Banding Together for Patient Safety

1
Banding Together for Patient Safety

• Wristband Standardization Project
• RISNA Cabinet on Nursing Practice
• 2009

2
Acknowledgements

• CONP Members who worked on project
• Cathy Duquette - Chair
• Denise Bezila
• Nancy Lancaster
• Jean Taft
• Dave Thomas
• Sue Thomas

3
Wristband Standardization

• The RISNA Cabinet on Nursing Practice is
  recommending that all Rhode Island healthcare
  facilities voluntarily agree to use standardized
  wristband colors
• Colors selected are consistent with national
  direction

4
The Problem

• In Pennsylvania a patient was labeled incorrectly
  as DNR with a yellow wrist band. Clinicians
  nearly failed to resuscitate the patient until
  another nurse recognized the mistake.

5
Did You Know?

• In some states, acute care settings were using up
  to 10 different colors to designate 19 different
  risk factors.
• RI is not much different!
• The only color standardized in RI is
• Purple for Latex Allergy

6
Why Consider Statewide Adoption?

• Rhode Island is a small state
• Many healthcare professionals work in more than
  one hospital
• Students rotate to many different sites
• Having standardized colors decreases potential
  for error and increases patient safety

7
Review of Standardization Models

• RISNA CONP completed a scan of state actions on
  Standardizing Wristband Colors as of April 2,
  2008
• CONP scan revealed that most states are using or
  planning to use
• RED for Allergies
• YELLOWfor Falls
• PURPLE for DNR

8
Review of Standardization Models

• Pennsylvania and Arizona were first states to
  implement wristband standardization
• As of July 2008, 35 states have already
  undertaken standardization projects
• 28 have adopted the 3 recommended colors, several
  have adopted 2 additional colors
• 7 have identified they are waiting for national
  standardization
• RI was not included

9
Review of Standardization Models

• In September 2008 the American Hospital
  Association (AHA) identified
• National standardization initiative planned
• AHA efforts endorse adoption of
• RED for Allergies
• YELLOW for Falls
• PURPLE for DNR

10
Recommended Colors
11
Recommended Process

• All colored wristbands will have the precaution
  pre-printed on the wristband
• Colorless/white/clear admission identification
  bands have not been identified as a cause for
  concern, and are not included in the recommended
  colors discussion

12
Allergy

• RED for Allergies
• Think Stop! Danger!

13
Red for Allergy

• Do we write the allergies on the wristband too?
• No! Allergies should not be written on the
  wristband for a couple of reasons including
• Legibility
• Allergy list may change
• Patient chart should be the source for specifics

14
DO NOT RESUSCITATE

• PURPLE for Do Not Resuscitate
• Why not BLUE for a Code Blue?
• Potential for confusion do I code or do I not
  code?

15
DNR

• 100 Hospitals in RI use code blue for a medical
  emergency
• Patient safety is about eliminating any potential
  for confusion
• Code Blue Resuscitate Patient
• If used Blue Wristband Do Not Resuscitate

16
Purple for DNR

• If using the purple band, do we still need to
  look in the chart?
• Yes! A chart should always be reviewed even if
  colored wristbands are used.
• Code designation can and does change during a
  patients stay.

17
Fall Risk

• YELLOW for Fall Risk
• Think Caution! Slow Down!

18
Fall Risk

• Why yellow for fall risk?
• Yellow has an association that implies CAUTION or
  SLOW DOWN
• All healthcare providers want to be alert to fall
  risks as they can be prevented by anyone.

19
Additional Colors

• A number of states have identified standardized
  colors for other common conditions

20
Latex Allergy

• GREEN for Latex Allergy
• Think Environment
• No RI healthcare facility uses green for latex
  allergies

21
Latex Allergy

• Why GREEN for latex allergy?
• While purple is consistently used for latex
  allergy in Rhode Island, green is consistent with
  where the national standardization is headed.

22
Restricted Extremity

• PINK for Restricted Extremity
• Think

23
Introducing Change

• Rollout October 2008 RISNA Meeting
• Implementation presentation available for all
  participating Rhode Island facilities
• Anticipated implementation date no later than
  July 1, 2009

24
Any Barriers to Implementation?

• Lessons learned
• States already standardized have noted little
  staff resistance
• Cost has not been noted as a major barrier in
  either state.
• Education has not been noted as a barrier

25
Cabinet Recommendations

• Encourage voluntary participation by RI health
  care facilities
• Continue clear or white wristbands for patient
  identification
• Use the wristband colors consistent with national
  efforts
• Color coded wristbands must include pre-printed
  alert message
• Educational emphasis needed for change in PURPLE

26
Cabinet Recommendations

• Encourage adoption of facility policy to remove
  social cause wristbands (e.g., Live
  Strong) to minimize confusion
• Consider refusal form and cover band with white
  tape if patient refuses to remove
• Facilities should adopt policies that require the
  removal of colored wristbands applied at other
  facilities

27
Questions
For statewide implementation in RI no later than
July 1, 2009
28
Current CONP Members

• Cathy Duquette - Chair
• Kathy Bergeron
• Janice Caianiello
• Christine Gadbois
• Nancy Lancaster
• Nicole Piermont
• Christina Sokoloff
• Jean Taft