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Hospital wristband color standardization

Health Factors: Quality of Care
Decision Makers: State Government Healthcare Professionals & Advocates
Evidence Rating: Insufficient Evidence
Population Reach: 10-19% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

Color-coded wristbands are visual cues that inform health care providers about hospitalized patients’ circumstances such as elevated fall risk, allergies, or do-not-resuscitate (DNR) status, prompting providers to consult medical records for full details (AHRQ HCIE-PA wristband, AHA-Wristbands 2008). Color-coded wristbands are often used as part of a multi-component approach to patient safety. In many hospitals, red signifies allergy, yellow elevated fall risk, and purple DNR status. Some also use pink to warn of a restricted extremity for blood draws or blood pressures (AHRQ HCIE-PA wristband, Colors of Safety). However, color codes vary across hospitals (Dixon-Woods 2016, Wood 2011, Sehgal 2007). 

Expected Beneficial Outcomes

Improved patient safety

Evidence of Effectiveness

There is insufficient evidence to determine whether standardizing the color codes of hospital wristbands improves patient safety. Anecdotal reports suggest that the potential for provider confusion decreases and patient safety increases following standardization of wristband colors (AHRQ HCIE-Severson, AHRQ HCIE-PA wristband), and a UK-based study suggests that color-coded wristbands that indicate target oxygen range for patients who receive supplemental oxygen can remind providers to monitor oxygen statistics, improving safe prescription of oxygen (Forster 2016). However, wristbands can be difficult to discern at a distance, in low light or when obscured, and can go unnoticed during a crisis; other visible cues may be more noticeable than wristbands in some situations (Wood 2011). Additional evidence is needed to confirm effects.

Experts suggest that providers routinely consult patients’ charts along with wristband cues (AHA-Wristbands 2008) and ensure wristbands are updated as needed to reflect patients’ medical status (Wood 2011).

Implementation

United States

The Institute for Clinical Systems Improvement (ICSI) and the Agency for Healthcare Research and Quality (AHRQ) multi-component fall prevention efforts are two examples of widely used efforts that include color-coded wristbands. These programs also use signs on patients’ doors and white boards, notes above beds, and color-coded, nonskid socks (yellow for fall risk, red for high fall risk) to indicate fall status (ICSI-Degelau 2012, AHRQ-RAND Ganz 2013). 

Wisconsin

The Wisconsin Hospital Association (WHA) set Wisconsin’s voluntary standard color scheme. Red indicates allergy, yellow elevated fall risk, and purple do-not-resuscitate (DNR) status (WHA-WI).

Implementation Resources

Colors of Safety - Greater New York Hospital Association (GNYHA) and Continuing Care Leadership Coalition (CCLC). The colors of safety across the continuum of care. 2011. Accessed on March 29, 2017
LHA-Wristband - Louisiana Hospital Association (LHA). Color-coded wristband standardization in Louisiana: Implementation tool kit. 2009. Accessed on March 27, 2017

Citations - Description

AHA-Wristbands 2008 - American Hospital Association (AHA). FDA quality advisory on implementing standardized colors for patient alert wristbands. Washington, DC: American Hospital Association (AHA); 2008. Accessed on March 20, 2017
AHRQ HCIE-PA wristband - Agency for Healthcare Research and Quality (AHRQ). Consortium of Pennsylvania hospitals adopts standardized wristband colors, leading to reduction in falls, allergic reactions at rehabilitation hospital. Rockville: AHRQ Health Care Innovations Exchange. Accessed on March 20, 2017
Colors of Safety - Greater New York Hospital Association (GNYHA) and Continuing Care Leadership Coalition (CCLC). The colors of safety across the continuum of care. 2011. Accessed on March 29, 2017
Dixon-Woods 2016 - Dixon-Woods M, Pronovost PJ. Patient safety and the problem of many hands. BMJ Quality & Safety. 2016;25(7):485-488. Accessed on March 29, 2017
Sehgal 2007* - Sehgal NL, Wachter RM. Identification of inpatient DNR status: A safety hazard begging for standardization. Journal of Hospital Medicine. 2007;2(6):366–71. Accessed on March 20, 2017
Wood 2011* - Wood SD, Bagian JP. A cognitive analysis of color-coded wristband use in health care. Proceedings of the Human Factors and Ergonomics Society Annual Meeting. 2011;55(1):281–5. Accessed on March 20, 2017

Citations - Evidence

AHA-Wristbands 2008 - American Hospital Association (AHA). FDA quality advisory on implementing standardized colors for patient alert wristbands. Washington, DC: American Hospital Association (AHA); 2008. Accessed on March 20, 2017
AHRQ HCIE-PA wristband - Agency for Healthcare Research and Quality (AHRQ). Consortium of Pennsylvania hospitals adopts standardized wristband colors, leading to reduction in falls, allergic reactions at rehabilitation hospital. Rockville: AHRQ Health Care Innovations Exchange. Accessed on March 20, 2017
AHRQ HCIE-Severson - Severson S. Statewide standards for color-coded wristbands are adopted by vast majority of Arizona hospitals. Rockville: AHRQ Health Care Innovations Exchange. Accessed on March 20, 2017
Forster 2016 - Forster S, Smith S, Daniel P, et al. Optimising prescription and titration of oxygen for adult inpatients using novel silicone wristbands: Results of a pilot project at three centres. Clinical Medicine. 2016;16(4):330-334. Accessed on March 29, 2017
Wood 2011* - Wood SD, Bagian JP. A cognitive analysis of color-coded wristband use in health care. Proceedings of the Human Factors and Ergonomics Society Annual Meeting. 2011;55(1):281–5. Accessed on March 20, 2017

Citations - Implementation

AHRQ-RAND Ganz 2013 - Ganz DA, Huang C, Saliba D, et al. Preventing falls in hospitals: A toolkit for improving quality of care. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); 2013. Accessed on March 29, 2017
ICSI-Degelau 2012 - Degelau J, Belz M, Bungum L, et al. Institute for Clinical Systems Improvement (ICSI). Health care protocol: Prevention of falls (acute care). 2012. Accessed on March 29, 2017
WHA-WI - Wisconsin Hospital Association (WHA). The color of safety: Standardization and implementation manual. Madison: Wisconsin Hospital Association (WHA). Accessed on March 20, 2017

Page Last Updated

March 29, 2017

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