Use of Colorcoded Wristands to Communicate Alerts in Illinois 使用顏色編碼的腕帶傳達警報在伊利諾斯

www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgUse of Color-coded Wristbands to Communicate Alerts in Illinois HospitalsIllinois Hospital Associationwww.mchc.orgIllinois Hospital Associationwww.ihatoday.orgObjectives Provide historical perspective on use of color to communicate alerts to caregivers Provide overview of practice in Illinois Describe rationale for colors selected to alert caregivers Provide recommendations for adoption and the Work Plan to implement adoption Identify resources to support standardization of color-coded wristbands2www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgHistorical Perspective3www.mchc.orgIllinois Hospital Associationwww.ihatoday.org4Why do hospitals use color-coded wristbands?Color-coded wristbands are used in healthcare settings to quickly communicate a certain healthcare status, condition, or an “alert” that a patient may have. The wristband is used so every staff member can provide the best care possible, even if they do not know the patient.*New Jersey Department of Health and Senior Services FAQswww.mchc.orgIllinois Hospital Associationwww.ihatoday.orgThe case for standardization In 2005, clinicians in Pennsylvania failed to rescue a patient who had a cardiopulmonary arrest because the patient had been incorrectly identified with a “DNR” status. The source of confusion was traced to a nurse who had incorrectly placed a yellow wristband on the patient (which meant DNR at that hospital) In a nearby hospital where this same nurse also worked, yellow meant “restricted extremity,” which was her intent as an alert5www.mchc.orgIllinois Hospital Associationwww.ihatoday.org6Could this happen again?In response to this near miss, the Pennsylvania Patient Safety Reporting System (PA-PSRS) surveyed Pennsylvania hospitals and found:78% of the facilities used color-coded patient wristbands45% used text on the wristbandsWide variation existed among the facilities regarding the colors used to communicate information via wristbandsOnly 33% of responding facilities required patients to remove the popular non-medical wristbands commonly used to show support for charitable endeavorswww.mchc.orgIllinois Hospital Associationwww.ihatoday.org7An alert was issuedIn December 2005, the Pennsylvania Patient Safety Reporting System (PA-PSRS) released a patient safety advisory making hospitals aware of the inherent risks associated with the use of patient colored wristbands, commonly used by hospital staff to convey significant clinical information. www.mchc.orgIllinois Hospital Associationwww.ihatoday.org8Pennsylvania Patient Safety Reporting System Identified Risk Reduction Strategies Limit the number and colors Standardize the meaning of colors Use brief, pre-printed text on the bands No handwriting on bands Educate patient/families re: bands Remove “social cause” bands Develop policies and procedures defining wristband usage-authority/responsibility/maintenancewww.mchc.orgIllinois Hospital Associationwww.ihatoday.org9Recommendations for Pennsylvania HospitalsAugust 2006 Initiated the recommendations via distribution of the “Color of Safety” manualFollow-up Survey 2007 80% of hospitals reviewed “Color of Safety” manual 50% of hospitals initiated the recommended changeswww.mchc.orgIllinois Hospital Associationwww.ihatoday.orgPractice in Illinois10www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgIllinois caregivers request guidance on the standardization of color-coded wristbands Illinois Critical Access Hospital Network (ICAHN)Regional meeting of suburban Chicago hospitalsChicago area hospitals surveyed on the use of color-coded wristbands by Metropolitan Chicago Healthcare Council (MCHC)Illinois hospitals surveyed on the use of color-coded wristbands by Illinois Hospital Association (IHA)Adjacent states favor standardization across borders11www.mchc.orgIllinois Hospital Associationwww.ihatoday.org2007 Survey of Illinois Hospitals Use of color-coded wristbandsAmong Illinois hospitals responding to survey:57 % use color-coded wristband to indicate Do Not Resuscitate Six different colors Most frequent color - blue58 % use color-coded wristband to indicate an Allergy Six different colors Most frequent color - red65 % use color-coded wristband to indicate Risk to Fall Six different colors Most frequent color orangeIL Survey Data, 200712www.mchc.orgIllinois Hospital Associationwww.ihatoday.org2007 Survey of Illinois Hospitals Results for Do Not Resuscitate13www.mchc.orgIllinois Hospital Associationwww.ihatoday.org2007 Survey of Illinois HospitalsDo Not ResuscitateShould Illinois hospitals use a standard color on wristbands to alert caregivers that a patient is not to be resuscitated? 