Color-coded Wristband Standardization in Illinois

Transcription

Implementation Toolkit
Color-coded
Wristband
Standardization
in Illinois
DNR
ALLERGY
FALL RISK
Sponsored by:
“Patient safety is sound clinical practice”
Distributed May 2009
Illinois Hospital Association
Metropolitan Chicago Healthcare Council
Address: 1151 East Warrenville Road
Address: 222 S. Riverside Plaza, Suite 1900
P.O. Box 3015, Naperville, Illinois 60566
Phone: 630-276-5400
Fax: 630-276-5467
Online: www.ihatoday.org
Chicago, Illinois 60606
Phone: 312-906-6000
Fax: 312-906-6123
Online: www.mchc.org
Illinois Hospital Association and Metropolitan Chicago Healthcare Council produced this publication with permission from the Arizona Hospital and Healthcare Association. Contact MCHC at (312) 906-6000 or IHA
at (630) 276-5400 with any questions. Copyright © 2007 Arizona Hospital and Healthcare Association (AzHHA). Users may copy this publication for noncommercial purposes only so long as authorship is attributed
to AzHHA (but not in any way that suggests AzHHA endorses you or your use of the publication). The colors for DNR (purple), Allergy (red) and Fall Risk (yellow) cannot be changed if using any portion of this manual.
Color-coded Wristband
Standardization in Illinois
Table of Contents
Executive Summary
Background/Illinois Survey................................................ 4-5
Recommendations for Adoption
The Colors....................................................................... 7-11
Risk Reduction Strategies............................................. 13-14
Work Plan – How to Implement
Work Plan Guide........................................................... 16-17
Task Charts................................................................... 18-27
Staff and Patient Education Materials
Staff Education – Training Tips and Tools..................... 29-65
Staff Brochure............................................................... 46-48
Patient Brochure........................................................... 49-51
FAQs.............................................................................. 52-55
PowerPoint.................................................................... 56-65
Policy and Procedure
Sample P & P................................................................ 67-70
Patient Refusal Form...........................................................71
Vendor Information.................................................................73
Acknowledgments
To Access the Toolkit..........................................................75
Partners...............................................................................75
Sponsorship........................................................................76
St. John Products............................................................. 78-81
2
Executive Summary
DNR
ALLERGY
FALL RISK
DNR
3
Executive Summary
In December 2005, a patient safety advisory was issued
from the Pennsylvania Patient Safety Reporting System
that received national attention. This advisory brought
to the surface an incident that occurred in a hospital in
which clinicians nearly failed to rescue a patient who had
a cardiopulmonary arrest because the patient had been
incorrectly designated as “DNR” (Do Not Resuscitate).
The source of confusion was the incorrect placement
of a yellow wristband on the patient by a nurse. In that
hospital, a yellow wristband meant DNR. In a nearby
hospital, where the nurse also worked, yellow meant
“restricted extremity” which was what she wanted to
alert staff about. Fortunately in this case, another nurse
recognized the mistake and the patient was resuscitated.
Most of us can imagine this type of near miss occurring
in any institution. Consider these statistics from a survey
conducted by the Illinois Hospital Association:
• In 2007, hospitals in Illinois reported an average RN
vacancy rate of 6.9% (funded but unfilled positions).
• The same survey reported a mean turnover rate for
RNs providing direct patient care of 14.9%.
• Most hospitals in the state are using some registry or
traveler RNs to staff vacant positions.
Due to the large number of inquiries from hospitals
across the state, the Metropolitan Chicago Healthcare
Council (MCHC) and the Illinois Hospital Association
(IHA) decided to assess if there was a potential
for confusion in Illinois. In 2007, Illinois hospitals
participated in a survey asking questions related to
color-coded wristbands. The results were as suspected
with wide variation across hospitals in the use and
meaning of wristbands; specifically, those used to alert
caregivers to DNR, Allergies, and Risk to Fall.
Figure 1: Color-coded Wristbands
Six different colors / methods
are being used by Illinois
hospitals to convey Do Not
Resuscitate.
What color wristband do you use for
“Do Not Resuscitate?”
43%
11%
32%
3%
Do Not Use
Red
Blue
5%
3%
3%
Purple
Orange
Other
Yellow
4
Executive Summary
continued
Survey results were presented to the Board of the Illinois
Hospital Association and the Metropolitan Chicago
Healthcare Council’s Patient Safety and Nursing
Subcommittees, and the decision was made to form a
joint workgroup to address the voluntary standardization
of color-coded wristbands in Illinois. The workgroups
focused on three condition alerts:
The information that follows in this kit will guide your
organization through:
1. Colors for the “alert” designation and logic for the colors
selected;
2. Work plan for implementation;
3. Staff education, including competencies;
4. FAQs for general distribution;
5. Sample policy and procedure;
6. Vendor information for easy adoption of the
recommendation; and
7. Patient education brochure.
1. Do Not Resuscitate
2. Allergies
3. Risk to Fall (Fall Risk)
The workgroup represented a diverse group of hospitals,
ranging from critical access hospitals to academic
medical centers. The deliverables for this workgroup
were:
1. Standardize color-coded wristbands in hospitals
statewide;
2. Reach consensus on color definitions of wristbands;
and
3. Develop a work plan and create an implementation
toolkit to standardize wristbands for use by hospitals
that choose to use color-coded wristbands.
Insanity: doing the same
thing over and over again and
expecting a different result.
~A. Einstein
5
Recommendations
for Adoption
DNR
ALLERGY
FALL RISK
DNR
6
Overview
If hospitals elect to use color-coded wristbands, why
should they adopt the recommendations for standardized
color-coded wristbands?
It is important to realize that while standardizing colorcoded wristbands helps to impart important medical
information to caregivers, color-coded “alert” wristbands
should not be relied on exclusively for critical information.
Health care providers should always refer to the
medical record and other documentation to support the
meaning conveyed by the wristband. In addition, colorcoded wristbands should not replace efforts aimed at
standardizing how and when this information should be
included in ongoing communication between caregivers,
including assuring that information in patients’ medical
records corresponds with the information communicated
by the wristbands that are applied.
While there has been extensive discussion regarding the
use of color-coded “alert” wristbands, a literature review to
date has not conclusively identified a better intervention
in an emergency situation. A number of health care
providers are not hospital-based staff or may work at
more than one organization; it is imperative that this fact
be considered when hospital processes are produced
and implemented. The need to have certain medical
conditions conveyed in a transparent and universal
fashion is crucial for patient safety. Registry, traveler, and
non-clinical staff may not be familiar with how to access
information in a hospital (e.g., computerized medical
records), where to find information in the medical record,
or even where to find the medical record in a timely
manner. When seconds count, having a color-coded
“alert” wristband on the patient will serve to notify health
care providers of a certain medical designation. Similar
to a second identifier, the color-coded wristband can
quickly communicate information in a crisis situation, an
evacuation situation, or in a transit situation.
There is no evidence that the use of color-coded
“alert” wristbands is superior to traditional methods of
communicating clinical information; therefore, it is not the
purpose of this manual to advise that health care facilities
begin this practice if they have not already done so. This
toolkit does not advocate implementation of a wristband
program, only standardization of colors for alerts if a
facility elects to use color-coded banding.
7
Recommendations for Adoption continued
Do Not Resuscitate
DNR
DNR
Recommendation:
It is recommended that hospitals adopt the color of PURPLE for the Do Not Resuscitate designation with
the letters “DNR” embossed/pre-printed on the wristband, clasp, or label.
FAQs
Q. W
e don’t use wristbands for DNRs at this hospital. Why should we consider adopting this?
A. The use of this toolkit does not advocate
about this alert. It is also a means to communicate to
the family that all hospital personnel are clear about
the patient’s end-of-life wishes. Finally, if a patient
is transferred between units or departments, or to
other facilities, a wristband is a quick communication
about the patient’s end-of-life wishes should anything
happen to the patient when he or she is not on the
home unit.
implementation of a wristband program but advocates
standardization of colors if a hospital chooses to
use “alert” wristbands. Wristbands are used in many
Illinois hospitals to communicate an alert. Registry
staff, travelers, non-clinical staff, etc. may be unaware
of where to look in the medical record if they are new
to your hospital. A purple color-coded wristband can
communicate a quick warning so anyone could know
8
Q. Why not use Blue?
Q. So, if we adopt the purple DNR wristband then do
we still need to look in the chart?
A. T he work group considered the color designation in
A. Yes. Some hospitals do not use wristbands for DNRs
the 27 states that have adopted purple to standardize
DNR, and the rationale behind their decisions. It
also took into consideration that many hospitals use
“Code Blue” to summon a resuscitation team. By
having the DNR wristband as “no code,” there was
potential for confusion, i.e., “does blue mean we
code or do not code?”. To avoid creating any second
guesses in this critical situation, the decision was
made to adopt the same guideline as in the majority
of states – purple to designate DNR.
because they want the chart to be reviewed first for
the most current code designation. However, that
practice should be the practice in all cases – whether
a wristband is being used or not. Code status can
change throughout a hospitalization. It is important to
know the current status so the patient’s and family’s
wishes can be honored.
Q.Why not Green?
A. Again, we considered this color as well; however,
due to color-blindness concerns, we decided to avoid
it altogether. Also, in other settings the color green
often has a “Go Ahead” connotation, such as traffic
lights. We again want to avoid any possibility of
sending “mixed messages” in a critical moment. “Patient safety is sound clinical practice”
9
Allergy Alert
ALLERGY
Recommendation:
It is recommended that hospitals adopt the color of RED for the Allergy Alert designation with the words
“Allergy Alert” embossed/pre-printed on the wristband, clasp, or label.
FAQs
Q. Why did you select red?
Q. Do we write the allergies on the wristband, too?
A. Red was selected because the 2007 survey results
A. It is recommended that allergies be written in the
medical record according to your hospital’s policy and
indicated that 55% of Illinois hospitals that use a
procedure. We suggest allergies not be written on the
wristband to signify allergies have selected red. Red
wristband for several reasons:
also is the color selected in all 27 states that have
adopted standardized colors. It
1. Legibility may hinder the correct
makes sense to continue with a color
interpretation of the allergy written on the
Quick Adoption
that is already established in Illinois
wristband.
and well on its way to becoming a
By adopting red
2. By writing allergies on the wristband,
national standard.
for allergy alert,
someone may assume the list is
the standardization
comprehensive. However, space is limited
Q. A re there any other reasons for
for this is easily
on a wristband and some patients have in
using red?
excess of 12 or more allergies. The risk is
achieved since 55%
that some allergies would be inadvertently
of Illinois hospitals
A. Yes. Research of other industries
omitted – leading to confusion or missing
tells us that red has an association
already use red for
an allergy.
that implies extreme concern.
The American National Standards
Institute (ANSI) has designated
certain colors with very specific
warnings. ANSI uses red to
communicate “Stop!” or “Danger!” We
think that message should hold true
for communicating an allergy status.
allergy alert.
3. Throughout a hospitalization, allergies may
be discovered by other caregivers, such
as dieticians, radiologists, pharmacists,
etc. This information is typically added
to the medical record and not always
a wristband. By having one source of
information to refer to, such as the medical
