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What does a yellow wristband on a patient mean to you?

The Missouri Center for Patient Safety announced Banding Together--For Patient Safety at the closing session of the Patient Safety: Achieving Success in Missouri conference on March 29, 2007.

Banding Together--For Patient Safety establishes standardized guidelines and resources for the use of red, yellow and purple wristbands for voluntary implementation by Missouri hospitals. Missouri is the eighth state in the nation to establish such guidelines.

At the request of a physician in Columbia concerned about the risk to patients of non-standardized use of colored wristbands, the Center assessed standardization activities in other states, surveyed Missouri hospitals and nursing homes and formed a team to address the topic. The results of this assessment reveal:

* In Pennsylvania, an error occurred when a nurse placed a yellow wristband on a patient to designate "restricted extremity;" however, in that hospital yellow designates "do not resuscitate." When the patient arrested, resuscitation was delayed until an alert staff member identified the discrepancy and revived the patient. The nurse who placed the wristband worked at another hospital in the same community where yellow designates "restricted extremity"--an error that can easily be made. In response to this event, the Pennsylvania Patient Safety Authority implemented a voluntary statewide guideline for the use of colored wristbands.

* In response to the Pennsylvania event, Arizona and five other Southwestern states also implemented voluntary statewide guidelines.

* A number of other states are in the process of addressing the issue.

The November 2006 survey of Missouri hospitals and nursing homes identified:

* 92 percent of hospital respondents and only a few nursing homes use colored wristbands;

* 21 different clinical conditions are designated by no fewer than 29 different colors;

* the color yellow is currently used to designate at least nine different conditions;

* red is currently used to designate at least seven conditions;

* do not resuscitate is designated by at least seven different colors;

* most wristbands also include text but use of text varies widely among users;

* most hospitals do not have a policy to address personal wristbands such as the yellow "Lance Armstrong" and pink "Breast Cancer Awareness" bracelets that are worn by patients when they are admitted to the hospital; and a majority of respondents believe a voluntary statewide guideline would reduce risk to patients.

In response, the Center's team is now implementing the following recommendations:

* Standardization of the use of wristband colors in hospitals-red for allergy, yellow for fall risk, purple for do not resuscitate;

* Hospitals to be leaders in their market area by working with other providers to adopt the same guidelines, as appropriate

* Use of text on the wristband in addition to the color

* Development of policies to remove personal wristbands upon admission to the hospital

Implementation of Banding Together--for Patient Safety will include distribution of an Implementation Toolkit containing resources for policies and procedures; education of staff, patients and the public and tips to engage other providers within the community as well as support for hospital implementation of the voluntary guidelines during the summer of 2007.

Hospitals wanting to implement the guidelines are to identify a champion for their hospital and provide that individual's contact information to the Center for ongoing communication about roll-out of the project.

Additional information about the project is available at To contact the Center, call 573-636-1014 or email Becky Miller, Executive Director, at
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Publication:Missouri Nurse
Geographic Code:1U4MO
Date:Apr 1, 2007
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