74 % YES26 % NO IL Survey Data, 200714www.mchc.orgIllinois Hospital Associationwww.ihatoday.org2007 Survey of Illinois HospitalsResults for Allergies15www.mchc.orgIllinois Hospital Associationwww.ihatoday.org2007 Survey of Illinois Hospitals AllergiesShould Illinois hospitals use a standard color on wristbands to alert caregivers that a patient has allergies? 78 % YES 22 % NOIL Survey Data, 200716www.mchc.orgIllinois Hospital Associationwww.ihatoday.org2007 Survey of Illinois Hospitals Results for Risk to Fall17www.mchc.orgIllinois Hospital Associationwww.ihatoday.org2007 Survey of Illinois HospitalsRisk to FallShould Illinois hospitals use a standard color on wristbands to alert caregivers that a patient is at risk to fall? 78 % YES22 % NOIL Survey Data, 200718www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgNext Steps Survey results presented to IHA Patient Safety Task Force (PSTF), the Board of IHA, and MCHCs Clinical, Administrative, Professional, & Emergency Services (CAPES) Patient Safety & Nursing Subcommittees Formation of diverse workgroup: IHA Patient Safety Task Force MCHC ICAHN Chicago Patient Safety Forum Individual hospitals19www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgCharge to IHA / MCHC Workgroup Explore standardization of color-coded alerts Voluntary initiative Acknowledge risks and benefits Explore downstream effects among early adopters Select alerts and associated color Formulate recommendation Develop toolkit for implementation20www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgWorkgroup approach Reviewed current standardization models in use in other states Reached consensus on color definitions and wristbands Formulated recommendation for statewide voluntary standardization of color-coded wristbands21www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgThe following slides were developed as part of the Arizona toolkit (copyright 2007 Arizona Hospital and Healthcare Association), and have been modified with the permission of the Arizona Hospital and Healthcare Association.Recommendations for standardization22www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgColor-coded Wristband Standardization in Illinois Do Not ResuscitateRecommendation: DNR - PurpleIt is recommended that hospitals adopt the color PURPLE for the “Do Not Resuscitate” designation with the words embossed / pre-printed on the wristband, “DNR” CALLING CODE BLUE! Used by many Illinois hospitals to summon assistance for a patient without adequate pulse or respirations.If Illinois selected the color blue for the DNR wristband, the potential for confusion exists.“Does blue mean I code or I do not code?”23www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgColor-coded Wristband Standardization in Illinois Purple - Do Not ResuscitateRecommendation - PURPLE for Do Not Resuscitate 1.Why not blue?Should not be the same color that is used for calling a code Registry, turnover, travelers, etc2.Why not orange?Pre-hospital confusion with Advance Directives3.Why not green?Color blind“Go ahead” confusion4.If we adopt purple, do we still need to look in the chart?Yes!Code designation can and does change during a patients stay24www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgColor-coded Wristband Standardization in Illinois AllergyAllergies Recommendation: Allergy - RedIt is recommended that hospitals adopt the color RED for the ALLERGY ALERT designation with the words embossed / pre-printed on the wristband, “ALLERGY” 25Quick AdoptionAccording to survey results, more Illinois hospitals use red to alert caregivers to allergies than any other color. www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgColor-coded Wristband Standardization in Illinois AllergyRecommendation - RED for the Allergy Alert 1.Why Red?Currently associated with allergies by 55% of Illinois hospitals that use color-coded wristbands2.Any other reasons?Associated with other messages such as STOP! DANGER! due to traffic lights and ambulance/police lights 3.Do we write the allergies on the wristband too?No because that may create new errors due to:Legibility issuesAllergy list may changePatient chart should be the source for the specifics26www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgRecommendation: Fall Risk - YellowIt is recommended that hospitals adopt the color YELLOW for the Fall Risk Alert designation with the words embossed / pre-printed on the wristband, “Fall Risk”AllergiesFalls account for more than 