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1. “Patient safety is sound clinical practice” 1 Color-coded Wristband Standardization in Florida
2. “Patient safety is sound clinical practice” 2 Color-coded Wristband Standardization in Florida Executive Summary – Sept. 2008 Background:
In Pennsylvania, there was confusion regarding wristband color that resulted in a patient being labeled DNR erroneously.
In October 2007, the Florida Hospital Association collected baseline data after concern was voiced about wristband variation in Florida hospitals.
In December 2005, a patient safety advisory was issued from the Pennsylvania Patient Safety Reporting System that received national attention. This advisory brought to 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 a nurse that had incorrectly placed a yellow wristband on the patient. 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.
In December 2005, a patient safety advisory was issued from the Pennsylvania Patient Safety Reporting System that received national attention. This advisory brought to 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 a nurse that had incorrectly placed a yellow wristband on the patient. 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.
3. “Patient safety is sound clinical practice” 3 Color-coded Wristband Standardization in Florida Executive Summary – Sept. 2008 The survey results indicate that six different colors/methods are being used throughout Florida to convey Do Not Resuscitate.
4. “Patient safety is sound clinical practice” 4 Color-coded Wristband Standardization in Florida Executive Summary – Sept. 2008
What about staff impact?
New staff – Florida hospitals reported an RN vacancy rate of 10.2% (2006);
RN turnover rate at 8.5%; and
Use of agency and travelers. Most of us can imagine this type of near miss occurring in any institution. Consider these statistics regarding hospital staff:
In 2006, Florida hospitals reported a vacancy rate of 10.2%
The same survey reports hospital turnover rate for RNs as 8.5%Most of us can imagine this type of near miss occurring in any institution. Consider these statistics regarding hospital staff:
In 2006, Florida hospitals reported a vacancy rate of 10.2%
The same survey reports hospital turnover rate for RNs as 8.5%
5. “Patient safety is sound clinical practice” 5 Color-coded Wristband Standardization in Florida Executive Summary – Sept. 2008
What does this mean?
Potential for confusion exists; and
Opportunity to reduce potential for harm and improve patient safety.
The potential for confusion is obvious, significant, and avoidable.
The potential for confusion is obvious, significant, and avoidable.
6. “Patient safety is sound clinical practice” 6 Color-coded Wristband Standardization in Florida Executive Summary – Sept. 2008 What did we do?
Reviewed current standardization models in use in other states;
Discussed whether Florida could “build the will” for change; and
Recommended to standardize three condition alerts:
Do Not Resuscitate
Allergy
Fall Risk.
Insanity: doing the same thing over and over again and expecting different results.
~ A. Einstein
As you have heard, the initial work to standardize color-coded wristbands began in Pennsylvania.
Arizona quickly followed in this patient safety endeavor to standardize color-coded wristbands in their own state.
CA, CO, MN, MO, OR, NM, NJ, NY and WV have adopted a standardization model. AL, AR, KS, TX, UT, WA and WI are following are in the process of standardizing.
Based on the baseline data in our state, we began discussions and there was consensus to proceed with this project.
As you have heard, the initial work to standardize color-coded wristbands began in Pennsylvania.
Arizona quickly followed in this patient safety endeavor to standardize color-coded wristbands in their own state.
CA, CO, MN, MO, OR, NM, NJ, NY and WV have adopted a standardization model. AL, AR, KS, TX, UT, WA and WI are following are in the process of standardizing.
Based on the baseline data in our state, we began discussions and there was consensus to proceed with this project.
7. “Patient safety is sound clinical practice” 7 Color-coded Wristband Standardization in Florida Executive Summary – Sept. 2008
Florida’s model tracks the Arizona model:
Multidisciplinary workgroup formed through the Arizona Hospital and Healthcare Association.
Task:
- Reach consensus on color definitions; and
- Develop work plan and implementation tool kit.
