Banding Together for Patient Safety

1. Banding Together for Patient Safety Wristband Standardization Project RISNA Cabinet on Nursing Practice 2009

2. Acknowledgements CONP Members who worked on project: • Cathy Duquette - Chair • Denise Bezila • Nancy Lancaster • Jean Taft • Dave Thomas • Sue Thomas

3. Wristband Standardization • The RISNA Cabinet on Nursing Practice is recommending that all Rhode Island healthcare facilities voluntarily agree to use standardized wristband colors • Colors selected are consistent with national direction

4. The Problem • In Pennsylvania a patient was labeled incorrectly as DNR with a yellow wrist band. Clinicians nearly failed to resuscitate the patient until another nurse recognized the mistake.

5. Did You Know? • In some states, acute care settings were using up to 10 different colors to designate 19 different risk factors. • RI is not much different! • The only color standardized in RI is Purple for Latex Allergy

6. Why Consider Statewide Adoption? • Rhode Island is a small state • Many healthcare professionals work in more than one hospital • Students rotate to many different sites • Having standardized colors decreases potential for error and increases patient safety

7. Review of Standardization Models • RISNA CONP completed a scan of state actions on Standardizing Wristband Colors as of April 2, 2008 • CONP scan revealed that most states are using or planning to use • RED for Allergies • YELLOWfor Falls • PURPLE for DNR

8. Review of Standardization Models • Pennsylvania and Arizona were first states to implement wristband standardization • As of July 2008, 35 states have already undertaken standardization projects • 28 have adopted the 3 recommended colors, several have adopted 2 additional colors • 7 have identified they are waiting for national standardization • RI was not included

9. Review of Standardization Models • In September 2008 the American Hospital Association (AHA) identified • National standardization initiative planned • AHA efforts endorse adoption of: RED for Allergies YELLOW for Falls PURPLE for DNR

10. Recommended Colors

11. Recommended Process • All colored wristbands will have the precaution pre-printed on the wristband • Colorless/white/clear admission identification bands have not been identified as a cause for concern, and are not included in the recommended colors discussion

12. Allergy • RED for Allergies • Think Stop! Danger!

13. Red for Allergy • Do we write the allergies on the wristband too? • No! Allergies should not be written on the wristband for a couple of reasons including: • Legibility • Allergy list may change • Patient chart should be the source for specifics

14. DO NOT RESUSCITATE • PURPLE for Do Not Resuscitate • Why not BLUE for a Code Blue? • Potential for confusion – do I code or do I not code?

15. DNR • 100% Hospitals in RI use code blue for a medical emergency • Patient safety is about eliminating any potential for confusion • Code Blue = Resuscitate Patient • If used Blue Wristband = Do Not Resuscitate

16. Purple for DNR • If using the purple band, do we still need to look in the chart? • Yes! A chart should always be reviewed even if colored wristbands are used. • Code designation can and does change during a patient’s stay.

17. Fall Risk • YELLOWfor Fall Risk • Think Caution! Slow Down!

18. Fall Risk • Why yellow for fall risk? • Yellow has an association that implies CAUTION or SLOW DOWN • All healthcare providers want to be alert to fall risks as they can be prevented by anyone.

19. Additional Colors • A number of states have identified standardized colors for other common conditions…

20. Latex Allergy • GREEN for Latex Allergy • Think Environment • No RI healthcare facility uses green for latex allergies

21. Latex Allergy • Why GREEN for latex allergy? • While purple is consistently used for latex allergy in Rhode Island, green is consistent with where the national standardization is headed.

22. Restricted Extremity • PINK for Restricted Extremity • Think

23. Introducing Change • Rollout October 2008 RISNA Meeting • Implementation presentation available for all participating Rhode Island facilities • Anticipated implementation date – no later than July 1, 2009

24. Any Barriers to Implementation? Lessons learned… • States already standardized have noted little staff resistance • Cost has not been noted as a major barrier in either state. • Education has not been noted as a barrier

25. Cabinet Recommendations • Encourage voluntary participation by RI health care facilities • Continue clear or white wristbands for patient identification • Use the wristband colors consistent with national efforts • Color coded wristbands must include pre-printed alert message • Educational emphasis needed for change in PURPLE

26. Cabinet Recommendations • Encourage adoption of facility policy to remove “social cause” wristbands (e.g., ‘Live Strong’) to minimize confusion • Consider refusal form and cover band with white tape if patient refuses to remove • Facilities should adopt policies that require the removal of colored wristbands applied at other facilities

27. Questions For statewide implementation in RI no later than July 1, 2009

28. Current CONP Members • Cathy Duquette - Chair • Kathy Bergeron • Janice Caianiello • Christine Gadbois • Nancy Lancaster • Nicole Piermont • Christina Sokoloff • Jean Taft