AHA calls for standard wristband color scheme

The American Hospital Association (AHA) in Washington, DC, is urging the health care community to adopt a standardized color scheme for patient wristbands in order to avoid dangerous confusion about what the wristbands mean from one facility to another.

In a recent warning to health care leaders, the AHA notes that more than 25 state hospital associations have provided their hospitals with voluntary guidelines on standardized patient wristband colors. "Standardizing the colors that hospitals use to alert staff to certain patient risks is a common-sense approach to improving patient safety," the AHA states. "Many physicians and nurses work in multiple hospitals within their communities and even across state lines. In states that have adopted the consensus wristband colors, caregivers have welcomed the standardization and report reduced confusion caused by the numerous previous variations.

The AHA is urging a national standardization, focusing on three condition alerts that have been adopted by the states that have addressed standardization. These are the standardized codes recommended by the AHA:

• Red: Allergy

"Red means stop. Caregivers will be alerted to stop and check the medical record to see if the patient is allergic to the medication, food, or treatment he or she is about to receive," the AHA states.

• Yellow: Fall risk

"Yellow is a warning to slow down, pay attention, and take special precautions. Nurses review patients all the time to determine if they need extra attention to prevent a fall. Sometimes a person may become weakened during an illness or because of surgery," the AHA says. "When a patient has this colored alert wristband, it says that this person needs to be assisted when walking or transferring to help prevent a fall."

• Purple: Do not resuscitate

"When a patient is wearing a purple wristband, it alerts the hospital staff to check the patient record for important information on patient end-of-life directives," the AHA says.

The AHA offers this other advice for making the best use of color-coded wristbands:

• Clearly define which staff members are responsible for the initial assessment and subsequent reassessments that may determine whether a patient has a condition related to one of the alerts.

• Colored alert wristbands should be placed on the same extremity as the patient ID band by a nurse or licensed professional and documented in the patient's chart per hospital policy. In the event that a colored alert wristband has to be removed for a treatment or procedure, a nurse should remove the band and then reconfirm the patient risks and replace the band as appropriate immediately following the treatment or procedure.

• Use wristbands with the alert message pre-printed or embossed on the band. To minimize confusion, refrain from hand writing anything on the band.

• If a patient is wearing a "social cause" wristband, the nurse should explain the risks associated with the social cause wristband and ask the patient to remove it. If the patient refuses, you may request that the patient sign a refusal form acknowledging the risks associated with social cause wristbands.

• Verify the patient's risks during handoffs in care, such as before invasive procedures or during changes in the level of care.

• Wristbands should not be removed at discharge. For home discharges, patients are advised to remove the bands at home; for discharges to another facility, the bands are left intact as a safety alert during transfer.

(Editor's note: For the AHA advisory on safe use of wristbands, go to http://www.aha.org/aha/advisory/2008/080904-quality-adv.pdf.)