Arizona’s model involved convening a workgroup. They focused on three condition alerts: Do Not Resuscitate, Allergy, and Fall Risk.
The Arizona model has now been duplicated in many other states.
The information that follows in this kit will guide your organization through a methodical and system wide approach for a successful implementation.
Arizona’s model involved convening a workgroup. They focused on three condition alerts: Do Not Resuscitate, Allergy, and Fall Risk.
The Arizona model has now been duplicated in many other states.
The information that follows in this kit will guide your organization through a methodical and system wide approach for a successful implementation.
8. “Patient safety is sound clinical practice” 8 Color-coded Wristband Standardization in Florida Executive Summary – Sept. 2008 The tool kit contents include:
The colors for the alert designations;
The logic for the colors selected;
A work plan for implementation;
Staff education, including competencies;
(cont.)
The information that follows in this kit will guide your organization through:
1 & 2. The colors for the alert designation and logic for the colors selected; there were many colors to consider so we accessed other resources to make the best decision, including:
Human Factors and the science of human error
Other industry experts (such as ANSI – the American National Standards Institute) to determine color selection.
Common sense. Where there was an already prevalence of use, we did not change.
3. Work plan for implementation;
Work plans often fail because they do not consider all of the stakeholders.
This work plan is comprehensive with step by step cues so stakeholders are considered and involved.
4. Staff education including competencies;
The staff education includes hand outs for staff, notice reminders, sign in sheets, education brochure for staff and competencies – should you chose to use them.
The information that follows in this kit will guide your organization through:
1 & 2. The colors for the alert designation and logic for the colors selected; there were many colors to consider so we accessed other resources to make the best decision, including:
Human Factors and the science of human error
Other industry experts (such as ANSI – the American National Standards Institute) to determine color selection.
Common sense. Where there was an already prevalence of use, we did not change.
3. Work plan for implementation;
Work plans often fail because they do not consider all of the stakeholders.
This work plan is comprehensive with step by step cues so stakeholders are considered and involved.
4. Staff education including competencies;
The staff education includes hand outs for staff, notice reminders, sign in sheets, education brochure for staff and competencies – should you chose to use them.
9. “Patient safety is sound clinical practice” 9 Color-coded Wristband Standardization in Florida Executive Summary – Sept. 2008 (cont.)
5. FAQs for general distribution;
6. Sample policy and procedure;
7. Vendor information for easy adoption; and
8. Patient education brochure.
The information that follows in this kit will guide your organization through:
5. FAQs for general distribution;
This is an easy to read document that provides the answers to the most common questions.
6. Sample policy and procedure;
This document will need to be revised to some extent to fit your organizations’ format, however, it is an excellent resource with information that you can mostly “Cut and Paste” into your P&Ps.
7. Vendor information for easy adoption of the recommendation and
This is provided because there are various hues within colors. This allows for an exact match – as close as possible. Also, it provides a sample of the text so font style and size can be as close a match as possible – regardless of vendor.
8. Patient education brochure
Patients need to know what the wristbands mean because it is their life we are talking about and they can also correct any mis-information. This brochure clearly and succinctly conveys that information.
The information that follows in this kit will guide your organization through:
5. FAQs for general distribution;
This is an easy to read document that provides the answers to the most common questions.
6. Sample policy and procedure;
This document will need to be revised to some extent to fit your organizations’ format, however, it is an excellent resource with information that you can mostly “Cut and Paste” into your P&Ps.
7. Vendor information for easy adoption of the recommendation and
This is provided because there are various hues within colors. This allows for an exact match – as close as possible. Also, it provides a sample of the text so font style and size can be as close a match as possible – regardless of vendor.
8. Patient education brochure
Patients need to know what the wristbands mean because it is their life we are talking about and they can also correct any mis-information. This brochure clearly and succinctly conveys that information.
10. “Patient safety is sound clinical practice” 10 Color-coded Wristband Standardization in Florida Executive Summary – Sept. 2008
Our safety as a state and success in this
effort will depend on the participation
and adoption of each and every hospital
in this state.
