www.mchc.org Illinois Hospital Association www.ihatoday.org M M ETROPOLITAN ETROPOLITAN C C HICAGO HICAGO H H EALTHCARE EALTHCARE C C OUNCIL OUNCIL Use of Color-coded Wristbands to Communicate Alerts in Illinois Hospitals Illinois Hospital Association
Www.mchc.org Illinois Hospital Association M ETROPOLITAN C HICAGO H EALTHCARE C OUNCIL Use of Color-coded Wristbands to Communicate Alerts.
Dec 27, 2015
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MMETROPOLITAN ETROPOLITAN CCHICAGOHICAGO
HHEALTHCARE EALTHCARE CCOUNCILOUNCIL
Use of Color-coded Wristbands to Communicate Alerts in Illinois Hospitals
Illinois Hospital Association
www.mchc.org
Illinois Hospital Association
www.ihatoday.org
Objectives
• Provide historical perspective on use of color to communicate alerts to caregivers
• Provide overview of practice in Illinois• Describe rationale for colors selected to
alert caregivers• Provide recommendations for adoption and
the Work Plan to implement adoption• Identify resources to support
standardization of color-coded wristbands
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Historical Perspective
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Why do hospitals use color-coded wristbands?
Color-coded wristbands are used in healthcare settings to quickly communicate a certain healthcare status, condition, or an “alert” that a patient may have. The wristband is used so every staff member can provide the best care possible, even if they do not know the patient.*
*New Jersey Department of Health and Senior Services
FAQs
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The case for standardization
• In 2005, clinicians in Pennsylvania failed to rescue a patient who had a cardiopulmonary arrest because the patient had been incorrectly identified with a “DNR” status.
• The source of confusion was traced to a nurse who had incorrectly placed a yellow wristband on the patient (which meant DNR at that hospital)
• In a nearby hospital where this same nurse also worked, yellow meant “restricted extremity,” which was her intent as an alert
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Could this happen again?
In response to this near miss, the Pennsylvania Patient Safety Reporting System (PA-PSRS) surveyed Pennsylvania hospitals and found:
• 78% of the facilities used color-coded patient wristbands• 45% used text on the wristbands• Wide variation existed among the facilities regarding
the colors used to communicate information via wristbands
• Only 33% of responding facilities required patients to remove the popular non-medical wristbands commonly used to show support for charitable endeavors
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An alert was issued
In December 2005, the Pennsylvania Patient Safety Reporting System (PA-PSRS) released a patient safety advisory making hospitals aware of the inherent risks associated with the use of patient colored wristbands, commonly used by hospital staff to convey significant clinical information.
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Pennsylvania Patient Safety Reporting System Identified Risk Reduction Strategies
• Limit the number and colors • Standardize the meaning of colors• Use brief, pre-printed text on the bands• No handwriting on bands• Educate patient/families re: bands• Remove “social cause” bands• Develop policies and procedures defining
wristband usage-authority/responsibility/maintenance
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Recommendations for Pennsylvania Hospitals
August 2006– Initiated the recommendations via distribution
of the “Color of Safety” manual
Follow-up Survey 2007– 80% of hospitals reviewed “Color of Safety”
manual– 50% of hospitals initiated the recommended
changes
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Practice in Illinois
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Illinois caregivers request guidance on the standardization of color-coded
wristbands
• Illinois Critical Access Hospital Network (ICAHN)• Regional meeting of suburban Chicago hospitals• Chicago area hospitals surveyed on the use of
color-coded wristbands by Metropolitan Chicago Healthcare Council (MCHC)
• Illinois hospitals surveyed on the use of color-coded wristbands by Illinois Hospital Association (IHA)
• Adjacent states favor standardization across borders
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2007 Survey of Illinois Hospitals Use of color-coded wristbands
Among Illinois hospitals responding to survey:• 57 % use color-coded wristband to indicate Do Not
Resuscitate Six different colors Most frequent color - blue
• 58 % use color-coded wristband to indicate an Allergy Six different colors Most frequent color - red
• 65 % use color-coded wristband to indicate Risk to Fall Six different colors Most frequent color – orange
IL Survey Data, 2007
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2007 Survey of Illinois Hospitals Results for Do Not Resuscitate
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2007 Survey of Illinois HospitalsDo Not Resuscitate
Should Illinois hospitals use a standard color on wristbands to alert caregivers that a patient is not to be resuscitated?
74 % YES26 % NO
IL Survey Data, 2007
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2007 Survey of Illinois HospitalsResults for Allergies
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2007 Survey of Illinois Hospitals Allergies
Should Illinois hospitals use a standard color on wristbands to alert caregivers that a patient has allergies?
78 % YES
22 % NO
IL Survey Data, 2007
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2007 Survey of Illinois Hospitals Results for Risk to Fall
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2007 Survey of Illinois HospitalsRisk to Fall
Should Illinois hospitals use a standard color on wristbands to alert caregivers that a patient is at risk to fall?
