The Color of Safety

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The Color of Safety
Reducing the Risks Associated with the use of
Colored Wrist Bands
2
What is the Problem?

• Pennsylvanias Patient Safety Authority received
  a report that the hospital staff nearly failed to
  resuscitate a patient who was incorrectly
  designated as a DNR (Do Not Resuscitate). 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 (which means not to use that arm to
  draw blood, etc.).

3
What did the survey show?

• PA-PSRS surveyed Pa. Hospitals and found that of
  those responding
• 78 used color-coded patient wristbands
• There were no standard meanings among the
  hospitals.

4
What Risk Reduction Strategies were recommended?

• 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
• Educate hospital staff on risks of wristband
  usage/authority/responsibility/maintenance

5
What is the standardized Color Code and the
Intent of Specific Colors?
Band Color Communicates (Reminder)
Red Allergy (Stop!)
Yellow Fall Risk (Use Caution)
Green Latex Allergy (Environment)
Blue DNR (Cyanosis)
Pink Restricted Extremity (Breast Ca/lymphedema)
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What happens if you are color blind?

• To reduce misinterpretation of the bands, the
  actual risk alert is preprinted so it can also be
  read easily.
• Except in emergencies, there will be no
  handwriting on the bands.

7
Who keeps checking the bands , especially if
patients travel about?

• The medical staff will re-confirm colored bands
• before treatment such as drawing blood or
  starting an IV.
• When a patient in transferred to another
  facility/hospital.
• Errors and/or omissions are corrected immediately.

8
How do you educate the patient?

• When admitted, the pt./family is
• Educated regarding the band(s) message and
  importance.
• Advised to contact the nurse if the band falls
  off or is removed and not reapplied immediately.

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What about the use of Community Charity Bands?

• If the patient is wearing a charity 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.

10
When can the color band be removed?

• 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
  staff at the next hospital.

11
Can band intentions be carried from one place to
another?

• 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

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PATIENT SAFETY

• As always your SAFETY is our biggest concern.
• We are working together to provide you the best
  care possible