Wristband standardization: Why we aren't there yet

AHA issues quality advisory on wristband colors

In September, the American Hospital Association issued a quality advisory on implementing standardized colors for patient alert wristbands, citing a near miss when a nurse mistakenly placed a wrong-colored bracelet on a patient, confusing the color codes of the two hospitals for which she worked.

The dangers in confusion about wristbands are well noted, and the AHA is encouraging the adoption of three consensus colors on a nationwide basis — red for allergy, yellow for fall risk, and purple for do not resuscitate — while emphasizing that the final word on all patients' care is the medical record.

"This is really an issue I like to give state hospital associations credit for," says Beth Feldpush, AHA's senior associate director for policy. "They've been really engaged for several years with this. Now over 25 state hospital associations have adopted a voluntary initiative for these three consensus colors."

She says "it made sense" for the AHA to encourage all U.S. hospitals to adopt the three consensus colors while emphasizing that hospitals have to choose "what makes sense to them" in implementation — for example, using what they have before purchasing new bands.

State laws, however, can conflict. Ohio's law reads that the DNR wristbands be clear with the DNR logo. But Tiffany Himmelreich, of the Ohio Hospital Association, says state legislators and the Department of Health are currently looking to revise the DNR wristband guidelines.

"The hope is, going into the future, Ohio can join in with this national standard," she says.

The reasons nationwide standardization has not yet taken hold are multidimensional and represent a larger truth about the health care system, says Robert Wachter, MD, professor and associate chairman of the department of medicine at the University of California, San Francisco.

"There's sort of a macro issue and a micro issue," he says.

The larger issue is that "you've got to get a lot of different stakeholders to sit down and agree on something."

The micro issue?

"We didn't even start thinking this way until four or five years ago. It wasn't seen as odd or unusual that every hospital in the country would have its own way of doing it — it's a metaphor for a larger problem in health care," Wachter says.

He cites the aviation industry and the strict standardization there. Get on any 747, he says, and it will look the same as any other 747 you've been on. "People will speak in the same language with standard terms and that creates a huge amount of predictability and safety," he says, something you don't see in hospitals because facilities and physicians like to do things in their own ways.

"The reason I find the wristband issue interesting is not that it's the most important thing in the universe — it's not — but it's a nice metaphor for this larger issue of the importance of standardization, and it's something we really haven't thought about much in health care."

Wachter favors nationwide use of standard colors. He points to The Joint Commission's list of high-risk abbreviations. "When The Joint Commission came out and said, 'Here's a list of high-risk abbreviations that are dangerous. We want you to purge them from the lexicon of medicine,' they didn't allow every state to come up with a different list. And that's actually eased implementation tremendously," he says.

"The same thing should be true for something like wristbands."

Though he favors standardized wristband colors, Peter Angood, MD, vice president and chief patient safety officer for The Joint Commission, says wristband use is not without risk. "The color coding could be put into place wrong, there can be loss of bracelets, there can branding of the patients by what kind of color they have, there can be lack of understanding of why they have those bracelets on, [patients] can remove them or take them off.

"A reliance on what seems like a simple solution is not without risk," he says. "In general, we support appropriate use of bracelets, but they are not a replacement for good, solid patient identification and the strong processes of patient care."

(Editor's note: To view the AHA advisory, go to http://www.aha.org/aha.)