Pink identifies a patient who has a limb or other body part that needs to be handled carefully. Yellow tells you the patient is at risk of falling. Red is an allergy alert. Purple is "do not resuscitate" if you're on the West Coast. If you're on the East Coast, use blue for DNR.
Think you got it? Good. Maybe someday the entire country might be on the same page with you.
A patient safety initiative that got its start when a patient was misidentified at a Pennsylvania hospital in 2005 has now gained the acceptance of patient safety associations in at least a dozen states. The movement is to create uniform color-coded wristbands for patient conditions.
With increased movement of patients from institution to institution and an equally mobile national nursing staff, the idea is that wristband color codes need to be consistent to cut down on hospital errors. One obvious goal is to reduce the number of medical-malpractice claims.
A 2006 study by the Arizona Hospital and Health Association found, for example, that there were as many as seven different colors used for "do not resuscitate" wristbands in Arizona hospitals.
By Jan. 1, hospitals in Arizona and the other member states of the Western Regional Alliance of Patient Safety (Oregon, California, Utah, Nevada and New Mexico) will have implemented their new four-color code, which will use pink for restricted extremity, red for allergy, purple for DNR and yellow for fall risk.
"By and large, our staff is excited about the continuity," said Lori Davis, director of risk management for Tuality Healthcare in Oregon, which is implementing the new color scheme. She added that the state of Washington is watching what Oregon is doing with a mind to follow suit.
But there are obstacles. Davis said Tuality is holding off on implementing a purple DNR band at the behest of families who don't want failing relatives to feel stigmatized. Davis said her hospital feels it's only compassionate to accommodate them.
"They're not accepting as to where the patient is," Davis said.
And social-cause wristbands are an issue too. Patients wearing bands such as Lance Armstrong's "LiveStrong" yellow wristband supporting cancer survival will be asked to remove them or sign a release absolving the hospital of liability for any confusion that might result.
And then there's the East-West inconsistency. In Pennsylvania, where the concept of moving to color conformity got its start, blue, not purple, is still the color for do not resuscitate.
Hospitals in the West, on the other hand, are following the Arizona model and using purple for do not resuscitate. Eastern states are following Pennsylvania and using blue, according to Fran Charney, the risk manager for the Holy Spirit Health System in Camp Hill, Pa., and one of the architects of uniform color coding in the Keystone State. She said the goal, ultimately, must be for every hospital in the country to be using the same code.
"It's simple and it makes sense," said Charney.
The idea to move to consistent color codes was born in Pennsylvania in 2005 after a nurse moving from one hospital to another placed a blue wristband on a patient allergic to latex. That would have been appropriate in the hospital she had just left, but in the hospital she moved to, blue meant do not resuscitate.
When the patient went into decline and the staff took no action to save her, it dawned on the nurse what was happening. She spoke up, and the staff mobilized to save the patient. No harm was done, and a movement was born.
"It's an idea whose time has come," said Dan Groszkruger, the director of legal services for the Tri-City Medical Center in Oceanside, Calif., speaking in support of uniform color-coded wristbands at the American Society for Healthcare Risk Management annual conference in Chicago in October.
Paul Smith, the president of ASHRM, said the organization's Patient Safety Interest Network is gathering data on which states have moved to uniform color-coded wristbands with the goal of making a push for the entire country to adopt the same codes.
Mike Doering, the executive director of the Camp Hill-based Pennsylvania Patient Safety Authority, which helped to publicize the color-code initiative in that state, said his group is on the verge of approaching the state's Department of Health with the idea of getting the state to regulate the idea.
Doering said that, to date, about 50 out of about 240 Pennsylvania hospitals have gone to the color-code system, which includes a green code for patients allergic to latex.
The PPSA is a state agency with a mandate to find ways to reduce medical errors but has no enforcement powers. "We don't have the power to regulate what happens in Pennsylvania. We can't say facilities have to do this," Doering said.
December 1, 2007
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