This effort will require a willingness to change for the greater good. Some hospitals will have a minor change while others may have a major change. We realize that change is difficult; we also realize that change made for reasons that benefit the safety of your staff, your loved ones and your communities are changes for all the right reasons.
Our goal is 100 % adoption in the state.
This effort will require a willingness to change for the greater good. Some hospitals will have a minor change while others may have a major change. We realize that change is difficult; we also realize that change made for reasons that benefit the safety of your staff, your loved ones and your communities are changes for all the right reasons.
Our goal is 100 % adoption in the state.
11. “Patient safety is sound clinical practice” 11 Color-coded Wristband Standardization in Florida
12. “Patient safety is sound clinical practice” 12 Color-coded Wristband Standardization in Florida Do Not Resuscitate Recommendation: DNR – Purple
It is recommended that hospitals
adopt the color PURPLE for the
Do Not Resuscitate designation
with “DNR” embossed/printed on
the wristband, clasp, or label.
Calling CODE BLUE!
Recommended in the Standardized Hospital Emergency Code for the State of Florida.
If Florida selected the color blue for the DNR wristband, the potential for confusion exists.
“Does blue mean I code or I do not code?”
Recommendation: Purple for the Do Not Resuscitate designation
While there is much discussion regarding the issue of “to band or not to band”, to date a comprehensive peer-reviewed literature search has not identified better interventions. 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 health care providers are not hospital based staff, so it is imperative that current processes take this into consideration.
Wristbands are used in many Florida hospitals to communicate an alert. Registry staff, travelers, non-clinical staff, nursing students, and medical healthcare providers, etc would most likely be unaware of where to look in the medical record. By having a wristband on, a quick warning is communicated so anyone could know about this alert.
Additionally, it is also a means to communicate to the family and significant others that we are clear about their end of life wishes. By not having a band on, errors of omission could potentially be created.
When seconds count, as in a code situation, we believe having an alert wristband on the patient will serve as a great tool. Similar to a second identifier, it will serve as a ready communication in a crisis situation, an evacuation situation, or in a transit situation.
Recommendation: Purple for the Do Not Resuscitate designation
While there is much discussion regarding the issue of “to band or not to band”, to date a comprehensive peer-reviewed literature search has not identified better interventions. 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 health care providers are not hospital based staff, so it is imperative that current processes take this into consideration.
Wristbands are used in many Florida hospitals to communicate an alert. Registry staff, travelers, non-clinical staff, nursing students, and medical healthcare providers, etc would most likely be unaware of where to look in the medical record. By having a wristband on, a quick warning is communicated so anyone could know about this alert.
Additionally, it is also a means to communicate to the family and significant others that we are clear about their end of life wishes. By not having a band on, errors of omission could potentially be created.
When seconds count, as in a code situation, we believe having an alert wristband on the patient will serve as a great tool. Similar to a second identifier, it will serve as a ready communication in a crisis situation, an evacuation situation, or in a transit situation.
13. “Patient safety is sound clinical practice” 13 Color-coded Wristband Standardization in Florida Do Not Resuscitate Recommendation: DNR – Purple (cont.)
Why not blue?
Should not be the same color that is used for calling a code; and
Registry, turnover, travelers, etc.
Why not green?
Color-blind; and
“Go ahead” confusion.
If we adopt purple, do we still need to look in the chart?
Yes!; and
Code designation can and does change during a
patient’s stay. Recommendation: Purple for the Do Not Resuscitate designation
1. Why not use Blue?
The work group considered the work in Pennsylvania, where blue is used to standardize DNR, and Arizona and the 11 additional states that have subsequently adopted purple to standardize DNR, and the rationale behind their decisions. It also took into consideration that the standardized hospital emergency codes, which were first recommended for use in Florida in 2003, utilize a call of “code blue” to summon the resuscitation team. By also having the DNR wristband as “no code,” there was potential for confusion. “Does blue mean we code or do not code?” To avoid creating any second-guessing in this situation, the decision was made to adopt the same guideline as in themajority of states — purple to designate DNR.
