Transcript You Can’t Make This Stuff Up”

Background: Color-coded Wristband Standardization
Project in Texas
 In 2005, Pennsylvania had a “near miss” when there was
confusion regarding wristband color that resulted in a
patient being labeled DNR erroneously.
 Following the incident in Pennsylvania, states started
standardizing wristband colors.
 As of fall 2008, more than 25 states standardized
wristband colors:
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Do-Not-Resuscitate - Purple
Allergy - Red
Fall Risk - Yellow
Confusion regarding wristband color resulted in a patient being
labeled DNR erroneously.
Was there a potential for harm in Texas? In January 2008, surveys were
sent to members of the Texas Organization of Nurse Executives asking
questions related to color-coded wristbands. The results were
concerning. Six solid colors were used to designate 32 conditions.
2008 Texas Hospital Nurse Staffing Survey
Texas Center for Nursing Workforce Study
 Texas hospitals reported an average of 11.2 percent
nursing positions as vacant.
 The same survey reports the hospital turnover rate
for RNs as 16.1 percent.
 More than 56.4 percent of hospitals reported using
temporary staffing agencies or contract traveling RNs
to replace sick or absent nurses.
The Texas Initiative
Insanity: doing the same
thing over and over again
and expecting different
results.
~ A. Einstein
Under the direction of the Texas Hospital
Association, TMF Health Quality Institute, Texas
A&M Health Science Center Rural and
Community Health Institute and the Texas
Organization of Nurse Executives, a workgroup
was convened to address the standardization of
color-coded wristbands in Texas.
Standardize three condition alerts:
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Do-Not-Resuscitate
Allergy
Fall Risk
The Texas Initiative – Partner Deliverables
 Standardize color-coded wristbands statewide
 Reach consensus on color definitions
 Develop a toolkit for all hospitals
Implementation Materials
1.
Executive Summary and Background
2.
Standardized Wristband Colors
3.
Work Plan for Implementation
4.
Staff and Patient Education/Materials
5.
Policy and Procedure
Standardized Wristband Colors
Recommendation: DNR - Purple
Texas hospitals are encouraged
to adopt the color PURPLE for
the do-not-resuscitate
designation with the letters
“DNR” reversed out in white
on the wristband.
Recommendation: Allergy - Red
Texas hospitals are
encouraged to adopt the color
RED for the allergy alert
designation with the words
“ALLERGY” embossed/printed
on the wristband.
By adopting red for
allergy, the
standardization for
this is easily
achieved since most
Texas hospitals
already use red for
allergy alert
Recommendation: Fall Risk - Yellow
Texas hospitals are encouraged
to adopt the color YELLOW for
the fall risk alert designation
with the words “FALL RISK”
embossed/printed on the
wristband.
Falls account for
more than 70
percent of the
total injuryrelated health
care costs
among people
60 years of age
and older.
Work Plan – How to Implement
Work Plan – How to Implement
A suggested work plan for facility preparation, staff
education and patient education includes:
1.
2.
3.
4.
Organizational Approval
Supplies Assessment and Purchase
Hospital-specific Documentation
Staff and Patient Education and Training
Following the work plan is a task chart for each activity
that provides cues for methodical and successful
implementation.
Sample Work Plan Document
Sample Task Chart
Staff and Patient Education
Tools for Staff Education
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PowerPoint® presentation
Poster announcing training meeting session
dates/times
Staff sign-in sheet
Tri-fold staff education brochure about this initiative
Frequently Asked Questions
Staff competency checklist
Tri-fold patient education brochure about color-coded
wristbands
Sample news release
Tri-fold Staff Education Brochure
1.
How this all got started…the Pennsylvania story
2.
Why we need to do this in Texas
3.
The colors for allergy, fall risk and DNR
4.
Model script to deliver consistent information to patients
about the standardized color-coded wristbands program
5.
“Quick Reference Card” that lists 7 risk-reduction
strategies
Risk-Reduction Strategies
Color-Coded “Alert” Wristbands / Risk-Reduction Strategies –
A Quick Reference Card
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1. Use wristbands with the alert message pre-printed
(such as “DNR”).