record, staff of all disciplines will know
where to add newly discovered allergies.
10
Q. Does this mean we can no longer use red or “R”
Q. W
hy is a separate standardized color to designate
on bands to designate blood bank information?
latex allergy not part of the recommendation?
A. No, although it is important to thoroughly educate
A. There was concern that, if too many standardized
staff about the difference between your current
blood bank bands and any newly implemented
red bands to designate allergies. This is another
reason text is recommended to be placed on the
red bands to designate “Allergy Alert” or “Allergy”
as another way to differentiate these two bands.
The product decision made by your hospital should
consider the style and hue of red used for current
blood bank wristbands and make sure new products
implemented to designate allergy are easily
differentiated from blood bank bands.
colors were used, staff would have difficulty
remembering all of them. With red used to alert staff
to the patient having an allergy, it will prompt them
to confirm the allergy with the patient and/or check
the medical record regardless of the specific type of
allergy the wristband is used to designate.
11
Fall Risk
FALL RISK
Recommendation:
It is recommended that hospitals adopt the color of YELLOW for the Fall Risk Alert designation with the
words “Fall Risk” embossed/pre-printed on the wristband, clasp, or label.
FAQs
Q. Why did you select yellow?
other causes.
• Of those who fall, 20% – 30%
Falls account
suffer moderate to severe infor more than
juries that reduce mobility and
70% of the total
independence, and increase
injury-related
the risk of premature death.
health cost
• The total cost of all fall injuries
for people age 65 or older
among people
in 1994 was $27.3 billion (in
60 years of age
current dollars).
and older.
• By 2020, the cost of fall injuries
is expected to reach $43.8
billion (in current dollars).
• Hospital admissions for hip
fractures among people
over age 65 have steadily
increased, from 230,000
admissions in 1988 to 338,000
admissions in 1999. The
number of hip fractures is
expected to exceed 500,000
by the year 2040.
• As the aging population enters the acute care
environment, consideration must be given to the risk that is
present and do all possible to communicate that to hospital
staff.
A. R esearch of other industries tells us that yellow has an
association that implies “Caution!” Think of yellow traffic
lights; proceed with caution or stop altogether is the
message. ANSI has designated certain colors with very
specific warnings. ANSI uses yellow to communicate
“Tripping or Falling hazards.” Thus, yellow fits well
in healthcare, too, when associated with a fall risk.
Caregivers want to be alert to and use caution with a
person who has a history of previous falls, dizziness
or balance problems, fatigability, or confusion about
his/her current surroundings.
Q. Why even use an alert band for Fall Risk?
A. T here are a number of potential contributors to patient
falls in the health care setting including the side effects
of certain medications, recent surgery, pain, pre-existing
medical conditions and others. Age is also a factor.
• More than one-third of adults aged 65 years or older
fall each year.
• Older adults are hospitalized for fall-related injuries
five times more often than they are for injuries from
12
Color-coded “Alert” Wristbands/Risk Reduction Strategies
4.Initiate banding upon admission, changes in
Color-coded “Alert” Wristbands/
Risk Reduction Strategies
condition, or when information is received during the
hospital stay.
5.Educate patients and family members regarding the
Quick Reference Card
wristbands.
1.Use wristbands with the alert message pre-printed
6.Coordinate chart/white board/care plan/door
2.Remove any “social cause” colored wristbands (such
7.Educate staff to verify patient color-coded “alert”
(such as “DNR”).
signage information/stickers with same color coding.
as the yellow Lance Armstrong “LIVESTRONG”).
wristbands upon assessment, hand-off of care, and
facility-to-facility transfer communication.
3.Remove wristbands that have been applied from
another facility.
The following information takes each risk reduction strategy and provides
further detail and/or explanation of that strategy.
1.Use wristbands that are pre-printed with text
that tells what the band means.
condition, or when information is received
during the hospital stay.
a. This can reinforce the color-coding system
for new clinicians, help caregivers interpret
the meaning of the band in dim light, and also
help those who may be color-blind.
5.Educate patients and family members regarding
the purpose and meaning of the wristbands.
b. Eliminates the chance of confusing colors with
alert messages.
a. Including the patient and family safeguards the
hospital, healthcare professionals, and patient
from potential errors.
2.Remove any “social cause” colored wristbands
b. Remind patients and families that color-coding
provides another opportunity to prevent errors.
(such as the yellow Lance Armstrong
“LIVESTRONG”).
c. Use the patient/family education brochure
located in the toolkit.
a. Be sure this is addressed in your hospital
policy.
b. If that can’t be done, you can cover the band
with a bandage or medical tape, but removal
altogether is best.
signage information/stickers with the same
color-coding – red for allergies, yellow for fall
risk, and purple for DNR status.
another facility.
wristbands upon assessment, hand-off of care,
and facility-to-facility transfer communication.
a. This should be done when patients are
processed to enter the facility and/or during
patient admission.
13
8.When possible, limit the use of colored
10.If your facility uses pediatric wristbands
wristbands for other categories of care, e.g.
contact isolation, special needs, etc.
that correspond to the Broselow colorcoding system for pediatric resuscitation,
take steps to reduce any confusion between
these Broselow colors and the colors on the
wristbands used elsewhere in the facility.
9.Remember, the wristband is a tool to
communicate an alert status.
a. Educate staff to utilize the patient medical
record information (physician order for DNR)
as an additional resource for verification
processes for allergies, fall risk, and advance
directives.
To improve patient safety in the delivery of healthcare has become a goal for every
organization. A part of that is to reduce risks for injury or harm whenever possible. By
implementing risk reduction strategies, we demonstrate patient safety in a consistent
fashion.
Risks are about events that, when triggered, may cause potential harm, significant
injury, or in the worse case scenario, death of a patient. The commitment to practice
healthcare safely begins at the bedside and is underscored through leadership support
to be proactive in the effort to ensure safe practice.
The initial step begins with risk identification. Trends in adverse events or “the risk
thereof” are key to organizational claims management. Failure to rescue, medication
errors, and falls consistently challenge organizations to improve patient safety and
reduce losses. Medication errors and falls are among the highest reported incidents
and are often underestimated “based on their everyday occurrence.” Human factors are
often the root cause of such preventable events and are often related to a complicated
communication process, an ever-changing environment, and inconsistent caregivers.
Communication is a leading, contributing factor for sentinel events that occur in the
healthcare setting. One method to assist with effective communication is using colorcoding for “alert” wristbands. This provides a simplified tool that, when standardized,
provides a continuous communication link within an organization, as well as between
other healthcare facilities.
14
Work Plan —
How to Implement
DNR
ALLERGY
FALL RISK
DNR
15
Suggested Work Plan for Facility Preparation, Staff Education
and Patient Education
Area #1
Organizational Approval
See Task Chart for specific steps
Review
√ Adopting this initiative may need approval by appropriate committees, such as:
~ Patient Safety Committee
~ Medical Staff Committee
~ Quality Improvement Committee ~ Board of Directors
Action Plan
Organizations have different committees that need to approve system wide changes, or changes that directly impact
patient care. Each organization needs to assess which committees need to approve the adoption of the initiative and
begin to get on meeting agendas for approval. For some organizations this may mean simply presentation at one
committee, such as the Patient Safety Committee. Other organizations would need to have this approved by several
committees, depending on their culture.
Consider the stakeholders and be sure they approve and understand the initiative before
it is implemented so they can support it.
Area #2
Supplies Assessment and Purchase
See Task Chart for specific steps
Review
√ Assessment of current supply
√ Wristband procurement
Action Plan
Most organizations have a vendor they are using for wristbands. Inform the vendor of the colors and the alert
message needs to be printed directly on the band (please see “Vendor Information” section). They do need some
lead time for the imprinting (about 2-3 weeks).
Coordinate with your Materials Management department to evaluate when current stock will be used up. Once this
is known, the rest of the implementation plan will “back fill” into this date.
Coordinate with your Materials Management department to evaluate when current stock
will be used up. Once this is known, the rest of the implementation plan will “back fill” into this date.
16
Suggested Work Plan for Facility Preparation, Staff Education
and Patient Education continued
Area #3
Hospital-Specific Documentation
Review
√ Policy adoption
√ Assessment Revision
√ Forms revised to meet standards
√ Consents
Action Plan
Color-banding policy should be reviewed and approved if changes are made.
Hospitals should review their respective forms for possible modifications (patient education assessments, etc.). You
may want to include language that the patient received the wristband education brochure. (See Patient Education
section.)
If a patient refuses to wear a wristband, do you have a document indicating this? Perhaps this needs to be discussed
at a Patient Safety Committee meeting. A sample has been provided in this toolkit.
Coordinate with: Risk Management Staff and Individual Hospital Administrators
Area #4
Staff and Patient Orientation, Education and Training
Review
√ Schedule/training content
√ Documentation requirement
√ Posters & FAQs
Action Plan
Education format and training materials need to be reviewed.
Competency content and format has been standardized. The competency form included in the toolkit may be
individualized for the hospital.
Hospital staff education will need to be scheduled, completed and documented per hospital policy.
Make changes to the New Employee Orientation so they are provided current information.
Coordinate with: Individual Hospital Education Staff
17
Suggested Task Chart for Facility Preparation
Task Chart for Facility Preparation
Area #1 Organizational Approval & Awareness
STEP 1
What to Do
When: WEEK ONE enter date this is done:___________
Notes / Comments / Follow-ups
Find out who the staff person is who supports
the following committee meetings. Get the
contact info for each one:
~ Patient Safety Committee
Committee
Name
Email / ext.
Patient Safety Comm.
Medical Staff Comm.
~ Medical Staff Committee
~ Nursing Committee
Nursing Comm.
~ Quality Improvement Committee
QI Comm.
~ Board of Directors
~ Other?
Board of Directors
NOTE: Not all committees will need to approve
this initiative; however, they will usually benefit
from a presentation that provides the information
about this initiative so they can support it. Seek
guidance from your Administrative team to
determine meetings to which this needs to be
presented.
Other
Other
Other
STEP 2
What to Do
Find out when the next meetings are and get
on the agenda to present the initiative for the
purpose of acquiring approval or conveying
information.
When: WEEK ONE
Committee
Date of Next Meeting
Patient Safety Comm.
Medical Staff Comm.
NOTE: Not all committees will need to approve
this initiative; however, they will usually benefit
from a presentation that provides the information
about this initiative so they can support it. This
is equally important and should be considered a
priority as well.
Nursing Comm.
QI Comm.
Board of Directors
Other
Other
Other
18
On Agenda? (Y / N)
STEP 3
What to Do
After presentations are made
and approval is obtained to
adopt recommendations,
contact pertinent dept./staff to
move forward.
continued
When: Pending Committee Approvals
Dept.
Convey info – see right column
Materials Management
Staff Education
Risk Management
and/or QI Director
Other Departments to
consider:
Medical Staff, Admitting,
ED, Peri-Op, Nursing,
Lab, Dietary, Laboratory,
Radiology, Pharmacy, etc.
Info to be Conveyed
1. Approvals obtained.
2. OK to order wristbands.
3. W
hen will bands be available?
Take that date and add 5-7 more
days – that is your “Go Live” date.
(The 5-7 more days are added to
allow for distribution of wristbands
to pertinent areas.)
Follow-ups
How long until delivery?
1. W
ristbands will be arriving in
about _______ weeks.
2. “Go Live” Date is _______.
3. OK to start education.
1. W
