Confusion Over Meaning of Color-Coded Wristbands

A hospitalized patient with a prior anaphylactic reaction to latex was given a green bracelet which, at this hospital, signaled a latex allergy. During his stay, he was transported to an ambulatory diagnostic center for a test. Staff at the center were not aware that green bracelets meant a latex allergy and performed the testing with latex-containing vials/syringes. The patient experienced an anaphylactic reaction and required medical treatment to correct the situation.

An interesting survey of Pennsylvania (PA) hospitals, surgery centers, and birthing centers was conducted by the PA Patient Safety Authority (PSA) and published in a recent Supplementary Advisory.¹ The survey found that four out of five facilities use color-coded patient wristbands to signal important medical information. However, the potential for confusion is great, and the Advisory included another event reported to the PA Patient Safety Reporting System in which a patient had been incorrectly identified as DNR (do not resuscitate) during an arrest. A nurse had mistakenly placed a yellow wristband on the patient which, in this hospital, was used to designate DNR status. The nurse worked at another hospital in which yellow wristbands were used to identify a "restricted extremity" that should not be used for drawing lab studies or IV access. Luckily the mistake was quickly realized and the patient was rescued.

The survey identified wide variation among PA facilities regarding the colors used to communicate information via wristbands (see Table 1). The survey also found that only one-third of the responding facilities require patients to remove the popular colored, non-medical wristbands used to show support for charitable endeavors. According to the Advisory, wristbands may also be omitted when they should be put on, removed for a procedure and not replaced, or removed or covered up by clinicians or patients.

It seems clear that a national standard is needed to assign specific colors used with wristbands if they are used to communicate various types of clinical information. Until that time, the PSA offered the following recommendations to reduce confusion.

• Limit the number of different colors used on patient wristbands.
• Use only primary and secondary colors and avoid shades of the same color to convey different messages
• Select wristbands with brief, preprinted descriptive text on the band (e.g., "Restricted Extremity") to provide clarification to clinicians. (However, do not attempt to include the names of drugs to which patients are allergic; rather, a descriptive text such as "Allergies" can be preprinted on the bracelet for clarification.)
• Consider removing colored wristbands that patients may be wearing when they present to the facility. Explain the hazards to patients who refuse, and cover the wristband with a bandage or medical tape if necessary.
• If your facility uses wristbands for pediatric patients that relate to the Broselow color-coding system for pediatric resuscitation carts, take steps to reduce the potential for confusion between the Broselow bands (which are most likely to be used in the emergency department, pediatric units, and neonatal intensive care units) and other color-coded wristbands your facility uses.

Reference

1. Pennsylvania Patient Safety Authority. Use of color-coded patient wristbands creates unnecessary risk. Supplementary Advisory. December 14, 2005