The Color of Safety

1
The Color of Safety
2
Problem

• PA-PSRS received a report in which clinicians
  nearly failed to resuscitate a patient who was
  incorrectly designated as a DNR. A nurse
  incorrectly placed a yellow wristband on the
  patient. In that hospital, the yellow band meant
  DNR. The nurse also worked in another hospital in
  which yellow meant that there was a restricted
  extremity that was not be used for phlebotomy or
  IV access.

3
Safety First

• PA-PSRS surveyed PSOs of Pa. Hospitals and found
  that of those responding
  
• 78 of the facilities used color-coded patient
  wristbands
  
• There were no standard meanings among healthcare
  facilities.
  

4
Risk Reduction Strategies

• Limit the number and colors
• Standardize the meaning of colors
• Use brief, pre-printed text on the bands
• Educate patient/families re bands
• Remove community charity bands
• Develop P/P defining wristband usage-authority/res
  ponsibility/maintenance

5
Color Code-Intent of Specific Colors
6
Registration/Admission Bands

• Colorless or clear admission identification bands
  and temporary clear or temporary yellow emergency
  room ID bands are applied in accordance with
  specific hospital policy.
• These bands have not been identified as a cause
  for concern in the Color of Safety initiative,
  and therefore, are not included for discussion.
  

7
Authority for Application of the Band

• During initial and reassessment procedures, risk
  factors associated with falls, allergies, DNR or
  restricted extremity may be identified by the
  nurse.
• The appropriately colored wrist band is applied
  by the nurse on the same arm as the ID band(s),
  except in the case of restricted extremity.
  
• Application of the band(s) is documented in the
  chart according to hospital policy.

8
Band Confirmation Use of Supporting
Documentation

• To reduce misinterpretation of the bands, they
  will be embossed to be read easily.
  
• Except in emergencies, there will be no
  hand-writing on the bands.
  
• Per specific hospital policy alert
  labels/stickers may be used as an ancillary means
  of communicating the risk factors (used on the
  Kardex, MAR, chart front, etc.) and will have a
  corresponding color and text.

9
Hand-off Communication

• The nurse will re-confirm colored bands before
  invasive procedures, at transfer and during
  changes in level of care with patient/family,
  other caregivers and the patients chart.
• Errors and/or omissions are corrected immediately.

10
Re-application of band

• In the event that any colored band(s) have to be
  removed for the treatment of the patient, the
  nurse will
  
• Remove the band(s)
• Reconfirm the risks
• Retrieve new band(s)
• Place the band(s) on another extremity and
  document the action.

11
Patient Education

• When admitted, the pt./family is
• Educated regarding the band(s) message and
  importance.
  
• Advised to contact the nurse if the band falls
  off or is removed and not reapplied immediately.
  
  
• Patient education is documented in the patient
  record per hospital policy.

12
Use of Community Charity Bands

• If the patient is wearing a band
• The nurse will explain the risks associated with
  the band and he/she will be asked to remove the
  band.
  
• If the patient refuses, the nurse will cover the
  band with medical tape and have the patient sign
  a refusal form acknowledging the risks associated
  with the community band.
• To avoid confusion, colored charity wrist bands
  are not allowed to be worn by staff, students,
  volunteers or patients on hospital grounds.
  

13
Patient Refusal or is Incapable to Comply with
Policy

• If patient is capable and refuses the band
• Reinforce the safety risks with the pt/family
• Refusal will be documented in the medical record
• He/she will be asked to sign a release
• If patient is incapable, combative or refuses
• A photo ID will be taken and affixed to the photo
  ID form
  
• Colored alert bands or labels are affixed to the
  photo ID form to alert staff to the safety
  risks.
  

14
Discharge/Transfer of Patient

• Color coded bands are not removed at discharge
• For home discharges, the patient is advised to
  remove the band when he/she is off hospital
  property.
  
• For discharges or transfer to another facility,
  the bands are left intact as a safety alert for
  hand off communication.
  
• If a photo ID with safety alert form was used, it
  should be photocopied and attached to the
  transfer in lieu of the use of safety wrist
  bands.

15
In addition

• 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 receiving hospital is responsible for
  re-assessment and subsequent band removal,
  reconfirmation and application

16
Conclusion

• Safety risks will be be assessed and the
  appropriate color band applied.
  
• After the band is applied you need to be sure to
  document the application in the patients
  record.
  
• Frequently check the band and hand-off the
  information to other staff.
  
• Educate the patient/family re the band and
  document.
  
• Take a picture if the patient is incapable of
  wearing or refuses a band, getting a release
  signed.
  
• You dont D/C the bands when patient is
  discharged.