2. “Go Live” date is _______.
3. C
onfirm Policy and Procedure
has been approved and prepare
to add to Policy and Procedure
manual.
1. W
2. “Go Live” Date is _______.
3. O
K to start education. Coordinate
with Education department for
either materials / training / or
information.
19
STEP 4
What to Do
STEP 5
What to Do
STEP 6
What to Do
If any other steps required, add them here.
20
continued
Area #2 Supplies Assessment and Purchase
STEP 1
What to Do
When: WEEK ONE enter date this is done:___________
Other Notes / Cues
Contact Materials Manager and brief them on the
initiative. Answer questions and share the toolkit.
Coordinated with Materials Management (MM) person who will do the ordering.
MM Name: __________________________________________
Remember: You are just gathering information. Do
not order wristbands until Organizational Approval
Email: ______________________________________________
has been obtained.
Phone: _____________________________________________
STEP 2
When: WEEK ONE
What to Do
Other Notes / Cues
Ask Materials Manager when current supply of
Allergy Bands run out about _________________ (ex: mid-Jan. 09)
wristbands will run out. This is based on estimates
from typical order patterns and staff usage.
Fall Bands run out about ___________________
DNR Bands run out about __________________
STEP 3
When: WEEK ONE
What to Do
Other Notes / Cues
Ask Materials Manager to contact the wristband
vendor and alert them to change in supply color.
Convey information listed in the right-hand
column. Check off items once communicated to
vendor.
ALLERGY BAND:
£ Red: PMS 1788
£ “ALLERGY” pre-printed on band in black – 48 pt. Arial Bold, all caps
FALL BAND:
£ Yellow: PMS 102
£ “FALL RISK” pre-printed on band in black – 48 pt. Arial Bold, all caps
DNR BAND:
£ Purple: PMS 254
£ “DNR” pre-printed on band in white – 48 pt. Arial Bold, all caps
STEP 4
When: WEEK TWO
What to Do
Follow-up with MM in a week and validate that
they were able to contact vendor.
Other Notes / Cues
Lead time required when ordering wristbands is:
ALLERGY BAND - ________ weeks
Complete information in the right hand column
from MM.
FALL BAND -
________ weeks
DNR BAND -
________ weeks
21
Area #2 Supplies Assessment and Purchase
STEP 5
What to Do
When to Do It
Assure Materials Management
staff that you will contact them
to order wristbands once
organizational approval has
been obtained and Policy and
Procedure changes have been
approved.
Give status report within
a month of initial contact
so MM knows this is still
being worked on.
STEP 6
What to Do
When to Do It
STEP 7
What to Do
Other Notes / Cues
When to Do It
STEP 8
What to Do
Other Notes / Cues
Other Notes / Cues
When to Do It
Other Notes / Cues
22
continued
Area #3 Hospital Specific Documentation
STEP 1
When: WEEK TWO or THREE enter date this is done:___________
What to Do
Other Notes and Cues
Contact Director of Nursing and clinical directors
to review if documentation records contain specific
information about wristbands, such as daily nursing
charting.
Coordinate with DON and Clinical Directors
It may be helpful or more efficient for you to pull the daily documentation
information for the various areas and review the current requirement.
Consider these documents:
Remember: This is not a recommendation to add
“wristbands” to your documentation process
or color specific information, but to review your
current documents/process.
• ED triage record or treatment/ED nurses’ notes
• Admitting assessment
• ICU nurses’ notes
• Peri-Op assessments/notes
• Daily nursing documentation
• Other:________________________________________________
STEP 2
When: WEEK TWO or THREE
What to Do
Again, this is not a recommendation that the documentation reflect
color information about wristbands. However, if your documentation
is color specific, this is a cue to validate that the information be
updated to reflect the new colors – if that is your current process.
If your current documentation addresses wristband
information, review documents to assure any
references to colors are updated to reflect these
changes.
STEP 3
What to Do
When: WEEK THREE or FOUR
If changes are required to the documentation forms,
contact the Forms or Documentation Committee and
pertinent clinical directors and initiate process for
changes.
STEP 4
What to Do
Some organizations require any changes to forms be reviewed through a
“Forms Committee” or similar entity. Other organizations do not require
this process if the information being changed is minimal and does not
change “content”. This step is to determine your organization’s process.
When: WEEK THREE or FOUR
Once process is known, and if a form(s) update is
required, factor the print time and new form availability
into the timeline so the education and implementation
processes are in sync with the arrival of new
documents.
23
STEP 5
What to Do
The Policy and Procedure (P&P) for wristband
application needs to be reviewed and updated to reflect
the new process.
Obtain a copy of the current wristband P&P and review
content.
STEP 6
What to Do
continued
When: WEEK FOUR
A sample P&P has been provided for you to use as a template. Review
this sample and adopt its content as it makes sense in your organization.
NOTE: It is important that you compare your current process with
the sample P&P and determine what elements you will change. The
sample P&P is not prescriptive but rather suggestive.
When: WEEK FOUR
Some banding processes may vary slightly within the
organization given the area of care and its unique
needs, such as ED, Peri-Operative, Radiology, L&D,
etc. You will want to contact the Directors of each of
these areas and ask if they have their own P&P for
banding a patient or if they use the facility wide P&P. If
they have a unique P&P, obtain a copy of it so you can
compare its content with the facility wide P&P.
Contact ED Director. Name/ext: _______________________
Review with each area that has a unique P&P their
current P&P and the proposed changes.
Contact Radiology Director. Name/ext: _________________
Unique P&P? No______ Yes______ (obtain copy)
Contact Peri-Op Director. Name/ext: ___________________
Contact L&D Director. Name/ext: _____________________
Contact “other” Director. Name/ext: ___________________
Contact “other” Director. Name/ext: ___________________
STEP 7
What to Do
Get this item on P&P committee agenda and have
approval for the changes.
P&P Committee Contact / ext. _________________________
Coordinate this with the departments that have “unique”
P&Ps so all are changed at the same time.
Date / Month on P&P Committee ______________________
Communicate the P&P Committee date to other pertinent Directors so the
proposed changes are reviewed and agreed upon before P&P Committee date.
24
STEP 8
What to Do
STEP 9
What to Do
STEP 10
What to Do
continued
25
Task Chart for Staff / Patient Education
Area #4 Staff and Patient Education
STEP 1
What to Do
Familiarize yourself with training content and
the tools (FAQs, brochures, posters & more).
Review the contents of the Education session in this toolkit. This is important
because as discussions occur about who will do what, you can inform Directors
about the tools that are available for staff to use. Because the Education section
is so comprehensive, some may opt to participate in the facilitation process. By
giving the Directors all of the information about the tools and training section in this
manual, they can make a better and informed decision.
STEP 2
What to Do
Determine the education format by discussing
with the Education Department and Clinical
Directors. By education format we refer to the
way the education is going to be managed - at
the unit specific level or in a general session
where multiple departments are present. Also,
is the education going to be facilitated through
the department specific Directors or Education
department?
It is important to consider all of the
stakeholders: Physicians, Dietary, Pharmacy,
Therapies, Radiology, Peri-Op, ED, L&D,
Housekeeping, etc. The column on the
right is a tool that you will need for all of the
stakeholders. Use the back of this if more
room is needed.
When: TWO to THREE weeks
When: TWO to THREE weeks
Education Dept. preferences are: ____ Unit Specific _____ General session
____ Other (explain_____________________________________________)
Facilitator Preferences: ____ Unit Based
____Educ Dept
Critical Care Dir. preferences are: ____ Unit Specific _____ General session
____ Other (explain_____________________________________________)
____Educ Dept
Med / Surg Dir. preferences are: ____ Unit Specific _____ General session
____ Other (explain_____________________________________________)
____Educ Dept
Pharmacy Dir preferences are: ____ Unit Specific _____ General session
____ Other (explain_____________________________________________)
STEP 3
What to Do
Obtain the names of the trainers and send
an email advising of an upcoming Train the
Trainer. This meeting should be no longer than
45 minute to one hour. Schedule this about
one month out to accommodate already full
schedules.
____Educ Dept
When: THREE to FOUR weeks
Whether training occurs at a unit based level or in a general session, a Train the
Trainer session ought to be considered so the Education Materials and Training
Tips can be viewed by all.
26
Task Chart for Staff / Patient Education
Area #4 Staff and Patient Education
STEP 4
What to Do
Find out the name of the chair of the Patient/
Community Education Committee. Contact
that person and schedule appointment to
review the patient brochure. If necessary, get
on the agenda of the next committee meeting
to get approval for the brochure to be used.
STEP 5
What to Do
continued
When: THREE to FOUR weeks
Another component to the education section is the patient education. Many
organizations have a “Patient / Community Education” Committee that reviews
education materials before it can be given to patients.
When: TWO weeks before Train the Trainer Session
Make one copy of the education section
of this toolkit for each Trainer so they each
have their own set of materials. Don’t forget
about the PowerPoint presentation too. Some
organizations may want to put the PowerPoint
on a shared drive, while others may want to
burn a copy of the CD.
Updates will be occurring to this toolkit as new information is added or great
suggestions are made by the users. Be sure to visit the website where the toolkit is
posted and check for any updates before you make all of the copies of materials.
The toolkits are posted at www.ihatoday.org and www.mchc.org.
STEP 6
When: THREE weeks before Staff Education Roll-out
What to Do
Send out a reminder email to all Trainers
reminding them to make copies of the following
handouts for their staff:
It may be useful to obtain the actual wristbands to show staff exactly what they
look like. Also, try to incorporate some fun into this by using purple, red and yellow
“props” or candy – like M&Ms, Skittles or other items.
~ Staff education brochure
~ Patient education brochure
~ FAQs
~ Posters announcing the meeting (there are
three to choose from)
~ Sign-in sheet
~ Competency check list (if you are using that)
STEP 7
What to Do
27
Staff and Patient
Education Materials
DNR
ALLERGY
FALL RISK
DNR
28
Staff Education Training Tips
Introduction
The following section regarding staff education has been
developed knowing that you may choose to do all of this,
or part of it. We hope that we have made this section
comprehensive without being overly burdensome. Make
this plan work for you; use what you want and remember
the goal is to communicate the changes with color-coded
“alert” wristbands to your staff.
This section was created with the following
design objectives in mind:
1. Staff can be easily guided through the changes with color-coded “alert” wristbands.
2. The instructors are well-equipped to teach about these changes.
3. No new materials have to be created by staff; this should be nearly a “turnkey” education event.
4. Staff can feel confident that all Illinois hospitals are hearing the same message and a similar implementation
plan. This is important if staff work at more than one hospital.
Who and how will this be done?
This is a decision that needs to be made within your
organization. It can be as simple or formal as you desire.
Suggestions include staff meetings, formal education
sessions, annual competencies – whatever works for your
organization. It should be done routinely at new employee
orientations so the new staff are quickly brought up to
speed on this initiative.
29
Key Preparation Before You Start
Review your section under the “Implementation Work Plan”
to be sure you have included all of your stakeholders in this
process. Consider all of the stakeholders in your organization
when it comes to color-coded wristbands and who is impacted
in this system change.
Thoughts to consider:
1. While ultimately the nurses are the people who
usually band the patient, the health unit clerks are
greatly involved in the system process. Include them
in the training. They can better assist the nurses
when they have this information.
5. Who else? Take some time to quietly observe the
activities of the day at one of the nurses’ stations.
Just a 30-minute observation and you will probably
“see” and “hear” things that make you remember
another stakeholder. Include them in the education
process. Once done, you can begin the actual
training part.
2. Consider the housekeeping staff. They are often