78 % YES22 % NO
IL Survey Data, 2007
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Next Steps• Survey results presented to IHA Patient
Safety Task Force (PSTF), the Board of IHA, and MCHC’s Clinical, Administrative, Professional, & Emergency Services (CAPES) Patient Safety & Nursing Subcommittees
• Formation of diverse workgroup:– IHA Patient Safety Task Force– MCHC– ICAHN– Chicago Patient Safety Forum– Individual hospitals
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Charge to IHA / MCHC Workgroup
• Explore standardization of color-coded alerts– Voluntary initiative– Acknowledge risks and benefits– Explore downstream effects among early
adopters– Select alerts and associated color
• Formulate recommendation• Develop toolkit for implementation
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Workgroup approach• Reviewed current
standardization models in use in other states
• Reached consensus on color definitions and wristbands
• Formulated recommendation for statewide voluntary standardization of color-coded wristbands
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The following slides were developed as part of the Arizona toolkit (copyright © 2007 Arizona Hospital and Healthcare Association), and have been modified with the permission of the Arizona Hospital and Healthcare Association.
Recommendations for standardization
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Color-coded Wristband Standardization in Illinois Do Not Resuscitate
Recommendation: DNR - Purple
It is recommended that hospitals adopt the color PURPLE for the “Do Not Resuscitate” designation with the words embossed / pre-printed on the wristband, “DNR”
CALLING CODE BLUE!
• Used by many Illinois hospitals to summon assistance for a patient without adequate pulse or respirations.
• If Illinois selected the color blue for the DNR wristband, the potential for confusion exists.
• “Does ‘blue’ mean I code or I do not code?”
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Color-coded Wristband Standardization in Illinois Purple - Do Not Resuscitate
Recommendation - PURPLE for Do Not Resuscitate
1. Why not blue?– Should not be the same color that is used for calling a code – Registry, turnover, travelers, etc
2. Why not orange?– Pre-hospital confusion with Advance Directives
3. Why not green?– Color blind– “Go ahead” confusion
4. If we adopt purple, do we still need to look in the chart?– Yes!– Code designation can and does change during a patients stay
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Color-coded Wristband Standardization in Illinois Allergy
Allergies
Recommendation: Allergy - Red
It is recommended that hospitals adopt the color RED for the ALLERGY ALERT designation with the words embossed / pre-printed on the wristband, “ALLERGY”
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Quick Adoption
According to survey results, more Illinois
hospitals use red to alert caregivers to allergies than
any other color.
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Color-coded Wristband Standardization in Illinois Allergy
Recommendation - RED for the Allergy Alert 1. Why Red?
– Currently associated with allergies by 55% of Illinois hospitals that use color-coded wristbands
2. Any other reasons?– Associated with other messages such as STOP! DANGER! due
to traffic lights and ambulance/police lights
3. Do we write the allergies on the wristband too?– No because that may create new errors due to:
• Legibility issues• Allergy list may change• Patient chart should be the source for the specifics
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Recommendation:
Fall Risk - Yellow
It is recommended that hospitals adopt the color YELLOW for the Fall Risk Alert designation with the words embossed / pre-printed on the wristband, “Fall Risk”
Allergies
Falls account for more than 70 percent of the total
injury-related health costs among people 60 years of
age and older.
Color-coded Wristband Standardization in Illinois Fall Risk
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Color-coded Wristband Standardization in Illinois
Fall Risk
Recommendation - YELLOW for Fall Risk
1. Why Yellow?– Associated with “Caution” or “Slow Down”
• Stop lights • School buses• Hazardous intersections
– American National Standards Institute (ANSI) uses yellow to communicate tripping or falling hazards
2. All health care providers want to be alert to fall risks as they can be prevented by anyone
Allergies
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According to AHA survey dated 7/22/2008, twenty-six states have standardized color-coded wristbands
associated with Allergies (red), Fall Risk (yellow) and DNR (purple)Alabama Arkansas Arizona
California Colorado* Florida
Illinois Iowa Kansas
Michigan Minnesota* Missouri*
Nebraska Nevada New Hampshire
New Jersey* New Mexico Ohio*
Oregon* Pennsylvania* Texas
Utah Virginia Washington
West Virginia Wisconsin Louisiana*
*Plus one or two additional colors *Adopted late in 2008
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American Hospital Association (AHA) Position
“America’s Hospitals are committed to delivering safe care. To alert caregivers to certain patient risks, many facilities use color-coded patient wristbands…. Standardizing the colors of the wristbands used in hospitals is the sensible approach to improving patient safety, and many state hospital associations have already engaged their hospitals in this effort. As the national advocate for America’s hospitals, the AHA is asking all hospitals to consider using three standardized colors for alert wristbands. The colors, which have been adopted as a consensus in numerous states, are: red for patient allergies; yellow for a fall risk; and purple for do-not-resuscitate patient preferences.”*
* American Hospital Association Quality Advisory, September 4, 2008
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Work Plan
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Suggested Work Plan for facility preparation, staff education, and
patient education includes:
1. Organizational approval2. Supplies assessment and purchase3. Hospital-specific documentation4. Staff and patient education materials and
training Following the work plan is a task chart for each
element that provides cues for methodical and successful implementation.
