In 2005, a nurse working at a hospital in Pennsylvania inadvertently jeopardized a patient’s life when she placed an incorrect color-coded wristband around the patient’s arm. At her previous hospital, a yellow wrist band had been used to identify a ‘restricted extremity’. Unbeknownst to the nurse, at her new facility, the yellow wristband meant “do not resuscitate”. The patient went into cardiac arrest and nearly died when the resuscitation team hesitated to perform CPR until another nurse recognized the error.
Since this alarming incident, there has been a steady move towards establishing a national standard of color coded wristbands, to improve patient safety. Color coding is an internationally recognized way to reduce medication errors. According to Bonnie Perratto, Chief Nursing Officer at Bayhealth (Delaware): “Standardizing the color of patient wristbands provides a visual cue regarding a patient’s condition, regardless of where that care is being delivered. This benefits patients because consistency of care will be improved”.
The standardization of color-coded wristbands is critically important to all healthcare professionals, but especially for those who work at more than one facility. One of the greatest risk reduction strategies will be the achievement of a national standard for color coding wristbands.
The Pennsylvania Patient Safety Authority (PSA) has pioneered a color-coded wristband initiative. To date, thirty six states have adopted or committed to adopting the national standardized wristband system. This system is endorsed by The American Hospital Association (AHA).
The AHA recommends that all member hospitals standardize colors of their alert wristbands: red for allergy, yellow for fall risk and purple for do not resuscitate. This single step will improve communication and drastically reduce medical errors. The AHA is sponsoring education programs to help hospitals transition to the new colors. Training should include all employees. The association suggests employing formal and informal education at department meetings, in-services and online modules, and following up while annually evaluating competencies. The AHA reminds members that the wristbands should serve only as an alert, not a care directive. Caregivers should return to the medical record to confirm orders. Nurses must also inform patients and their families about the meaning of the bands.
In addition to the color standardization, the AHA Quality Center recommends several wristband risk-reduction strategies. For instance, the alert wristbands should be placed on the same arm as the patient’s ID band. Hospitals should use preprinted or embossed wristbands, and no one should write on the wristbands. To avoid confusion, nurses should ask the patient to remove a "social cause" or charity wristband, and if the person refuses, have him or her sign a form acknowledging the risks. Nurses should not remove the wristband at discharge, so it remains intact during transfers. Patients can remove the device one they arrive home.
The national association advises hospitals that are currently using wristbands with different color meanings than the new standard to discontinue all wristband use for about six months. This will allow the staff to adjust to the colors when they are reintroduced and avoid the potential for errors.
The Arizona Hospital and Healthcare Association has developed an Implementation Toolkit: Color-Coded Wristband Standardization in Arizona (November 2006). This Toolkit can be used as a blueprint for other states to develop a standardized color-coded wristband protocol. This toolkit can be accessed at: http://www.azhha.org/patient_safety/wristbandtoolkit.pdf