present in a patient’s room when a patient is trying to
get up or walk to the bathroom. If the housekeeping
staff know a yellow wristband means “Fall Risk,” and
they see a patient trying to get up, they can call the
nursing staff, alert them, and potentially prevent a
fall.
3. What about the dietary technicians? A red wristband
means there is an allergy – and not just to medicines.
Maybe it is a food allergy and the red band will alert
them to check for that and note it in the patient’s
profile.
4. Don’t make assumptions about the medical staff
getting this information. Attendings, intensivists,
residents, and interns need to know what these colors
mean. Pull them into the process. This promotes safe
healthcare for all providing and receiving it.
30
Getting Started
cation
Staff Edu g:
Regardin
ded
Color-co bands
Wrist
”
rt
le
“A
for
n intended
Informatio f, clinical
all staf
clinical.
and non-
Most people will use this brochure as the main teaching
material. It contains most of the pertinent information staff
need to know for this initiative. We suggest you do not
give out the brochure until the end of your training
because people may start reading the brochure instead
of listening to you. Pass it out at the end of the meeting,
but tell them upfront that there is a brochure with all of the
information you are presenting and you will pass it out later.
Here are the main points you want to make during your training session:
1
Start with a story – Adults want to know “why” they should do something; simply telling them they need to
start doing this “because they do” is not sufficient information to get high levels of compliance. Besides,
isn’t that what you would want to know, too? A story gives them information that makes the request
relevant – so they want to comply.
This story is true. One panel of the brochure tells the story of when a patient was not coded due to a mix-up
in the wristbands. The error was caught in time to quickly code the patient, but by telling this story, most
staff will understand how this error could happen to anyone – and they will be on board with this plan. The
story goes like this:
In 2005, a hospital in Pennsylvania submitted a report to the Pennsylvania Patient
Safety Reporting System (PA-PSRS) describing an event in which clinicians nearly
failed to rescue a patient who had a cardiopulmonary arrest because the patient
had been incorrectly designated as “DNR” (Do Not Resuscitate). The source of the
confusion was that a nurse had incorrectly placed a yellow wristband on the patient.
In this hospital, the color yellow signified that the patient should not be resuscitated.
In a nearby hospital, in which this nurse also worked, yellow signified “restricted
extremity,” meaning that this arm is not to be used for drawing blood or obtaining
IV access. Fortunately in this case, another clinician identified the mistake and the
patient was resuscitated. However, this “near miss” highlights a potential source of
error and an opportunity to improve patient safety by re-evaluating the use of colorcoded wristbands.
We want to thank and acknowledge this hospital for its transparency and disclosure
of this event. It could have happened anywhere, and it has served as a “wake-up call”
to many of us.
31
2
Follow the story with data results – Sharing with staff how hospitals in our state currently use wristbands
makes the information more relevant and reinforces to them why they should want to comply and
participate in this. Share this information with staff. It is on one of the panels in the brochure, too.
A survey of Illinois Hospitals was conducted in 2007 to evaluate our risk for a similar
event happening in Illinois. The results showed that six different colors/methods
were being used to designate DNR status with patient wristbands.
Our risk was apparent.
We identified the need to standardize the colors being used for
Allergies, Fall Risk, and DNR.
Our answer is this project.
3
The Big Picture – For many individuals, knowing that we are part of a bigger and unique situation fosters
pride and, again, reinforces the developing motivation to comply. Tell staff how this state is part of a
national effort to work together with the goal of using the same colors. Share this information with them:
This initiative is being adopted by hospitals throughout the nation. This will make it
safer for us as clinicians and as patients. Once achieved, it means whether you are
traveling on vacation to these states or relocated to work in another state, participating
hospitals will be using the following colors:
RED means ALLERGY ALERT
YELLOW means FALL RISK
PURPLE means “DNR”
32
4
Introduce the Colors – In the toolkit, you will find three sample wristbands that show the colors being
used and demonstrate the text that is pre-printed on the wristbands. These wristbands are from the
vendor, The St. John Companies, Inc. If your organization uses a different vendor (check with Materials
Management), then you may want to check to see if its bands are available so you can show what you will
be using. The colors should be the same since the vendors know the specifications for the colors that
are being used. This is the time to show the bands so there is a visual of the information you are going to
share. Review with staff the three bands, the colors, and the corresponding meaning. The text box below
will walk you through that information.
We are going to discuss the three different color-coded “alert” wristbands that are a
part of statewide standardization.
PURPLE means “DNR” or Do Not Resuscitate
Other “alert” wristbands that your organization uses may be introduced with this information, but are facility-specific, such as “latex allergy” or “restricted extremity,” etc.
5
AQs about the colors selected. This is a companion document to the staff brochure. Research about
F
colors and human association with certain colors contributed to the color selection process in this
project . This is important for staff to know so they can feel confident with this process. The FAQ document
reviews why the colors were selected and why other colors were not selected. At this time, hand out the
FAQ sheet to staff and review it with them. Don’t just hand out the FAQs. Make this interactive and ask
each person attending to take a question (there are 10) and read the answer out loud. This will make the
session more interesting. Also, by having staff read and hear the information, they will “re-engage” in the
presentation.
You are two-thirds done at this point.
Let staff know this so they mentally relax.
33
6
even Risk Reduction Strategies – In addition to the standardization of wristband colors in the state,
S
we recommend seven other risk reduction strategies that should be initiated. These are suggested as
a result of sentinel events that have occurred, near miss events, and common sense. This information
is also in the staff brochure and can be cut out as a quick reference card and laminated, if you desire.
Review these with staff now.
condition, or when information is received during the
hospital stay.
wristbands.
2.Remove any “social cause” colored wristbands (such
signage information/stickers with same color coding.
as the yellow Lance Armstrong “LIVESTRONG”).
another facility.
The following information takes each risk reduction strategy and provides
further detail and/or explanation of that strategy.
1.Use wristbands that are pre-printed with text
a. This can reinforce the color-coding system
for new clinicians, help caregivers interpret
the meaning of the band in dim light, and also
help those who may be color-blind.
5.Educate patients and family members regarding
that tells what the band means.
during hospital stay.
the purpose and meaning of the wristbands.
b. Eliminates the chance of confusing colors with
alert messages.
a. Including the patient and family safeguards the
hospital, healthcare professionals, and patient
from potential errors.
b. Remind patients and families that color-coding
provides another opportunity to prevent errors.
(such as the yellow Lance Armstrong
“LIVESTRONG”).
c. Use the patient/family education brochure
located in the toolkit.
a. Be sure this is addressed in your hospital
policy.
b. If that can’t be done, you can cover the band
with a bandage or medical tape, but removal
altogether is best.
signage information/stickers with the same color
coding – red for allergies, yellow for fall risk, and
purple for DNR status.
another facility.
wristbands upon assessment, hand-off of care,
and facility-to-facility transfer communication.
a. This should be done when patients are
processed to enter the facility and/or during
patient admission.
34
Additional points to make:
8.When possible, limit the use of colored
10.If your facility uses pediatric wristbands
wristbands for other categories of care, e.g.
contact isolation, special needs, etc.
that correspond to the Broselow colorcoding system for pediatric resuscitation,
take steps to reduce any confusion between
these Broselow colors and the colors on the
wristbands used elsewhere in the facility.
9.Remember, the wristband is a tool to
communicate an alert status.
a. Educate staff to utilize the patient medical
record information (physician order for DNR)
as an additional resource for verification
processes for allergies, fall risk, and advance
directives.
35
7
Teaching Patients - The patient education brochure is a companion document to the staff brochure. We
know that how we say something is just as important as what we say. Patients and their loved ones are
scared, vulnerable, and unfamiliar with hospital ways. We need to communicate to them in a respectful
and simple way without being condescending. The following text was written to serve as a “script” for
staff so all could be delivering the same information to patients and families. By having a consistent
message, we reinforce the information – this helps patients and families retain the information. Another
benefit of having a consistent message is patients and families experience a sense of confidence in
the healthcare system since we are all echoing each other. The text box below is taken directly from the
staff brochure. This is the time to mention to staff there is a patient/family brochure that can be handed
out (if your unit intends to do that). Tell staff you will hand out the brochure to them when you are done
presenting the material so they can see what the patients will have.
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
healthcare 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.
If a patient has an allergy to anything - food, medicine, dust, grass, pet hair, ANYTHING
– tell us. It may not seem important to you, but it could be very important in the care
he/she receives.
We want to prevent falls at all times. Nurses review 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 saying this person needs to be
assisted when walking or he/she may fall.
Some patients have expressed an end-of-life wish and we want to honor it.
36
8
nd finally…. Review with staff the points listed below. These are the items that are listed on the
A
competency so it is important to clarify that staff have a good understanding of these items. You should
emphasize, “this is what would impact your tasks every day…” and review those points. This is a good
time to hand out your organization’s P&P. Be sure your policy covers the areas listed below as they are
also a part of the competency. If your policy does not address an item on the competency, then you
should remove it from the form.
4 Color Code – what do the three colors mean?
4 Who can apply the wristband to the patient?
4 When does the application of the color-coded wristband(s) occur?
4 Policy requiring patients to remove the “social cause” bands.
4 Patient education and how to communicate (script) the information with patients/families.
4 Need for re-application of band.
4 Communication regarding wristbands during transfers and other reports.
4 Patient refusal to comply with policy.
4 Discharge instructions for home and/or facility transfer.
If you use the last copy of any of the implementation materials, you may go to www.ihatoday.com or www.mchc.org.
Click on the section identified as Color-coded Wristband materials. Find the file that contains the document you need.
37
Staff Education – The Tools
20 minutes will tell you
what to expect
1. Poster announcing the training session dates/times
(Document Provided)
with the new changes
Join us on the following dates for the training session
about Color-coded "Alert" Wristbands.
Day / Date / Time: ____________________________________________________________
Location: ____________________________________________________________________
The following poster was created to announce the sessions and the initiative. Post them
in the staff lounge, communication boards, employee locker room, staff bathrooms – any
place where staff will see them.
Day / Date / Time: ____________________________________________________________
Location: ____________________________________________________________________
Day / Date / Time: ____________________________________________________________
Location: ____________________________________________________________________
Questions? Contact: ___________________________________________ ext: ____________
If you use the last copy of any of the implementation materials, you may go to www.ihatoday.com or www.mchc.org.
