By guest blogger Michael Cohen:
A hospitalized patient with known severe allergy to natural rubber latex was given a green bracelet which, at this particular hospital, signaled that the patient had this condition. During his stay, he was transported to an outpatient diagnostic center for a test. Staff at the center was not aware that green bracelets meant latex allergy so they went ahead and performed the testing with latex containing vials/syringes. The patient experienced a potentially life-threatening severe allergic attack, known as anaphylaxis, and required immediate medical treatment to correct the situation.
An interesting survey of Pennsylvania (PA) hospitals, surgery centers, and birthing centers was conducted by the PA Patient Safety Authority (PSA) and published a few years ago by the Pennsylvania Patient Safety Authority in an Advisory (Reference 1. Pennsylvania Patient Safety Authority. Use of color-coded patient wristbands creates unnecessary risk. Supplementary Advisory. December 14, 2005; available here.) The survey found that four out of five facilities use color-coded patient wristbands to signal important medical information. However, the potential for confusion is great, and the Advisory included another event reported to the PA Patient Safety Reporting System in which a patient had been incorrectly identified as one who requested not to be resuscitated (referred to as “DNR” or “do not resuscitate) during an arrest.
A nurse had mistakenly placed a yellow wristband on the patient which, in this hospital, was used to designate DNR status. The nurse worked at another hospital in which yellow wristbands were used to identify a "restricted extremity" (an arm or leg that should not be used for drawing lab studies or IV access). Luckily the mistake was quickly realized and the patient was properly rescued when he suffered a cardiac arrest.
The PSA survey identified wide variation among PA facilities regarding the colors used to communicate information via wristbands. The survey also found that only one-third of the responding facilities require patients to remove the popular colored, non-medical wristbands used to show support for charitable endeavors. This is an important step since there have been instances where these colored charity bands were confused with medical bands.
Here’s a link to common messages used on armbands and their associated colors in various facilities.
Pennsylvania is not alone with the colored wristband problem. It’s a national issue so it seems clear that a national standard is needed to assign specific colors used with wristbands if they are used to communicate various types of clinical information. So far though, that hasn’t happened. Many state and regional hospital associations have developed local standards though on behalf of the hospitals they represent. However, while this is well-intentioned, there will still be geographical cross-over problems between states or regions, so workers may still be confused about the meaning of a specific color.
Frankly, I’d much rather see bar coded wrist bands as a requirement for every patient. Many hospitals have already adopted this technology although total penetration is still a way off. Prior to administering a medication at the bedside, a nurse scans the patient’s bar coded wristband to confirm identity. This opens the patient’s record from a hospital database which provides access to recorded patient information such as their list of medications and the restrictions that apply for that patient.
Without bar coding, rather than colored wristbands, I would at least like to see all of them be white, typed with the patient name and intended message. Having all bands look the same from a distance would require that workers read the message each time they interact with a patient for treatment, otherwise they would not know what was up.
In the mean time, here is what the PSA recommends that you, the patient, can do to reduce confusion:
- Remove all wristbands that you have placed on yourself before entering a healthcare facility for medical attention if they do not give any information about your medical condition. (e.g. Lance Armstrong, “Livestrong” yellow wristbands)
- Know the purpose of a wristband placed on you or a loved one by a healthcare provider.
- Ensure any writing on the wristband is clearly understood.
- Do not be afraid to ask the healthcare provider what colors mean for each wristband in that particular hospital.
- Do not be afraid to confirm the meaning of the wristband color with any “new” nurse or healthcare provider on your case or a loved one’s while in the hospital.
- If you are transferred to another healthcare facility during care, be sure to confirm the meaning of the colored wristbands in the new facility.
Patient wristbands are critically important for health care workers to properly identify patients prior to any test or procedure, including drawing blood specimens and administration of medications. However according to the PSA, wristbands may also be omitted when they should be put on, removed for a procedure and not replaced, or removed or covered up by clinicians or patients. So an important lesson for patients is that hospitalized patients and loved ones should never allow anything to be done unless the wristband is present, visible, and given a proper check.