2.. Why not use Green?
We considered this color as well, however, due 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.
3. If we adopt the purple DNR wristband do we still need to look in the chart?
Yes. Some hospitals do not use wristbands for DNRs 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 families wishes can be honored.
Recommendation: Purple for the Do Not Resuscitate designation
1. Why not use Blue?
The work group considered the work in Pennsylvania, where blue is used to standardize DNR, and Arizona and the 11 additional states that have subsequently adopted purple to standardize DNR, and the rationale behind their decisions. It also took into consideration that the standardized hospital emergency codes, which were first recommended for use in Florida in 2003, utilize a call of “code blue” to summon the resuscitation team. By also having the DNR wristband as “no code,” there was potential for confusion. “Does blue mean we code or do not code?” To avoid creating any second-guessing in this situation, the decision was made to adopt the same guideline as in themajority of states — purple to designate DNR.
2.. Why not use Green?
We considered this color as well, however, due 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.
3. If we adopt the purple DNR wristband do we still need to look in the chart?
Yes. Some hospitals do not use wristbands for DNRs 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 families wishes can be honored.
14. “Patient safety is sound clinical practice” 14 Color-coded Wristband Standardization in Florida Allergy
Easy Implementation
The transition to red for Allergy Alert should be easily achieved since 56% of Florida hospitals that use a wristband for allergies already use red for Allergy Alert.
Recommendation: Allergy - Red
It is recommended that hospitals
adopt the color RED for the
Allergy Alert designation with the
word “Allergy” embossed/printed
on the wristband, clasp, or label.
Recommendation: RED for the Allergy Alert designation
Recommendation: RED for the Allergy Alert designation
15. “Patient safety is sound clinical practice” 15 Color-coded Wristband Standardization in Florida Allergy Recommendation: Allergy – Red (cont.)
Why red?
56% of Florida hospitals that use wristbands currently use red for allergy alert.
Any other reasons?
Associated with other messages such as STOP! DANGER!
for example: traffic lights and ambulance/police lights.
Recommendation: RED for the Allergy Alert designation
Why did you select red?
Red was selected due to the October 2007 survey conducted with Florida hospitals that indicated 56% of hospitals already use the color red. It just made sense to continue with an established color that has such overwhelming use.
2. Are there any other reasons for using red?
Yes there are. Our 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 care giver sees a red allergy alert band they are prompted to “STOP!” and double check if the patient is allergic to the medication, food, or treatment they are about to receive.
3. Do we write the allergies on the wristband too?
It is our recommendation that allergies be written in the medical record according to your hospital’s policy and procedure. We suggest allergies not be written on the wristband for several reasons:
Legibility make hinder the correct interpretation of the allergy listed;
By writing allergies on the wristband someone may assume the list is comprehensive. However, space is limited on a wristband and some patients have in excess of 12 or more allergies. The risk is some allergies would be inadvertently omitted.
Throughout a hospitalization, allergies may be discovered by other care-givers, 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 t refer to, such as the medical record, staff of all disciplines will know where to add newly discovered allergies. Recommendation: RED for the Allergy Alert designation
Why did you select red?
Red was selected due to the October 2007 survey conducted with Florida hospitals that indicated 56% of hospitals already use the color red. It just made sense to continue with an established color that has such overwhelming use.
2. Are there any other reasons for using red?
Yes there are. Our 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 care giver sees a red allergy alert band they are prompted to “STOP!” and double check if the patient is allergic to the medication, food, or treatment they are about to receive.