Click on the section identified as Color-coded Wristband materials. Find the file that contains the document you need.
38
20 minutes will tell you
what to expect
with the new changes
Join us on the following dates for the training session
about Color-coded “Alert” Wristbands.
Day / Date / Time: _____________________________________________________________
Location:_____________________________________________________________________
Day / Date / Time: _____________________________________________________________
Location:_____________________________________________________________________
Day / Date / Time: _____________________________________________________________
Location:_____________________________________________________________________
Questions? Contact: ____________________________________________ ext:_____________
Got
Color?
DNR
ALLERGY
FALL RISK
DNR
Join us on the following dates for the
training session about Color-coded
“Alert” Wristband Standardization.
Day / Date / Time: _____________________________________________________________________
Location:_______________________________________________________________________________
Day / Date / Time: _____________________________________________________________________
Location:_______________________________________________________________________________
Day / Date / Time: _____________________________________________________________________
Location:_______________________________________________________________________________
Questions? Contact: ___________________________________________________ ext:_______________
ME
A
G
H
M ATC
YELLOW
“DNR”
PURPLE
Y
G
R
E
L
AL
RED
K
S
I
R
L
L
FA
Colors are FUN
but
patient safety
is NOT A GAME
Join us on the following dates for the training session about
Color-coded “Alert” Wristband Standardization.
Day / Date / Time: _____________________________________________________________________
Location:_______________________________________________________________________________
Day / Date / Time: _____________________________________________________________________
Location:_______________________________________________________________________________
Day / Date / Time: _____________________________________________________________________
Location:_______________________________________________________________________________
Questions? Contact: ___________________________________________________ ext:_______________
continued
2. Staff Sign-In Sheet (Document Provided)
Sample — Completed Staff Sign-In Sheet
• Use this form so there is a record of all staff who attended the training session.
• Make copies so you don’t use the last one.
you use the last copy, go to www.ihatoday.com or www.mchc.org. Click on the section identified as
•IfColor-coded
Wristband materials. Find the file identified as “Staff Sign-In Sheet.”
this sign-in sheet with your staff session/training folder. The Joint Commission or other regulatory
•Keep
agencies may ask you for it. This is especially important if you are making this a mandatory participation
session.
42
Staff Sign-In Sheet
Date :_____________________ Unit/Dept/Location__________________________________
Educator: _ __________________________________________________________________
Topic: Color-coded “Alert” Wristbands
Objective: 1. T
o inform staff of the new process and colors of the Allergy,
Fall Risk, and DNR wristbands.
2. S
taff to demonstrate understanding of information through
feedback of information.
Name/Title:_____________________________________________________________________ Shift:________________
Name/Title:_____________________________________________________________________ Shift:________________
Name/Title:_____________________________________________________________________ Shift:________________
Name/Title:_____________________________________________________________________ Shift:________________
Name/Title:_____________________________________________________________________ Shift:________________
Name/Title:_____________________________________________________________________ Shift:________________
Name/Title:_____________________________________________________________________ Shift:________________
Name/Title:_____________________________________________________________________ Shift:________________
Name/Title:_____________________________________________________________________ Shift:________________
Name/Title:_____________________________________________________________________ Shift:________________
Name/Title:_____________________________________________________________________ Shift:________________
continued
3. Staff competency checklist (Document Provided)
We recognize that some organizations will opt to use this form and some will not. Should
you decide to use a competency checklist in your process, we hope this form will provide
the documentation you need. This form also serves as a great checklist for the trainer so all
of the important elements in the training are remembered and taught.
If you do not use this as a staff form, consider using it as your form to help you remember
every element you should be reviewing with staff about the changes with the color-coded
wristbands.
If you use the last copy, go to www.ihatoday.com or www.mchc.org. Click on the section identified as Color-coded
Wristband materials. Find the file identified as “Staff Competency Checklist.”
44
Staff Competency Checklist
Purpose: T
hese are the standards of the technical competencies
necessary for performance and/or clinical practice.
To meet competency standards, the employee must demonstrate proficiency in performing the
technical procedures safely as evidenced by department-specific criteria.
Methods to Use:
A. Demonstration
B. Direct Observation/Checklist
C. Video/PowerPoint Review
D. Skills Lab
E. Self Study/Test
F. Data Management
G. Other
Supervisor’s
initials signify
competency
was met.
__________________________________________________________________________________________
Employee Name
Patient Color-coded
“Alert” Wristband Process
Job Title
Date
Method Supervisor’s
Used
Initials
Comments
Color Code – what do the three colors
mean?
Who can apply the wristband to the patient?
When does the application of the
wristband(s) occur?
Policy requiring patients to remove the
“social cause” bands.
Patient education and how to communicate
(script) the information with patients/families.
Need for re-application of band.
Communication regarding wristbands during
transfers and other reports.
Patient refusal to comply with policy.
Discharge instructions for home and/or
facility transfer.
__________________________________________ Signature
Initials
__________________________________________
Signature
Initials
__________________________________________________________________________________________
Employee Signature
Date
IHA/MCHC wishes to acknowledge the Pennsylvania Color of Safety Task Force, which developed the initial form that is the basis for this document.
continued
4. Tri-fold brochure called Staff Education
Regarding: Color-coded “alert” wristbands
cation
Staff Edu g:
Regardin
ded
Color-co bands
Wrist
“Alert”
for
n intended
Informatio f, clinical
all staf
.
clinical
and non-
(Document Provided)
Most people will use this brochure as the main teaching material. It contains
most of the pertinent information staff need to know for this initiative. We
suggest you do not give out the brochure until the end of your session
because people may start reading the brochure instead of listening to you.
Pass it out at the end of the session, but tell them upfront that there is a
brochure with all of the information you are presenting and you will pass it
out later.
46
*To view the entire report, go to http://www.psa.
state.pa.us/psa/lib/psa/advisories/v2_s2_
sup__advisory_dec_14_2005.pdf
In 2005, a hospital in Pennsylvania
submitted a report to the Pennsylvania
Patient Safety Reporting System (PA-PSRS)
describing an event in which clinicians
nearly failed to rescue a patient who had a
cardiopulmonary arrest because the patient
had been incorrectly designated as “DNR”
(Do Not Resuscitate). The source of the
confusion was that a nurse had incorrectly
placed a yellow wristband on the patient.
In this hospital, the color yellow signified
that the patient should not be resuscitated.
In a nearby hospital, in which this nurse
also worked, yellow signified “restricted
extremity,” meaning that this arm is not to
be used for drawing blood or obtaining IV
access. Fortunately in this case, another
clinician identified the mistake and the
patient was resuscitated. However, this
“near miss” highlights a potential source of
error and an opportunity to improve patient
safety by re-evaluating the use of colorcoded wristbands.*
We want to thank and acknowledge this
hospital for its transparency and disclosure
of this event. It could have happened
anywhere, and it has served as a “wake-up
call” to many of us.
How this all
got started…
This initiative is being adopted by hospitals
throughout the nation. That means, whether
you are traveling on vacation to these states or
relocated to work in another state, participating
hospitals will be using the following colors:
The Big Picture
Illinois hospitals seek to provide safe and
high-quality patient care. We accomplish this in
several ways, one of which is to standardize
the colors for “alert” wristbands. Most hospitals
are adopting the same colors so, regardless of
which hospital you work at today or tomorrow,
the color for Allergy, Fall Risk, or “DNR” (Do
Not Resuscitate) “alert” wristbands should be
the same.
What about Illinois?
Information intended for
all staff, clinical
and non-clinical.
Color-coded “Alert”
Wristbands
Staff Education
Regarding:
How we say something is just as
important as what we say. The next
column is a script you can use to tell your
patients/families about the color-coded
“alert” wristbands and what they mean.
If everyone says it the same, there is a
better chance patients and families will
understand what we are saying.
How to tell the patients what
the different colors mean?
We identified the need to standardize
the colors being used for Allergies, Fall
Risk, and DNR.
A survey of Illinois hospitals was
conducted in 2007 to evaluate our risk for
such an event. The results showed that six
different colors/methods were being used
to designate the DNR status with patient
wristbands.
Wristbands –
A Statewide Patient
Safety Initiative
PURPLE means “DNR” or Do Not
Resuscitate
Some patients have expressed an end-of-life
wish and we want to honor it.
We want to prevent falls at all times. Nurses
review 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
saying this person needs to be assisted when
walking or he/she may fall.
If a patient has an allergy to anything - food,
medicine, dust, grass, pet hair, ANYTHING
– tell us. It may not seem important to you but
it could be very important in the care he/she
receives.
There are three different color-coded “alert”
wristbands that we are going to discuss
because they are the ones most commonly
used.
Color-coded “alert” wristbands are used in
hospitals to quickly communicate a certain
healthcare status, condition, or “alert” that a
patient may have. This is done so every staff
member can provide the best care possible.
For any staff person talking
to a patient or family
SCRIPT
signage information/stickers with same color
coding.
wristbands.
condition, or when information is received during
the hospital stay.
another facility.
(such as the yellow Lance Armstrong “LIVESTRONG”).
Other Risk Reduction
Strategies
Staff Should Know
continued
5. Tri-fold brochure called Patient Safety:
Understanding what your color-coded “alert”
wristbands mean (Document Provided)
ing what
Understand
d “Alert”
de
co
Colors mean
Wristband
This brochure was created to hand out to patients and family members
so they understand what the wristband colors mean and can confirm the
information. Patients should have this information whether they need a
color-coded wristband or not because new information may surface as a
result of this education. For example, perhaps a patient has an allergy to
a certain food but was thinking only about medications when first asked
about allergies. During a family visit, a loved one could read this information
brochure and bring up the food allergy. This can now be corrected and the
patient is not at risk due to an oversight.
Wristband materials. Find the file that contains the document you need.
49
and their families.
patients
safer and better for
making healthcare
collaborative work,
supporter of this
proud to be a
Our hospital is
an endeavor to use the
same methods
or processes, like
color-coded wristbands.
Illinois healthcare
providers are working
together to make
patients safe.
We accomplish this goal
by working together on
statewide projects in
Wristbands mean
Understanding what
“Alert” wristbands are used in hospitals
to quickly communicate a certain
healthcare status or an “alert” that a
patient may have. This is done so every
staff member can provide the best
care possible, even if they do not know
that patient. The different colors have
certain meanings. The words for the
alerts are also written on the wristband
to reduce the chance of confusing the
alert messages.
What is a Color-coded
“Alert” Wristband?
Illinois hospitals seek to provide safe
and high-quality patient care. We
accomplish this in several ways, one
