
Cause” Bands
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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.

11. Blood Transfusion ID Bands
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If the patient requires a blood transfusion, a GREEN
transfusion band with a specific ID number will be
attached to the wrist.

•The Transfusion band, formally red in color, has been
changed so not to be confused with an Allergy wristband.
•Utilize the GREEN transfusion band
just as you did the red band in
the past.

12. Purple - DNR
F o r p a t i e n t s w h o h a v e e x p r e s s e d a n e n d - o f - l i f e w i s h , w e w i l l u s e t h e c o l o r o f P U R P L E f o r t h e D o N o t R e s u s c i t a t e d e s i g n a t i o n t h a t w i l l a s s i s t

u s i n h o n o r i n g t h a t w i s h .
Q . S h o u l d w e u s e w r i s t b a n d s f o r D N R d e s i g n a t i o n ?
A . While there is much discussion regarding the issue of “to band or not to band,” a literature review to date has not conclusively identified a better intervention in an emergency situation. 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 work-force that was largely employed by the hospital. Today, an increasing number of
healthcare providers working in hospitals are not hospital-based staff or work for more than one facility. Travel staff may not be as familiar with how to access information (as in the use of computerized
medical records) or may not be familiar with where to find information in the medical record. W h e n s e c o n d s c o u n t , a s i n a c o d e s i t u a t i o n , h a v i n g a w r i s t b a n d o n t h e p a t i e n t i s o n e
w a y t o i m p r o v e c o m m u n i c a t i o n a n d r e d u c e t h e r i s k o f a n e r r o r .
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13. Red - Allergy
If a patient has an allergy to anything – food, medicine, dust, grass,
pet hair, ANYTHING -the color of RED for the Allergy designation
will be the alert to all staff.
Q . D o w e w r i t e t h e a l l e r g i e s o n t h e a l e r t t o o ?
A . It is recommended that allergies be written in the m e d i c a l r e c o r d according to your hospital’s policy and procedure and should not be written on the alert for several reasons:
–
Legibility may hinder the correct interpretation of the allergy listed.
–
By writing allergies on the alert someone may assume the list is comprehensive. However, space is limited on an alert and some patients have multiple allergies. The risk is that
some allergies would be inadvertently omitted—leading to confusion or missing an allergy. By having one source of information to refer to, such as the medical record, staff of all
disciplines will know where to find a complete list of allergies.
–
Throughout a hospitalization, allergies may be discovered by clinicians such as dieticians, radiologists, pharmacists, etc. This information is typically added to the medical record and
not always to the alert. By having one source of information to refer to, such as the medical record, staff of all disciplines will know where to add newly discovered allergies.
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14. Yellow - Fall RiskYellow - Fall Risk
We want to prevent falls at all times. When a patient may need to be assisted when
walking or they may fall the color of YELLOW for the Fall Risk designation will be used.
Q . W h y d i d y o u s e l e c t Y e l l o w ?
A. Research of other industries tells us that yellow has an association that implies “Caution!” Think of traffic lights: yellow lights mean proceed with caution or stop altogether. The American National Standards Institute
(ANSI) has designated certain colors with very specific warnings. ANSI uses yellow to communicate “Tripping or Falling hazards.” This fits well in healthcare when associated with a Fall Risk. Caregivers 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.
Q . W h y e v e n u s e a n a l e r t f o r F a l l R i s k ?
A. According to the Centers for Disease Control and Prevention (CDC), falls are an area of great concern in the aging population.
–
More than a third of adults age 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.
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15. Gray – Multiple Victim
P a t i e n t T r a c k i n g S y s t e m
W i s c o n s i n i s i m p l e m e n t i n g a P a t i e n t T r a c k i n g s y s t e m t h a t w i l l a l l o w h o s p i t a l s a n d o t h e r a u t h o r i z e d p e r s o n s t o d e t e r m i n e t h e h o s p i t a l ( s ) t o w h i c h a
p e r s o n , i n v o l v e d i n a m u l t i p l e v i c t i m i n c i d e n t ( d e f i n e d a s f i v e o r m o r e p a t i e n t s b e i n g t r a n s f e r r e d t o o n e o r m o r e h o s p i t a l s ) , h a s b e e n t r a n s p o r t e d . T h i s
w i l l a s s i s t h o s p i t a l s w i t h f a m i l y r e u n i f i c a t i o n .
Q . W h o a p p l i e s t h e m u l t i p l e v i c t i m I D b a n d ?
A . The gray multiple victim wristband will be applied by EMS in the field when there is a multiple victim incident. The gray multiple victim wristband may also be applied to the patient by the hospital if the
patient presents and the hospital is able to identify that the person was involved in a multiple victim incident.
Q . W h a t s h o u l d w e d o i f w e n e e d t o r e m o v e t h e m u l t i p l e v i c t i m I D b a n d d u r i n g t h e h o s p i t a l i z a t i o n ?
A . The hospital may remove the gray multiple victim wristband if there is a medical or treatment reason to do so. However, the Patient Tracking policy requests that the wristband remain on the patient until
admission to a secondary hospital, i.e. secondary is the second hospital to which the patient may be transferred.
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16. Other Considerations
•For patients with a state DNR wristband
–State DNR wristband applies to community and emergency
services only
–Evaluate DNR status upon admission
–Cover but do not remove the State of Wisconsin DNR wristband
•Multiple victim ID band (applied by EMS)
–Gray band with bar coding
–Do not remove unless required to do so for medical purposes
•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.
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17. Safety risks will 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.
Tape over any colored “social cause”
wristbands if a patient will not removed
them.
You don’t D/C the bands when patient is
discharged.
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Conclusion