3. Do we write the allergies on the wristband too?
It is our recommendation that allergies be written in the medical record according to your hospital’s policy and procedure. We suggest allergies not be written on the wristband for several reasons:
Legibility make hinder the correct interpretation of the allergy listed;
By writing allergies on the wristband someone may assume the list is comprehensive. However, space is limited on a wristband and some patients have in excess of 12 or more allergies. The risk is some allergies would be inadvertently omitted.
Throughout a hospitalization, allergies may be discovered by other care-givers, 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 t refer to, such as the medical record, staff of all disciplines will know where to add newly discovered allergies.
16. “Patient safety is sound clinical practice” 16 Color-coded Wristband Standardization in Florida Allergy Recommendation: Allergy – Red (cont.)
3. Do we write the allergies on the wristband, too? NO
Legibility issues;
Changes in the allergy list; and
Patient chart should be the source for the specifics.
4. Does this mean we should no longer use red or “R” on bands to designate blood bank information? NO
Properly educate staff;
Use text on the bands to distinguish, e.g. “allergy”; and
Consider using different band styles and hues of red.
Recommendation: RED for the Allergy Alert designation
Why did you select red?
Red was selected due to the October 2007 survey conducted with Florida hospitals that indicated 56% of hospitals already use the color red. It just made sense to continue with an established color that has such overwhelming use.
2. Are there any other reasons for using red?
Yes there are. Our 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 care giver sees a red allergy alert band they are prompted to “STOP!” and double check if the patient is allergic to the medication, food, or treatment they are about to receive.
3. Do we write the allergies on the wristband too?
It is our recommendation that allergies be written in the medical record according to your hospital’s policy and procedure. We suggest allergies not be written on the wristband for several reasons:
Legibility make hinder the correct interpretation of the allergy listed;
By writing allergies on the wristband someone may assume the list is comprehensive. However, space is limited on a wristband and some patients have in excess of 12 or more allergies. The risk is some allergies would be inadvertently omitted.
Throughout a hospitalization, allergies may be discovered by other care-givers, 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 t refer to, such as the medical record, staff of all disciplines will know where to add newly discovered allergies. Recommendation: RED for the Allergy Alert designation
Why did you select red?
Red was selected due to the October 2007 survey conducted with Florida hospitals that indicated 56% of hospitals already use the color red. It just made sense to continue with an established color that has such overwhelming use.
2. Are there any other reasons for using red?
Yes there are. Our 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 care giver sees a red allergy alert band they are prompted to “STOP!” and double check if the patient is allergic to the medication, food, or treatment they are about to receive.
3. Do we write the allergies on the wristband too?
It is our recommendation that allergies be written in the medical record according to your hospital’s policy and procedure. We suggest allergies not be written on the wristband for several reasons:
Legibility make hinder the correct interpretation of the allergy listed;
By writing allergies on the wristband someone may assume the list is comprehensive. However, space is limited on a wristband and some patients have in excess of 12 or more allergies. The risk is some allergies would be inadvertently omitted.
Throughout a hospitalization, allergies may be discovered by other care-givers, 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 t refer to, such as the medical record, staff of all disciplines will know where to add newly discovered allergies.
17. “Patient safety is sound clinical practice” 17 Color-coded Wristband Standardization in Florida Fall Risk Recommendation: Fall Risk - Yellow
It is recommended that hospitals adopt the color YELLOW for the Fall Risk Alert designation with the words “Fall Risk” embossed/written on the wristband, clasp, or label.
Falls account for more than 70% of the total injury-related healthcare cost among people 60 years of age and older. Recommendation: YELLOW for the Fall Risk designation
Why even use an alert band for Fall Risk?
According to the Centers for Disease Control and Prevention (CDC), falls are an area of great concern in the aging population. According to the CDC,
More than a 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 other causes
Of those who fall, 20% to 30% suffer moderate to severe injuries that reduce mobility and independence, and increase the risk of premature death
The total cost of all fall injuries for people age 65 or older in 1994 was $27.3 billion (in current dollars).
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.