of which is to standardize the colors
for “alert” wristbands. This initiative is
occurring not just in Illinois, but in other
states throughout the nation.
Statewide Patient
Safety Initiatives
Some individuals have expressed an endof-life wish and the healthcare team wants to
honor that wish.
DNR
or Do Not Resuscitate
Healthcare workers want to prevent falls at all
times. Nurses observe and examine patients
throughout their hospital stay to determine if
they need extra attention in order to prevent
a fall. Sometimes a hospitalized patient may
become weakened during his/her illness or
following surgery. When this patient has a
YELLOW color-coded wristband, the nurse
and other healthcare workers are alerted that
this person needs to be assisted when walking
or he/she may fall.
FALL RISK
If you, as a hospitalized patient, have an allergy
to anything – food, medicine, dust, grass, pet
hair, ANYTHING – tell the healthcare team. It
may not seem important to you but it could be
very important in the care you receive.
ALLERGY
There are three different color-coded “alert”
wristbands that we will explain because they are
the wristbands most commonly used.
What do the different
colors mean?
Also, if you have an Advance
Directive, tell your healthcare team.
An Advance Directive tells your
doctor what kind of care you would
like if you become unable to make
medical decisions. The healthcare
team wants to respect and honor a
patient’s wishes and that is done best
when we have all of the information.
If there is information your healthcare
team does not know about you, such
as a food allergy or a tendency for
you to lose balance and almost fall,
share that with the healthcare team
because we want to ensure your
safety.
Keep us informed.
It is important that you, the patient,
and your family know these colors
and their meanings because you are
an important source of information
that can help your healthcare team
(e.g. physician, nurse) provide the
best care.
Involving Patients and
Family Members
continued
6. FAQ handout for staff (Document Provided)
This handout was created to offer further clarification regarding the changes being made. You can use this as a handout or
to post in staff areas as well.
Wristband materials. Find the file identified as “FAQ handout for staff.”
52
FAQs about Color-coded “Alert” Wristbands
Q #1. In the past, we never used wristbands. Why should we
Q #4. Why didn’t you select Green for DNR?
A.Again, we considered this color as well; however, due
consider it now?
A. While there is much discussion regarding the issue of
to color-blindness concerns, it was decided to avoid
it altogether. Also, in other industries, the color green
often has a “Go Ahead” connotation, such as traffic
lights. We again want to avoid any possibility of sending
“mixed messages” in a critical moment.
“to band or not to band,” a literature review to date has
not identified a better intervention conclusively. One
may say, “In the good old days, we just looked at the
chart and didn’t band patients at all.” However, those
days consisted of a workforce base that was largely
core staff employed by the hospital. Now, an increasing
number of healthcare providers are not hospital-based
staff, so it is imperative that current processes take this
into consideration.
Q #5. So, if we adopt the purple DNR wristband, then do we
still need to look in the chart?
Q #2. We don’t use wristbands for DNRs at this hospital. Why
should we consider adopting this?
A. The use of this toolkit does not advocate the
implementation of a wristband program but advocates
the standardization of colors if a hospital chooses to
use “alert” wristbands. Wristbands are used in many
hospitals to communicate an alert. Registry staff,
travelers, non-clinical staff, etc. may be unaware of
where to look in the medical record if they are new to
your hospital. By having a wristband on the patient, a
quick warning is communicated so anyone can know
about this alert. It is also a means to communicate
to the family that we are clear about their end-of-life
wishes.
A. Yes. Code status can change throughout a
hospitalization. It is important to know the current status
so the patient’s and family’s wishes can be honored.
Always validate that there is an order by a physician for
the DNR designation.
Q # 6. Why did you select red for Allergies?
A. Red was selected because the responses to the
Illinois 2007 survey indicated that 55% of hospitals
that use a wristband to signify allergies have selected
red. Red also is the color selected in all 27 states that
have adopted standardized colors. It makes sense
to continue with a color that is already established
in Illinois and well on its way to becoming a national
standard.
Q #7. Besides that, are there any other reasons for using red
Q #3. Why not use Blue for DNR?
A. The work group considered the color designation in the
for Allergies?
27 states that have adopted purple to standardize DNR,
and the rationale behind their decisions. It also took
into consideration that the many hospitals use “Code
Blue” to summon a resuscitation team. By having the
DNR wristband as “no code,” there was potential for
confusion, i.e., “does blue mean we code or do not
code?” To avoid creating any second guesses in this
critical situation, the decision was made to adopt the
same guideline as in the majority of states – purple to
designate DNR.
A. Yes, there are. Research of other industries tells us that
red has an association that implies extreme concern.
The American National Standards Institute (ANSI) has
designated certain colors with very specific warnings.
ANSI uses red to communicate “Stop!” or “Danger!” We
think that message should hold true for communicating
an allergy status. When a caregiver sees a red allergy
alert band, he/she is prompted to “STOP!” and double
check if the patient is allergic to the medication, food, or
treatment he/she is about to receive.
53
Q #8. Do we write the allergies on the wristband, too?
A. No - it is our recommendation that allergies be written
continued
Q #11. Why did you select yellow for Fall Risk?
A. Our research of other industries tells us that yellow
in the medical record according to your hospital’s policy
and procedure. We suggest allergies not be written on
the wristband for several reasons:
has an association that implies “Caution!” Think of the
traffic lights; proceed with caution or stop altogether
is the message. The American National Standards
Institute (ANSI) has designated certain colors with very
specific warnings. ANSI uses yellow to communicate
“tripping or falling hazards.” It fits well in healthcare,
too, when associated with a Fall Risk. Caregivers
want to be alert to and use caution with a person who
has a history of previous falls, dizziness or balance
problems, fatigability, or confusion about his/her current
surroundings.
1. Legibility may hinder the correct interpretation of the
allergy written on the wristband.
2. By writing allergies on the wristband, someone may
assume the list is comprehensive. However, space is
limited on a wristband. The risk is that some allergies
would be inadvertently omitted – leading to confusion or
missing an allergy.
3. Throughout a hospitalization, allergies may be
discovered by other caregivers, such as dieticians,
radiologists, pharmacists, etc. This information is
typically added to the medical record and not always a
wristband. By having one source of information to refer
to, such as the medical record, staff of all disciplines will
know where to add newly discovered allergies.
#12. Why even use an alert band for Fall Risk?
Q
A. According to the Centers for Disease Control and
Q #9. Why is a separate standardized color to designate latex
2. Older adults are hospitalized for fall-related injuries
five times more often than they are for injuries from
other causes.
Prevention (CDC), falls are an area of great concern in
the aging population.
1. More than a third of adults aged 65 years or older fall
each year.
allergy not part of the recommendation?
A. There was concern that, if too many standardized colors
3. Of those who fall, 20% to 30% suffer moderate to
severe injuries that reduce mobility and independence,
and increase the risk of premature death.
were used, staff would have difficulty remembering all
of them. With red used to alert staff to the patient having
an allergy, it will prompt them to confirm the allergy with
the patient and/or check the medical record regardless
of the specific type of allergy the wristband is used to
designate.
4. The total cost of all fall injuries for people age 65 or
older in 1994 was $27.3 billion (in current dollars).
5. By 2020, the cost of fall injuries is expected to reach
$43.8 billion (in current dollars).
6. Hospital admissions for hip fractures among people
over age 65 have steadily increased, from 230,000
admissions in 1988 to 338,000 admissions in 1999. The
number of hip fractures is expected to exceed 500,000
by the year 2040.
Q 10. Does this mean we can no longer use red or “R” on
#
bands to designate blood bank information?
A. No, although it is important to thoroughly educate
staff about the difference between your current blood
bank bands and any newly implemented red bands
to designate allergies. This is another reason text
is recommended to be placed on the red bands to
designate “Allergy Alert” or “Allergy” as another way
to differentiate these two bands. The product decision
made by your hospital should consider the style and
hue of red used for current blood bank wristbands and
make sure new products implemented to designate
allergy are easily differentiated from blood bank bands.
7. As the aging population enters the acute care
environment, consideration must be given to the
risk that is present and do everything possible to
communicate that to hospital staff.
54
Q #13. What is an organization to do if it uses the Broselow
#14. Who decided on these colors?
Q
A.The Illinois project is modeled after the original work
color-coding system for pediatrics?
continued
A.If your facility uses wristbands for pediatric patients that
by Arizona, which has subsequently been adopted in
a series of other states. By adhering to this model, we
hope eventually to see standardized colors across all
states.
relate to the Broselow color-coding system for pediatric
resuscitation carts, consider the potential for confusion
between the Broselow bands (which are most likely
used in the Emergency Department, Pediatrics, and
Neonatal Intensive Care) and the other color wristbands
your facility uses.
For questions or comments regarding this project, please
direct to:
We don’t believe this system conflicts with the
recommendations of this project. The colors and
bands used for the Broselow-Luten system are clearly
identified and used for broadly-defined conditions for
pediatric emergency treatment that should be easily
differentiated from bands used for Allergy, Fall, or DNR
as part of this project. As recommended when any
other color-coded processes are used in a healthcare
setting, staff and patient education is imperative and a
discussion about any color-coded products or systems
used should be included in any education provided
related to this initiative as well.
Becky Steward
1151 East Warrenville Road
P.O. Box 3015
Naperville, Illinois 60566
Phone: (630) 276-5585
E-mail: bsteward@ihastaff.org
Dawn Niedner
222 S. Riverside Plaza
Suite 1900
Phone: (312) 906-6164
E-mail: dniedner@mchc.com
55
continued
7. PowerPoint (Document Provided)
This presentation was created to provide alternate teaching methods for the trainer. It can be used in large and small
groups. Please check our Web site periodically as we will update the presentation as needed. To do that, go to
www.ihatoday.org or www.mchc.org. At the home page, you will see the Color-coded Wristband icon – just click on that.
Find the file that says “PowerPoint.” The CD in your toolkit also contains this PowerPoint presentation with speaker notes.
56
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
METROPOLITAN
CHICAGO
HEALTHCARE COUNCIL
Use of Color-coded Wristbands to
Communicate Alerts
in Illinois Hospitals
www.mchc.org
www.ihatoday.org
www.mchc.org
2
www.ihatoday.org
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.*
Historical Perspective
*New Jersey Department of
Health and Senior Services FAQs
www.mchc.org
3
www.ihatoday.org
www.mchc.org
4
The case for standardization
Could this happen again?
• 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
www.mchc.org
5
www.ihatoday.org
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
www.ihatoday.org
www.mchc.org
6
57
www.ihatoday.org
Pennsylvania Patient Safety Reporting System
Identified Risk Reduction Strategies
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.
www.mchc.org
7
www.ihatoday.org
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
www.mchc.org
8
www.ihatoday.org
Recommendations for
Pennsylvania Hospitals
August 2006
– Initiated the recommendations via distribution of the
“Color of Safety” manual
Follow-up Survey 2007
Practice in Illinois
– 80% of hospitals reviewed “Color of Safety” manual
– 50% of hospitals initiated the recommended changes
www.mchc.org
9
www.ihatoday.org
www.mchc.org
10
www.ihatoday.org
2007 Survey of Illinois Hospitals
Use of color-coded wristbands
Illinois caregivers request guidance on the
standardization of color-coded wristbands
Among Illinois hospitals responding to survey:
• Illinois Critical Access Hospital Network (ICAHN)
• Regional meeting of suburban Chicago hospitals
• Chicago area hospitals surveyed on the use of colorcoded 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
• 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
 Most frequent color - red
• 65 % use color-coded wristband to indicate Risk to Fall
 Most frequent color – orange
IL Survey Data, 2007
www.mchc.org
11
www.ihatoday.org
www.mchc.org
12
58
www.ihatoday.org
Results for Do Not Resuscitate
Do Not Resuscitate
Should Illinois hospitals use a standard color on
wristbands to alert caregivers that a patient is not
to be resuscitated?
74 % YES
26 % NO
www.mchc.org
13
www.ihatoday.org
14
www.mchc.org
www.ihatoday.org
Results for Allergies
Allergies
wristbands to alert caregivers that a patient has
allergies?
78 %
22 %
YES
NO
www.mchc.org
15
www.ihatoday.org
www.mchc.org
16
www.ihatoday.org
Results for Risk to Fall
Risk to Fall
wristbands to alert caregivers that a patient is at
risk to fall?
78 % YES
22 % NO
www.mchc.org
17
www.ihatoday.org
www.mchc.org
18
59
www.ihatoday.org
Charge to IHA / MCHC Workgroup
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
19
www.mchc.org
• 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
www.ihatoday.org
www.mchc.org
20
www.ihatoday.org
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 colorcoded wristbands
Recommendations for standardization
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.
21
www.mchc.org
www.ihatoday.org
www.mchc.org
22
Do Not Resuscitate
•
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”
www.mchc.org
Purple - Do Not Resuscitate
CALLING CODE BLUE!
Recommendation:
DNR - Purple
•
•
23
www.ihatoday.org
Recommendation - PURPLE for Do Not Resuscitate
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?”
www.ihatoday.org
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
www.mchc.org
24
60
www.ihatoday.org
Allergy
Recommendation:
Allergy - Red
Allergy
Recommendation - RED for the Allergy Alert
Quick Adoption
According to survey
results, more Illinois
hospitals use red to alert
caregivers to allergies
than any other color.
adopt the color RED for the
ALLERGY ALERT designation
with the words embossed / preprinted on the wristband,
“ALLERGY”Allergies
25
www.mchc.org
www.ihatoday.org
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
26
www.mchc.org
www.ihatoday.org
Fall Risk
Fall Risk
Allergies
Allergies
Recommendation:
Fall Risk - Yellow
Recommendation - YELLOW for Fall Risk
adopt the color YELLOW for the
Fall Risk Alert designation with the
words embossed / pre-printed on
the wristband, “Fall Risk”
1. Why Yellow?
– Associated with “Caution” or “Slow Down”
Falls account for more than
70 percent of the total
injury-related health costs
among people 60 years of
age and older.
•
•
•
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
27
www.mchc.org
www.ihatoday.org
www.mchc.org
28
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
California
Illinois
Michigan
Nebraska
New Jersey*
Oregon*
Utah
West Virginia
Arkansas
Colorado*
Iowa
Minnesota*
Nevada
New Mexico
Pennsylvania*
Virginia
Wisconsin
*Plus one or two additional colors
www.mchc.org
29
www.ihatoday.org
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.”*
Arizona
Florida
Kansas
Missouri*
New Hampshire
Ohio*
Texas
Washington
Louisiana*
*
American Hospital Association Quality Advisory, September 4, 2008
*Adopted late in 2008
www.ihatoday.org
www.mchc.org
30
61
www.ihatoday.org
Suggested Work Plan for facility preparation,
staff education, and patient education
includes:
1.
2.
3.
4.
Work Plan
Following the work plan is a task chart for each element that
provides cues for methodical and successful implementation.
31
www.mchc.org
Organizational approval
Supplies assessment and purchase
Hospital-specific documentation
Staff and patient education materials and training
www.ihatoday.org
www.mchc.org
32
Sample Work
Plan Document
www.mchc.org
Sample Task Chart
33
www.ihatoday.org
www.mchc.org
34
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)
•
•
•
•
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 colorcoded wristbands
• PowerPoint presentation
•
•
•
•
35
www.ihatoday.org
Tools for Staff Education
www.mchc.org
www.ihatoday.org
www.ihatoday.org
www.mchc.org
36
62
www.ihatoday.org
Color-coded “Alert” Wristbands/Risk Reduction
Strategies : A Quick Reference Card (cont.)
____________________________________
Color-coded “Alert” Wristbands/Risk Reduction
Strategies : A Quick Reference Card
____________________________________
1. Use wristbands with the alert message preprinted (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.
www.mchc.org
37
4. Initiate banding upon admission, changes in
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
www.ihatoday.org
www.mchc.org
38
Why have a script for staff?
SCRIPT for any staff person talking to a patient or family:
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.
www.mchc.org
39
www.ihatoday.org
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.
There are three different color-coded “alert” wristbands that we are going to
discuss because they are the ones most commonly used.
www.ihatoday.org
www.mchc.org
40
www.ihatoday.org
SCRIPT for any staff person talking to a patient or family (cont.):
SCRIPT for any staff person talking to a patient or family (cont.):
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.
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.
www.mchc.org
41
Some individuals have expressed an end-of-life wish and we, the
healthcare team, want to honor it.
www.ihatoday.org
www.mchc.org
42
63
www.ihatoday.org
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.
43
www.mchc.org
www.ihatoday.org
www.mchc.org
44
Excerpt from Refusal Form
In Closing
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
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.
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.
Remove “social caus e” 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 caus e” colored wristbands.
Reason provided (if any):__________________________________
•
__________________
_________________________________________
Date/Time
_____________________
Date/Time
Signature/Relationship
________________________________________________
Witness Signature/Job Title
www.mchc.org
45
www.ihatoday.org
www.ihatoday.org
www.mchc.org
46
www.ihatoday.org
Illinois Wristband Toolkit
Available for download:
www.ihatoday.org
www.mchc.org
Resources
www.mchc.org
47
www.ihatoday.org
www.mchc.org
48
64
www.ihatoday.org
Additional Websites
Questions?
American Hospital Association Quality Center
www.ahaqualitycenter.org/ahaqualitycenter/jsp/home.jsp
Arizona Hospital and Healthcare Association
www.azhha.org
Dawn Niedner
Program Director
Clinical and Emergency Services
Metropolitan Chicago Healthcare
Council
312-906-6164
Dniedner@mchc.com
www.mchc.org
Ohio Patient Safety Institute
www.ohiopatientsafety.org
Becky Steward
Manager, Patient Safety Collaborative
630-276-5585
Bsteward@ihastaff.org
49
Patient Safety Authority (Pennsylvania)
www.psa.state.pa.us/psa/lib/psa/advisories
www.ihatoday.org
www.mchc.org
50
65
www.ihatoday.org
DNR
ALLERGY
FALL RISK
DNR
66
Policy and Procedure Template
Policy name: Color-coded Wristbands
1. Purpose
To have a well-defined and standardized practice for identifying and communicating
patient-specific risk factors by standardizing the use of color-coded wristbands
(placards or stickers, etc.) to support optimal safe care based upon the patient’s
assessment, wishes, and medical status.
2. Objective - Color-coded Wristbands
Objectives are:
A. To reduce the risk of confusion associated with the use of color-coded wristbands.
B. To communicate patient safety risks to all healthcare providers.
C. To include the patient, family members, and significant others in the
communication process and promote safe healthcare.
D. To adopt the following risk reduction strategies:
1. A preprinted written descriptive text is used on the bands clarifying the intent
(i.e., “Allergy,” “Fall Risk,” or “DNR”)
2. Except in emergent situations, no handwriting is used on the wristband.
3. Colored wristbands may only be applied or removed by a nurse or licensed
staff person conducting an assessment.
4. If labels, stickers, or other visual cues are used in the medical record to
communicate risk factors or wristband application, those cues should use the
same corresponding color and text to the colored band.
5. “Social cause” wristbands, such as the yellow Lance Armstrong
LIVESTRONG and other causes, should not be worn in the hospital setting.
Staff should have family members take the “social cause” wristbands home or
remove them from the patient and store them with his/her other personal
items. This is to avoid confusion with the color-coded wristbands and to
enhance patient safety practices.
6. To involve the patient and his/her family members as a partner in the care
provided and safety measures being used, patient and family education should
be conducted regarding:
a) The meanings of the hospital wristbands and the alert associated with each
wristband; and
b) The risks associated with wearing “social cause” wristbands and why they
are asked to remove them.
IHA/MCHC wishes to acknowledge the Pennsylvania Color of Safety Task Force, which developed the initial policy that is the basis for this document.
3. Definitions
The following represents the meaning of each color-coded band:
Wristband Color
Communicates
Red
Allergy
Yellow
Fall
Purple
DNR
4. Identification (ID) Bands in Admission, Pre-Registration Procedure, and/or
Emergency Department
The colorless or clear admission ID wristbands are applied in accordance with
procedures outlined in organizational policy on patient ID and registration. These ID
bands may be applied by non-clinical staff in accordance with organizational policy.
5. Color-coded “Alert” Wristbands
During the initial patient assessment, data are collected to evaluate the needs of the
patient and a plan of care unique to the individual is initiated. Throughout the course
of care, reassessment is ongoing and may uncover additional pertinent medical
information, trigger key decision points, or reveal additional risk factors about the
patient. It is during the initial and reassessment procedures that risk factors
associated with falls, allergies, and DNR status are identified or modified. Because
this is an interdisciplinary process, it is important to identify who has responsibility
for applying and removing color-coded wristbands, how this information is
documented, and how it is communicated. The following procedures have been
established to remove uncertainty in these processes:
A. Any patient demonstrating risk factors on initial assessment will have a colored
band placed on the same extremity as the admission ID band by the nurse or
licensed professional, if the nurse is unavailable.
B. The application of the band is documented in the chart by the nurse, per hospital
policy.
C. If labels, stickers, or other visual cues are used to document in the record, the
stickers should correspond to wristband color and text.
D. Upon application of the colored wristband, the nurse will instruct the patient and
his/her family member(s) (if present) that the wristband is not to be removed.
E. In the event that any color-coded wristband has to be removed for a treatment or
procedure, a nurse will remove the wristband. Upon completion of the treatment
or procedure, a new wristband will be made, risks reconfirmed, and the wristband
reapplied immediately by the nurse. This same procedure applies if more than one
colored wristband is involved.
6. “Social Cause” Wristbands
Following the patient ID process, a licensed clinician, such as the admitting nurse,
examines the patient for “social cause” wristbands. If “social cause” wristbands are
present, the nurse will explain the risks associated with the wristbands and ask the
patient to remove them. If the patient agrees, the wristband will be removed and
given to a family member to take home, or stored with the other personal belongings
of the patient. If the patient refuses, the nurse will request the patient sign a refusal
form acknowledging the risks associated with the “social cause” wristbands (see
attached document). In the event that the patient is unable to provide permission and a
family member(s) or significant other is also not present, the licensed staff member
may remove the wristband(s) in order to reduce the potential of confusion or harm to
the patient and store the wristband with the patient’s other personal belongings.
7. Patient/Family Involvement and Education
It is important that the patient and family members are informed about the care being
provided and the significance of that care. It is also important that the patient and
his/her family member(s) be acknowledged as a valuable member of the healthcare
team. Including them in the process of color-coded wristbands will assure a common
understanding of what the wristbands mean, how care is provided when the
wristbands are worn, and the role of patient/family to validate or correct information
associated with the color-coded wristband. Therefore, during assessment procedures,
the nurse should take the opportunity to educate and re-educate the patient and his/her
family members about:
A. The meanings of the hospital wristbands and the alert associated with each
wristband;
B. The risks associated with wearing “social cause” wristbands and why they are