70 percent of the total injury-related health costs among people 60 years of age and older.Color-coded Wristband Standardization in Illinois Fall Risk27www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgColor-coded Wristband Standardization in Illinois Fall RiskRecommendation - YELLOW for Fall Risk1.Why Yellow?Associated with “Caution” or “Slow Down” Stop lights School busesHazardous intersectionsAmerican National Standards Institute (ANSI) uses yellow to communicate tripping or falling hazards2.All health care providers want to be alert to fall risks as they can be prevented by anyoneAllergies28www.mchc.orgIllinois Hospital Associationwww.ihatoday.org29According to AHA survey dated 7/22/2008, twenty-six states have standardized color-coded wristbands associated with Allergies (red), Fall Risk (yellow) and DNR (purple)AlabamaArkansasArizonaCaliforniaColorado*FloridaIllinoisIowaKansasMichiganMinnesota*Missouri*NebraskaNevada New HampshireNew Jersey* New MexicoOhio*Oregon*Pennsylvania*TexasUtahVirginiaWashingtonWest VirginiaWisconsinLouisiana*Plus one or two additional colors *Adopted late in 2008www.mchc.orgIllinois Hospital Associationwww.ihatoday.org30American Hospital Association (AHA) Position“Americas Hospitals are committed to delivering safe care. To alert caregivers to certain patient risks, many facilities use color-coded patient wristbands. Standardizing the colors of the wristbands used in hospitals is the sensible approach to improving patient safety, and many state hospital associations have already engaged their hospitals in this effort. As the national advocate for Americas hospitals, the AHA is asking all hospitals to consider using three standardized colors for alert wristbands. The colors, which have been adopted as a consensus in numerous states, are: red for patient allergies; yellow for a fall risk; and purple for do-not-resuscitate patient preferences.”* American Hospital Association Quality Advisory, September 4, 2008www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgWork Plan31www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgSuggested Work Plan for facility preparation, staff education, and patient education includes: 1. Organizational approval2. Supplies assessment and purchase3. Hospital-specific documentation4. Staff and patient education materials and training Following the work plan is a task chart for each element that provides cues for methodical and successful implementation.32www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgSample Work Plan Document33www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgSample Task Chart34www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgTools for Staff Education Poster announcing the training meeting dates/times Staff sign-in sheet Staff competency checklist Tri-fold staff education brochure about this initiative FAQs handout for staff Tri-fold patient education brochure about color-coded wristbands PowerPoint presentation35www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgTri-fold staff education brochure includes: How this all got startedthe Pennsylvania story Why this is recommended in Illinois The national picture What the colors are for: Allergy, Fall Risk, and DNR Script for any staff person talking to a patient or family about the wristbands “Quick Reference Card” cutout that lists seven other risk reduction strategies (more on the following slides)36www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgColor-coded “Alert” Wristbands/Risk Reduction Strategies : A Quick Reference Card _ 1. Use wristbands with the alert message pre- printed (such as “DNR). 2. Remove any “social cause” colored wristbands (such as the yellow Lance Armstrong “LIVESTRONG” wristband). 3. Remove wristbands that have been applied from another facility. 37www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgColor-coded “Alert” Wristbands/Risk Reduction Strategies : A Quick Reference Card (cont.)_ 4. Initiate banding upon admission, changes in condition, or when information is received during hospital stay. 5. Educate patients and family members regarding the wristbands. 6.Coordinate chart/white board/care plan/door signage information/stickers with same color coding. 7. Educate staff to verify patient color-coded “alert” wristbands upon assessment, hand-off care, and facility-to-facility transfer communication. 