Recommendation: YELLOW for the Fall Risk designation
Why even use an alert band for Fall Risk?
According to the Centers for Disease Control and Prevention (CDC), falls are an area of great concern in the aging population. According to the CDC,
More than a 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 other causes
Of those who fall, 20% to 30% suffer moderate to severe injuries that reduce mobility and independence, and increase the risk of premature death
The total cost of all fall injuries for people age 65 or older in 1994 was $27.3 billion (in current dollars).
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.
18. “Patient safety is sound clinical practice” 18 Color-coded Wristband Standardization in Florida Fall Risk Recommendation: Fall Risk – Yellow (cont.)
Why yellow?
Associated with “Caution” or “Slow Down”
for example: stop lights and school buses;
American National Standards Institute (ANSI)
designates yellow for tripping or falling hazards; and
All healthcare providers want to be alerted to fall risks so they can be prevented.
Recommendation: YELLOW for the Fall Risk Alert designation
1. Why did you select yellow?
Our research of other industries tells us that yellow has an association that implies “Caution!”. Think of the traffic lights; proceed with caution or slow down is the message with yellow lights. 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. Care givers would want to know to be on alert and use caution with a person who has history of previous falls, dizziness or balance problems, fatigability, or confusion about their current surroundings.
Recommendation: YELLOW for the Fall Risk Alert designation
1. Why did you select yellow?
Our research of other industries tells us that yellow has an association that implies “Caution!”. Think of the traffic lights; proceed with caution or slow down is the message with yellow lights. 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. Care givers would want to know to be on alert and use caution with a person who has history of previous falls, dizziness or balance problems, fatigability, or confusion about their current surroundings.
19. “Patient safety is sound clinical practice” 19 Color-coded Wristband Standardization in Florida
20. “Patient safety is sound clinical practice” 20 Color-coded Wristband Standardization in Florida Work Plan Documents The suggested work plan for facility preparation,
staff education, and patient education includes:
Organizational approval;
Supplies assessment and purchase;
Hospital-specific documentation; and
Staff and patient education materials and training.
Following the work plan is a task chart for each element that provides cues for methodical and successful implementation.
21. “Patient safety is sound clinical practice” 21 Color-coded Wristband Standardization in Florida Sample Work Plan Document This document has been designed to assist you in considering the stakeholders and the depth of a system-wide implementation. There may be more steps than these – or less, depending on your organizations infrastructure.
Use this as a tool and add to it as you need. This document has been designed to assist you in considering the stakeholders and the depth of a system-wide implementation. There may be more steps than these – or less, depending on your organizations infrastructure.
Use this as a tool and add to it as you need.
22. “Patient safety is sound clinical practice” 22 Color-coded Wristband Standardization in Florida Sample Task Chart This document has been designed to assist you in very specific tasks that need to be considered when launching a change like this. There may be more steps than these – or less, depending on your organizations infrastructure.
Use this as a tool and add to it as you need.
This document has been designed to assist you in very specific tasks that need to be considered when launching a change like this. There may be more steps than these – or less, depending on your organizations infrastructure.
Use this as a tool and add to it as you need.
23. “Patient safety is sound clinical practice” 23 Color-coded Wristband Standardization in Florida
24. “Patient safety is sound clinical practice” 24 Color-coded Wristband Standardization in Florida Staff Education Tools for staff education:
Poster announcing the training meeting dates/times;
Staff sign-in sheet;
Staff competency checklist;
Tri-fold staff education brochure about this initiative;
FAQs handout for staff;
Tri-fold patient education brochure about color-coded wristbands; and
PowerPoint presentation.
These tools are included in the tool kit.
They are designed to help you. Use them as you see fit. These tools are included in the tool kit.
They are designed to help you. Use them as you see fit.
25. “Patient safety is sound clinical practice” 25 Color-coded Wristband Standardization in Florida Staff Education Tri-fold staff education brochure that includes:
How this all got started…the Pennsylvania story;
Why we need to do this in Florida;
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; and
“Quick Reference Card” cutout that lists seven other risk reduction strategies.