asked to remove them;
C. The importance of notifying the nurse or other licensed personnel whenever a
wristband has been removed and not reapplied; or
D. The importance of notifying the nurse or other licensed personnel when a new
wristband is applied and they have not been given explanation as to the reason.
Patients and families have available to them a patient/family education brochure (see
attached) that explains this information as well.
8. Hand-off in Care
The nurse will validate the presence/appropriateness of color-coded wristbands before
invasive procedures, at transfer, and during changes in level of care with
patient/family, other caregivers, and the patient’s medical record. Errors are
corrected immediately.
Color-coded wristbands are not removed at discharge. For home discharges, the
patient is advised to remove the wristband at home. For discharges to another
facility, the wristbands are left intact as a safety alert during transfer. The meaning of
wristbands is communicated by hospital personnel to transport staff prior to the
patient being transported out of the hospital. Receiving facilities should follow their
policy and procedure regarding the use of color-coded alerts.
9. DNR (Do Not Resuscitate)
DNR status and all other risk assessments are determined by individual hospital
policy, procedure, and/or physician order written within and acknowledged within
that care setting only. The color-coded wristband serves as an alert and does not take
the place of an order. Do Not Resuscitate orders must be written and verification of
Advanced Directives must occur.
10. Staff Education
Staff education regarding color-coded wristbands will occur during the new
orientation process and be reinforced as indicated.
(Note to Hospitals: You should insert your specific language in this section so it
matches your annual processes and competencies, should you decide to include
color-coded wristbands in that process.)
11. Patient Refusal
If the patient is capable and refuses to wear the color-coded wristband, an explanation
of the risks will be provided to the patient/family. The nurse will reinforce that it is
the patient’s and his/her family’s opportunity to participate in efforts to prevent
errors, and it is the patient’s and his/her family’s responsibility as part of the team.
The nurse will document in the medical record patient refusals, and the explanation
provided by the patient or his/her family member. The patient will be requested to
sign an acknowledgement of refusal by the completion of a release.
{Facility Name}
{Form Number}
Patient Refusal to Participate in the Wristband Process
Patient Identifier Information
Name _________________________________
PID: __________________________________
DOB: _________________________________
Admitting Physician:
______________________________
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 healthcare 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 colorcoded 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” wristband(s) could cause confusion in my care, and despite this information, I do
not give permission for its removal.
Reason provided (if any): ___________________________________________________
_________________________________________________________________________
_____________
Date/Time
________________________________________________
Signature/Relationship
_____________
Date/Time
________________________________________________
Witness Signature/Job Title
Vendor Information
DNR
ALLERGY
FALL RISK
DNR
72
Vendor Information
Most providers belong to a Group Purchasing Organization (GPO) that works with your Materials Management
Department. In order for the colors of the wristbands to match from facility to facility, the vendor of choice will need the
following information:
Wristband Type
Color Specifications
Text Specifications
Font Style and Size
Allergy Wristband
Red — PMS 1788
“ALLERGY” in Black
Arial Bold,
48 pt. All Caps
Fall Risk Wristband
Yellow — PMS 102
“FALL RISK” in Black
Arial Bold,
48 pt. All Caps
DNR Wristband
Purple — PMS 254
“DNR” in White
Arial Bold,
48 pt. All Caps
73
Acknowledgments
DNR
ALLERGY
FALL RISK
DNR
74
To access the Toolkit
You may access the online information at www.ihatoday.org or www.mchc.org.
To discuss the process or to obtain information about this project, please contact:
Becky Steward
1151 East Warrenville Road
P.O. Box 3015
Naperville, Illinois 60566
Phone: (630) 276-5585
E-mail: bsteward@ihastaff.org
Dawn Niedner
222 S. Riverside Plaza
Suite 1900
Phone: (312) 906-6164
E-mail: dniedner@mchc.com
Partners
IHA and MCHC want to thank and acknowledge those organizations that have endorsed or contributed to this project.
Alexian Brothers Hospital Network
Elmhurst Memorial Healthcare
Illinois Critical Access Hospital Network
Lake Forest Hospital
Mendota Community Hospital
Northwest Community Healthcare
Northwestern Memorial Hospital
OSF Saint James-John W. Albrecht Medical Center
Sherman Hospital
University of Chicago Medical Center
75
Sponsorship
The Illinois Hospital Association and the Metropolitan Chicago Healthcare Council want to thank The St. John
Companies, Inc. for their generous sponsorship in this endeavor. If you would like to contact our sponsor, please
direct your inquiry to:
Karen Joseph
Senior Product Manager – Patient Identification / Patient Safety
The St. John Companies, Inc.
25167 Anza Drive, Valencia, CA 91355
Phone: 800-435-4242 x 448
Fax: 661-257-2587
Email: kjoseph@stjohninc.com
Web: www.stjohninc.com
www.patientidexpert.com
76
St. John Products
DNR
ALLERGY
FALL RISK
DNR
77
Your Complete Source for Patient Identification Solutions
Comply with
your state color
standardization
initiative!
Reduce errors and
improve patient safety.
Conf ID ent
™
Patient Identification
Wristbands
The St. John Companies, Inc., an established leader in patient
identification and patient safety products for the healthcare industry,
was founded in 1956.
During the past 50 years, St. John has since become one of the leading
manufacturers and distributors of Patient Identification, Healthcare
Labels, Medical Imaging, and Medical Records products to thousands of
U.S. hospitals and alternate care facilities.
Our Patient Identification Systems include:
• Admission Wristbands
• Alert Wristbands & Clasps
• Blood ID Wristbands
• Labor & Delivery Wristbands
ALLERGY
• Pediatric Wristbands
• Disaster Response Wristbands
• Emergency Room Wristbands
DNR
FALL RISK
Patent Pending
Alerts can be added to the strap
of any snap closure wristbands!
Healthcare facilities use color-coded alerts to indicate special needs,
precautions and warnings that can assist caregivers to quickly
assess treatment requirements. Because of concerns about lack of
standardization for colored alerts, many organizations – both regional and
national – have embarked on efforts to create standards for color usage
on alerts.
The St. John Companies is at the forefront of the standardization efforts
to ensure clear patient identification and improve patient safety.
ALLERGY
DNR
St. John’s products meet the recommendations for standardization.
The following states have already implemented their color-coding
initiatives and have chosen St. John as their patient ID partner: Alabama,
Arkansas, Arizona, California, Colorado, Florida, Kansas, Minnesota,
Missouri, Nevada, New Mexico, Oregon, Texas, Utah and Wyoming.
FALL RISK
For a complete selection of
patient identification wristbands,
including barcodable thermal and
laser products, visit us online at
www.patientIDexpert.com
Consolidate your admit and alert wristbands “In-A-Snap™!”
ONLINE: www.stjohninc.com • www.patientIDexpert.com • PHONE: 800.435.4242
FAX: 800.321.4409 • EDI: via GHX • ADDRESS: 25167 Anza Drive, Valencia, California 91355
78
Comply with your state color-code standardization
initiative “In-A-Snap®”
St. John has teamed up with many hospital associations
to help them achieve their color-coded standardization
initiatives. By using St. John’s proprietary In-A-Snap®
alert clasps you also comply with the color-code
standardization initiatives currently being adopted in your
state and in many states across the USA.
Patent Pending
In-A-Snaps are being used in hundreds of hospitals
because they:
• Comfortably consolidate your admit and alert
wristbands into one
• Meet state standardization requirements by
combining BOTH colors and words
• Eliminate the risk of alert wristbands becoming
obscured by other wristbands or patient’s gown
• Help to eliminate alert wristband mistakes and
confusion improving patient safety
Tamper Evident Alert Labels
Consolidate multiple alerts on your laser wristband
• Consolidate multiple alerts on one
wristband increasing patient comfort
and safety
• Use of standardized colors with words
meet hospital association guidelines for
color-code standardization
• Tamper evident destruct marks
increase security
• Available in roll or sheet format
• Label size 11/16" x 1/4"
• Cost effective
• Synthetic material is durable and
long lasting
DNR
LATEX ALLERGY
RESTRICTED
EXTREMITY
For a complete selection of patient identification wristbands, including barcodable
thermal and laser products, visit us online at www.patientIDexpert.com
79
Conf ID ent
™
Patient Identification Wristbands
3
q Admissions
3Blood Bank
q
3Emergency Room
q
3Outpatient Surgery
q
3 Labor & Delivery
q
Hundreds of Patient Identification Solutions
Choose from the largest selection of wristband materials, colors, sizes and closures
Imprint Wristbands
INSERT UNDER
PAPER FLAP
Insert Wristbands
INSERT UNDER
PAPER FLAP
Write-On Wristbands (Also available with clear protective covering)
INSERT UNDER
PAPER FLAP
Thermal Wristbands (Available with clasp or adhesive closure)
Mother/Father/Baby Serialized Wristband Sets (Readjustable or snap closure)
12345
ABC
ABC
12345
12345
ABC
ABC
12345
12345
ABC
ABC
12345
12345
ABC
ABC
12345
ABC
1234
ABC
1234
ABC
1234
ABC
1234
ABC
1234
ABC
1234
ABC
1234
ABC
1234
ABC
1234
ABC
1234
ABC
1234
ABC
1234
ABC
1234
ABC
1234
ABC
1234
ABC
1234
ABC
1234
ABC
1234
ABC
1234
ABC
1234
PB:
ABC
1234
Time:
MR#:
ABC
1234
Date:
PT.
ABC
1234
ABC
1234
ABC
1234
Blood Wristbands
Alert Wristbands (Other alert wristbands available)
RESTRICTED
EXTREMITY
ALLERGY
®
ALLERGY
FALL RISK
FALL RISK
RESTRICTED EXTREMITY
DNR
DNR
LATEX
ALLERGY
LATEX ALLERGY
Our patient safety experts will work with you to determine the best way to ensure clear patient identification and
patient safety. If you don’t see a solution that meets your needs, we’ll be happy to customize one for you.
For a complete selection of patient identification wristbands, visit us online at
80
When Technology Matters and You are Ready to Add a Barcode
Conf-ID-ent™ ScanRite® Thermal Wristbands
Clasp Closure
The ScanRite® adhesive and clasp closure wristbands offer low
cost and the ease of printing with a thermal printer. A barcode
printed by a thermal printer uses heat transfer to create a crisp
barcode image resulting in reliable first time read rates. Barcode
printers are compact in size with their small footprint. Supports
text, linear, 2D and Aztec barcodes.
Adhesive Closure
A thermal wristband is:
• Perfect for barcoding
• Durable – Alcohol, soap and water resistant
• Easy to use
• Tamperproof or tamper evident
• In-A-Snap® alert clasps can be used with
clasp closure wristbands
• Cost effective
Conf-ID-ent™ Laser Wristbands and Chart Labels
St. John offers the largest variety of laser wristband
and chart labels that work with most laser printers.
Laser wristbands and chart labels support text,
linear, 2D and Aztec barcodes.
• Clear fold over laminating shield protects the
integrity of the patient’s information
• Water resistant materials protects patient data
• Optional tamper evident adhesive closure
• Convenient pre-drilled filing holes available
• Laser printable
wristbands
• Available in a
variety of colors
and layouts
Conf
Patie
Reord
ID ent
icat
nt Id
entif
er: Call
ion S
yst
(800)
435-4
™
em
242
05/14
/1950
DR: W.
FRIE
56M
NDLY
DNR
ALLE
RGY
FALL
RISK
Conf-ID-ent™ Laminating Shield Style Wristbands
Laminating shield style wristbands are ideal for barcoding.
Featuring a clear anti-glare adhesive shield that provides
protection for laser labels by forming a barrier that resists
fluid penetration. The anti-glare shield is ideal for barcode
scanning providing excellent first time read rates.
• Ideal for barcoding
• Clear anti-glare shield protects patient data
• Tamperproof clasp closure
• Cost-effective
• Easy to use
• Supports text, barcodes and graphics
• Latex and phthalate-free
• In-A-Snap® alert clasps can be used with St. John’s
clasp closure wristbands
Adult
Adult/Pediatric
Infant
Easy-to-use laminating shield!
Step 1: Fold shield back from wristband.
Step 2: Apply label to the wristband.
Step 3: Peel white liner away from shield.
Step 4: Apply shield over label.
Laminating shield protects patient information.
For a complete selection of patient identification wristbands, visit us online at
81

Color-coded Wristband Standardization in Illinois

Transcription

Similar documents

Welcome to St. Patrick`s Day, Savannah Style!

Event Wristband.cdr

Oktoberfest 2015 - Trail Dust Town

Share Your Message Silicone Wristbands with

DuraPrint®

UBand™– Contactless Silicone Wristband

aISI..g 407-932-1178 - Moon-Walker Party Services Central

American Woodhenge: Archaeoastronoraly at Cahokia

Activate your wristband

Chocolate Vine/Five Leaf Akebia - Illinois Natural History Survey