2. Remove any “social cause” colored wristbands
(such as “LIVESTRONG”).
3. Remove wristbands that have been applied by another facility,
except for emergency identification bands.
Risk Reduction Strategies
Color-Coded “Alert” Wristbands / Risk-Reduction Strategies -A Quick Reference Card
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4. Initiate banding upon admission, changes in condition or
receipt of information during the hospital stay.
5. Educate patients and family members regarding the
wristbands.
6. Coordinate chart/white board/care plan/door signage
information/stickers with same color coding.
7. Educate staff to verify patient color-coded “alert”
wristbands upon assessment and during hand-off of care
and facility transfer communication.
Why have a script for staff?
1. How something is said is just as important as what is said. The
toolkit provides a “script” so staff can work on the “how” as well
as the “what.”
2. Serves as an aid to help staff be comfortable when discussing
the topic of a DNR wristband.
3. Promotes patient/family involvement and reminds the
patient/family to alert staff if information is not correct.
4. By following a script, patients and families receive a consistent
message – which helps with retention of the information.
5. A patient education brochure also is available for staff to
distribute.
Script for staff
What is a color-coded “alert” wristband?
Color-coded alert wristbands are used in hospitals to quickly
communicate a certain health care status or condition that a patient
may have. The color-coded wristband is a visual “alert” for all staff
members and helps every staff member.
What do the colors mean?
This hospital uses three different color-coded “alert” wristbands, and
they are the ones most commonly used in Texas as well as in hospitals
in multiple other states.
Script for staff
 Red means allergy alert
Patients should inform caregivers about an allergy to anything – food, medicine,
latex, dust, grass, pet hair, etc. The red wristband reminds caregivers to check the
allergy before delivering food, medicine or other aspects of care. This can be very
important to avoid unpleasant reactions.
 Yellow means fall risk
The hospital wants to prevent falls at all times. Nurses continuously assess
patients to determine if they need extra attention to prevent a fall. Sometimes, a
person may become weakened due to the illness or because of a recent surgery.
When a patient has this color-coded alert wristband, the nurse is indicating that
the patient needs to be assisted when walking to avoid a possible fall.
Script for staff
Purple means the physician has written a do-not-
resuscitate order.
When patients have expressed an end-of-life wish, the hospital and its caregivers
want to honor it.
Policy and Procedure
Hospital Policy and Procedure
A model policy and procedure is provided.
Modify as necessary so it fits your organization’s
process and culture.
A “Patient Refusal to Cooperate with Color-Coded
Wristband Standardization Project” form is included.
Excerpt from Refusal Form
The above named patient refuses to: (check what applies)
□
Wear color coded alert wristbands.
The benefits of the use of color-coded wristbands have been explained to me by a member of the health care team. I
understand the risk and benefits of the use of color-coded wristbands, and despite this information, I do not give
permission for the use of color-coded wristbands in my care.
□
Remove “social cause” colored wristbands (like “LIVESTRONG” and others).
The risks of refusing to remove the “social cause” colored wristband have been explained to me by a member of the
health care team. I understand that refusing to remove the “social cause” wristbands could cause confusion in my care,
and despite this information, I do not give permission for the removal of the “social cause” colored wristband.
Reason provided (if any): __________________________________________________
Date / Time
________________________________________________
Signature / Relationship
_____________
Date / Time
________________________________________________
Witness Signature / Job Title
Resources
Resources
 To access an online version of this toolkit, go to the Texas
Hospital Association Web site at:
www.texashospitalsonline.org/wristband
 To access the Pennsylvania Patient Safety Advisory report:
http://www.psa.state.pa.us/psa/lib/psa/advisories/v2_s2_sup
__advisory_dec_14_2005.pdf
 Questions? [Add facility-specific contact information here]
Color-coded Wristband
Standardization Project in Texas
O u r s a fe t y a s a state a n d s u c c e s s i n
t h i s e f fo r t w i l l d e p e n d o n t h e
p a r t i c i p at i o n o f a n d a d o pt i o n by e a c h
a n d eve r y h o s p i ta l i n t h i s state a s
s o o n a s fe a s i b l e .