This brochure was designed to be reprinted for all staff training.
This brochure has been produced in black and white.
A color version will be available at the FHA website, patient safety pageThis brochure was designed to be reprinted for all staff training.
This brochure has been produced in black and white.
A color version will be available at the FHA website, patient safety page
26. “Patient safety is sound clinical practice” 26 Color-coded Wristband Standardization in Florida Staff Education
Color-coded “Alert” Wristbands/Risk Reduction Strategies A Quick Reference Card
===============================
Use wristbands with the alert message pre-printed (such as “DNR”).
Remove any “social cause” colored wristbands (such as “Live Strong”).
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.
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.
Eliminates the chance of confusing colors with alert messages
2. Remove any “social cause” (such as Live Strong, Cancer, etc.) colored wristbands.
Be sure this is addressed in your hospital policy and during patient education. Goal is for the patient and family to understand that the removal of wristbands is solely done to enhance patient safety processes.
If that can't be done, you can cover the band with a bandage or medical tape, but removal altogether is best
3.Remove wristbands that have been applied from another facility.
This should be done during the entrance to facility process and/or admission
Be sure this is addressed in your hospital policyThe 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.
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.
Eliminates the chance of confusing colors with alert messages
2. Remove any “social cause” (such as Live Strong, Cancer, etc.) colored wristbands.
Be sure this is addressed in your hospital policy and during patient education. Goal is for the patient and family to understand that the removal of wristbands is solely done to enhance patient safety processes.
If that can't be done, you can cover the band with a bandage or medical tape, but removal altogether is best
3.Remove wristbands that have been applied from another facility.
This should be done during the entrance to facility process and/or admission
Be sure this is addressed in your hospital policy
27. “Patient safety is sound clinical practice” 27 Color-coded Wristband Standardization in Florida Staff Education Color-coded “Alert” Wristbands/Risk Reduction Strategies A Quick Reference Card (cont.)
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4. Initiate banding upon admission, changes in condition, or when information is received during hospital stay.
5. Educate patients and family members regarding the wristbands.
6. Coordinate chart/white board/care plan/door signage information/stickers with same color coding.
7. Educate staff to verify patient color-coded “alert” wristbands upon assessment, hand-off of care, and facility-to-facility transfer communication.
The following information takes each risk reduction strategy and provides further detail and / or explanation of that strategy.
Initiate banding upon admission, changes in condition, or information received during hospital stay.
5 .Educate patients and family members regarding purpose and meaning of the wristbands.
Including the family in this is a safe guard for you and the patient
Remind them that color coding provides another opportunity to prevent errors.
Use the Patient / Family Education brochure located in the tool kit
6. Coordinate chart/ white board/care plan/door signage information/stickers with same color coding.
For allergies, fall prevention and DNR status.
Educate staff to verify patient color coded “alert” wristbands upon assessment, hand- off of care and facility transfer communication.
Remember, the wristband is a tool to communicate an alert status. Other points to make include
Educate staff to utilize the patient, medical record information (physician order for DNR) as additional resource for verification process for allergies, fall risk, and advance directives.
When possible, limit the use of colored arm bands.
Such as, for other categories of care (i.e. latex, MRSA, tape)
If your facility uses pediatric wristbands that correspond to the Broselow color coding 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.The following information takes each risk reduction strategy and provides further detail and / or explanation of that strategy.
Initiate banding upon admission, changes in condition, or information received during hospital stay.
5 .Educate patients and family members regarding purpose and meaning of the wristbands.
Including the family in this is a safe guard for you and the patient
Remind them that color coding provides another opportunity to prevent errors.
Use the Patient / Family Education brochure located in the tool kit
6. Coordinate chart/ white board/care plan/door signage information/stickers with same color coding.
For allergies, fall prevention and DNR status.