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Sample Work Plan Document
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Sample Task Chart
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Tools for Staff Education
• Poster announcing the training meeting dates/times
• Staff sign-in sheet• Staff competency checklist• Tri-fold staff education brochure about this
initiative• FAQs handout for staff• Tri-fold patient education brochure about
color-coded wristbands• PowerPoint presentation
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Tri-fold staff education brochure includes:
• How this all got started…the Pennsylvania story• Why this is recommended in Illinois• The national picture• What the colors are for: Allergy, Fall Risk, and
DNR• Script for any staff person talking to a patient or
family about the wristbands• “Quick Reference Card” cutout that lists seven
other risk reduction strategies (more on the following slides)
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Color-coded “Alert” Wristbands/Risk Reduction Strategies : A Quick Reference Card
____________________________________
1. Use wristbands with the alert message pre- printed (such as “DNR).
2. Remove any “social cause” colored wristbands (such as the yellow Lance
Armstrong “LIVESTRONG” wristband).
3. Remove wristbands that have been applied from another facility.
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Color-coded “Alert” Wristbands/Risk Reduction Strategies : A Quick Reference Card (cont.)
____________________________________
4. Initiate banding upon admission, changes in condition, or when information is received during 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, hand-off care, and facility-to-facility transfer communication.
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Why have a script for staff?
1. We know how we say something is as important as what we say. This provides a script sheet 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. The Patient Education brochure also is available for staff to hand out.
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SCRIPT for any staff person talking to a patient or family:
What is a color-coded “alert” wristband?Color-coded “alert” wristbands are used in hospitals to quickly communicate a
certain health status, condition, or “alert” that a patient may have. This is done so every staff member can provide the best care possible.
What do the colors mean?
There are three different color-coded “alert” wristbands that we are going to discuss because they are the ones most commonly used.
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SCRIPT for any staff person talking to a patient or family (cont.):
RED means ALLERGY ALERT
If a patient has an allergy to anything – food, medicine, dust, grass, pet hair, ANYTHING – we want them to tell the healthcare team. It may not seem important to the patient, but it could be very important in the care the patient receives.
YELLOW means FALL RISK
We want to prevent falls at all times. Nurses assess patients throughout their stay to determine if they need extra attention in order to prevent a fall. Sometimes a person may become weakened during his/her illness or following surgery. When a patient has this color-coded “alert” wristband, the nurse is indicating this person needs to be closely monitored because he/she may fall.
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SCRIPT for any staff person talking to a patient or family (cont.):
PURPLE means “DNR” or Do Not Resuscitate
Some individuals have expressed an end-of-life wish and we, the healthcare team, want to honor it.
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Policy and Procedure
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Policy & Procedure Information
• A template policy and procedure has been provided.
• Make modifications to it so it fits your organization’s process and culture.
• Address how to respond when a patient refuses to wear a wristband.
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Excerpt from Refusal FormThe 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 healthcare team. I understand the risks 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 the yellow Lance Armstrong “LIVESTRONG” and others).
The risks of refusing to remove the “social cause” colored wristbands have been explained to me by a member of the healthcare 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 wristbands.
Reason provided (if any):__________________________________
__________________ _________________________________________Date/Time Signature/Relationship
_____________________ ________________________________________________
Date/Time Witness Signature/Job Title
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In Closing
The participation of each Illinois hospital in standardization of colors associated with alerts for Allergies, Risk to Fall, and DNR is strictly voluntary. The use of color-coded wristbands as a strategy to communicate Allergies, Risk to Fall, and DNR remains the decision of the individual facility.
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Resources
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Illinois Wristband Toolkit
Available for download:Illinois Hospital Association
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Metropolitan Chicago Healthcare Councilwww.mchc.org
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Questions?
Dawn NiednerProgram Director
Clinical and Emergency Services Metropolitan Chicago Healthcare
Council312-906-6164
Becky StewardManager, Patient Safety Collaborative
Illinois Hospital Association630-276-5585
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Additional Websites
American Hospital Association Quality Centerwww.ahaqualitycenter.org/ahaqualitycenter/jsp/home.jsp
Arizona Hospital and Healthcare Associationwww.azhha.org
Ohio Patient Safety Institute www.ohiopatientsafety.org
Patient Safety Authority (Pennsylvania)www.psa.state.pa.us/psa/lib/psa/advisories
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