38www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgWhy have a script for staff?1. We know how we say something is as important as what we say. This provides a script sheet so staff can work on the “how” as well as the “what.”2. Serves as an aid to help staff be comfortable when discussing the topic of a DNR wristband.3. Promotes patient/family involvement and reminds the patient/family to alert staff if information is not correct.4. By following a script, patients and families receive a consistent message which helps with retention of the information.5. The Patient Education brochure also is available for staff to hand out.39www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgSCRIPT for any staff person talking to a patient or family:What is a color-coded “alert” wristband?Color-coded “alert” wristbands are used in hospitals to quickly communicate a certain health status, condition, or “alert” that a patient may have. This is done so every staff member can provide the best care possible.What do the colors mean?There are three different color-coded “alert” wristbands that we are going to discuss because they are the ones most commonly used.40www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgSCRIPT for any staff person talking to a patient or family (cont.):RED means ALLERGY ALERTIf a patient has an allergy to anything food, medicine, dust, grass, pet hair, ANYTHING we want them to tell the healthcare team. It may not seem important to the patient, but it could be very important in the care the patient receives.YELLOW means FALL RISKWe want to prevent falls at all times. Nurses assess patients throughout their stay to determine if they need extra attention in order to prevent a fall. Sometimes a person may become weakened during his/her illness or following surgery. When a patient has this color-coded “alert” wristband, the nurse is indicating this person needs to be closely monitored because he/she may fall. 41www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgSCRIPT for any staff person talking to a patient or family (cont.):PURPLE means “DNR” or Do Not ResuscitateSome individuals have expressed an end-of-life wish and we, the healthcare team, want to honor it.42www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgPolicy and Procedure43www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgPolicy & Procedure Information A template policy and procedure has been provided. Make modifications to it so it fits your organizations process and culture. Address how to respond when a patient refuses to wear a wristband.44www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgExcerpt from Refusal FormThe above-named patient refuses to (check what applies):Wear color-coded “alert wristbands.The benefits of the use of color-coded wristbands have been explained to me by a member of the healthcare team. I understand the risks and benefits of the use of color-coded wristbands, and despite this information, I do not give permission for the use of color-coded wristbands in my care.Remove “social cause” colored wristbands (like the yellow Lance Armstrong “LIVESTRONG” and others).The risks of refusing to remove the “social cause” colored wristbands have been explained to me by a member of the healthcare team. I understand that refusing to remove the “social cause” wristbands could cause confusion in my care, and despite this information, I do not give permission for the removal of the “social cause” colored wristbands. Reason provided (if any):_Date/TimeSignature/Relationship_Date/TimeWitness Signature/Job Title45www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgIn ClosingThe participation of each Illinois hospital in standardization of colors associated with alerts for Allergies, Risk to Fall, and DNR is strictly voluntary. The use of color-coded wristbands as a strategy to communicate Allergies, Risk to Fall, and DNR remains the decision of the individual facility.46www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgResources47www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgIllinois Wristband ToolkitAvailable for download:Illinois Hospital Associationwww.ihatoday.orgMetropolitan Chicago Healthcare Councilwww.mchc.org48www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgQuestions?Dawn NiednerProgram DirectorClinical and Emergency Services Metropolitan Chicago Healthcare Council312-906-6164DBecky StewardManager, Patient Safety Collaborative Illinois Hospital Association630-276-5585 Bstewardihastaff.org49www.mchc.orgIllinois Hospital Associationwww.ihatoday.orgAdditional WebsitesAmerican Hospital Association Quality Centerwww.ahaqualitycenter.org/ahaqualitycenter/jsp/home.jspArizona Hospital and Healthcare Associationwww.azhha.orgOhio Patient Safety Institute www.ohiopatientsafety.orgPatient Safety Authority (Pennsylvania)www.psa.state.pa.us/psa/lib/psa/advisories50