Transcript Banding together for Patient Safety

Banding Together for
Patient Safety
Wristband Standardization Project
RISNA Cabinet on Nursing Practice
2009
Acknowledgements
CONP Members who worked on project:
 Cathy Duquette - Chair
 Denise Bezila
 Nancy Lancaster
 Jean Taft
 Dave Thomas
 Sue Thomas
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

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.
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

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

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

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


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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
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

Recommended Colors
Allergy
RED
DNR
PURPLE
Fall Risk
YELLOW
Latex Allergy
GREEN
Restricted
Extremity
PINK
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

Allergy

RED for Allergies
 Think Stop! Danger!
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
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?
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
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 patient’s stay.

Fall Risk

YELLOW for Fall Risk
 Think Caution! Slow Down!
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.
Additional Colors

A number of states have identified
standardized colors for other common
conditions…
Latex Allergy

GREEN for Latex Allergy
 Think Environment
 No RI healthcare facility uses green for latex
allergies
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.
Restricted Extremity

PINK for Restricted Extremity
 Think
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

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
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

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Color coded wristbands must include preprinted alert message
Educational emphasis needed for
change in PURPLE
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
Questions
Allergy
RED
DNR
PURPLE
Fall Risk
YELLOW
Latex Allergy
GREEN
Restricted
Extremity
PINK
For statewide implementation in RI no later than July 1, 2009
Current CONP Members
Cathy Duquette - Chair
 Kathy Bergeron
 Janice Caianiello
 Christine Gadbois
 Nancy Lancaster
 Nicole Piermont
 Christina Sokoloff
 Jean Taft