Educate staff to verify patient color coded “alert” wristbands upon assessment, hand- off of care and facility transfer communication.
Remember, the wristband is a tool to communicate an alert status. Other points to make include
Educate staff to utilize the patient, medical record information (physician order for DNR) as additional resource for verification process for allergies, fall risk, and advance directives.
When possible, limit the use of colored arm bands.
Such as, for other categories of care (i.e. latex, MRSA, tape)
If your facility uses pediatric wristbands that correspond to the Broselow color coding 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.
28. “Patient safety is sound clinical practice” 28 Color-coded Wristband Standardization in Florida Staff Education 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 health care 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 on doing that). Tell staff you will hand out the brochure to them so they can see what the patients will have when you are done presenting the material.
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 health care 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 on doing that). Tell staff you will hand out the brochure to them so they can see what the patients will have when you are done presenting the material.
29. “Patient safety is sound clinical practice” 29 Color-coded Wristband Standardization in Florida Staff Education
30. “Patient safety is sound clinical practice” 30 Color-coded Wristband Standardization in Florida Staff Education
31. “Patient safety is sound clinical practice” 31 Color-Coded Wristband Standardization in Florida Staff Education (Cont.)
SCRIPT for any staff person talking to a patient or family:
PURPLE means “DNR” Or Do Not Resuscitate
Some patients have expressed an end-of-life wish and we want to honor it.
32. “Patient safety is sound clinical practice” 32 Color-coded Wristband Standardization in Florida
33. “Patient safety is sound clinical practice” 33 Color-coded Wristband Standardization in Florida Policy & Procedure A template policy and procedure has been provided;
Make modifications to it so it fits your organization’s process and culture; and
Address how to respond when a patient refuses to wear a wristband. Always remember that when surveyors or regulatory entities visit your organization, they will survey your performance according to the policies you have implemented.
That being said, be sure that your final policy and procedure for the wristbands is “do-able.”
This template has been provided for your consideration – adopt all of it or none of it…but do review your current policy and update it to reflect your current changes. Always remember that when surveyors or regulatory entities visit your organization, they will survey your performance according to the policies you have implemented.
That being said, be sure that your final policy and procedure for the wristbands is “do-able.”
This template has been provided for your consideration – adopt all of it or none of it…but do review your current policy and update it to reflect your current changes.
34. “Patient safety is sound clinical practice” 34 Color-coded Wristband Standardization in Florida Excerpt from Refusal Form The above-named patient refuses to: (check what applies)
? Wear color-coded “alert” wristbands.
The benefits of the use of color-coded wristbands have been explained to me by a member of the healthcare team. I understand the risks and benefits of the use of color-coded wristbands, and despite this information, I do not give permission for the use of color-coded wristbands in my care.
? Remove “social cause” colored wristbands (like “Live Strong” and others).
The risks of refusing to remove the “social cause” colored wristbands have been explained to me by a member of the healthcare team. I understand that refusing to remove the “social cause” wristbands could cause confusion in my care, and despite this information, I do not give permission for the removal of the “social cause” colored wristbands.
Reason provided (if any): ___________________________________________________
________________________________________________
Date / Time Signature / Relationship
_____________ ________________________________________________
Date / Time Witness Signature / Job Title If a patient refuses to wear a band, how do you document that?
This form facilitates that process of documentation. If a patient refuses to wear a band, how do you document that?
This form facilitates that process of documentation.
35. “Patient safety is sound clinical practice” 35 Color-coded Wristband Standardization in Florida Resources Questions? Contact Karen Peterson at:
(850) 222-9800 or
karen@fha.org
To access an online version of this tool kit go to:
www.fha.org/wristband.html.
To access the Patient Safety Advisory report, go to: www.fha.org/acrobat/PApatadvisory.pdf.
To access the full Florida survey results, go to:
www.fha.org/acrobat/PatWristbandCht.pdf.
