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Concerns cause hospital to tweak color coding plan
One health care provider in Arizona found that staff and patient input can be key to making a color-coded wristband plan work. A plan that looks great on paper might need some changes before implementation, says Debbie Weller, manager of quality enhancement services, which includes risk management, at Scottsdale (AZ) Healthcare.
Scottsdale Healthcare recently decided to standardize wristbands for its two hospitals and a third opening in November. Using the guidelines from the Western Region Alliance for Patient Safety — a patient safety group that includes health care providers from Arizona, California, Nevada, New Mexico, Oklahoma, and Utah — Scottsdale settled on three standard colors: red for allergy alerts, yellow for fall risks, and purple for do not resuscitate (DNR). A January 2007 roll out was planned, but Weller says that staff raised some concerns about the original plan and said a purple bracelet with "DNR" could be demeaning to patients because it is a highly visible indicator of an intensely personal decision.
Physicians even suggested that such a visible indicator of the DNR decision could lead to a lower level of care from some caregivers. The discussion led to a change in the bracelets. Instead of purple bands for DNR, the hospital uses a plain band with a discreet purple jewel symbol. The symbol is clearly visible at the bed side but not to anyone a few feet away, Weller says.
The Western Region Alliance advises against including specific information on the wristbands, such as the type of allergy, and it suggests instead that staff should check the chart once alerted by the wristband color. But Weller says physicians and staff at Scottsdale argued that putting the text on the wristband was far more efficient and would not dissuade them from double-checking the chart, so the policy was modified to allow information on the wristbands.
"The yellow fall risk band was well accepted by staff, but when we asked patients, they told us that the large, 48-point font 'fall risk' on the band was a little embarrassing in front of family and friends," Weller says. "So we switched to a 12-point font that is easily readable but doesn't shout it to people 30 feet away."
The vendor for Scottsdale's wristbands is The St. John's Company in Valencia, CA. The company offers a web site with options for color-coded wristbands at www.patientidexpert.com. When Scottsdale rolled out the revised wristband program in June, system leaders introduced it at regular meetings of physicians and staff and also distributed brochures explaining how the system works. Scottsdale also included reminder sheets in the front of every patient chart.
"Once we made these changes to the original plan, we had great support from physicians and staff," Weller says.
For more information about the Scottsdale wristband program, contact: