Recently, the Pennsylvania Patient Safety Authority received the following query from a Patient Safety Officer (PSO) in Pennsylvania.

Our organization is moving to standardize the armband colors per the suggestions from the Pennsylvania Patient Safety Authority. We’ve read about also taking the step of “not allowing patients to wear recognition armbands while in the organization” (e.g., pink breast cancer awareness bands, yellow Lance Armstrong bands). Does the Authority have evidence to suggest that events have been prevented by taking this step? Phrased another way, has the Authority received “near misses” indicating that the potential for error exists? The color bands we intend to purchase will be much wider than the recognition bands and will have the stamped verbiage of the reason for the band clearly listed (e.g., fall prevention, allergy). Please provide some evidence to assist us with our risk assessment as we move forward with our decision.

From June 2004 to August 2009, there were no near misses (i.e., Incidents) or Serious Events reported to the Authority involving community wristbands (i.e., colored wristbands, not affiliated with healthcare color designations, pertaining to charity sponsorship or fashion). However, removing community wristbands from patients may avert potential confusion with hospital color-coded wristbands, particularly during an emergency. The Authority has received reports involving patients being admitted with colored wristbands applied by other healthcare facilities that may conflict with the admitting facility’s policy. The Authority also has received reports from hospitals that standardized on the Color of Safety Task Force model, in which clinicians applied outdated or leftover wristbands that were not collected and disposed of during implementation of the new policy. Other reports submitted to the Authority describe events in which clinicians nearly failed to identify a hospital wristband color’s designation, which could have had serious consequences. The reports indicated that confusion occurred when a clinician incorrectly placed a wristband on a patient or could not identify the meaning of a color-coded wristband.

In 2005, the Authority surveyed the PSOs of all Pennsylvania hospitals and ambulatory surgical facilities. The 139 survey respondents represented one-third of the combined number of healthcare facilities. The survey solicited whether the PSOs’ facilities required patients to remove community wristbands they may have been wearing outside the healthcare facility. One-third of the respondents said yes, 14% said sometimes, and more than half (53%) either said no or that they did not know.¹

The Authority recognizes the potential for confusion between community wristbands and hospital color-coded wristbands if the community wristbands are inadvertently interpreted as hospital wristbands, resulting in inadequate or incorrect care being delivered to patients, particularly in emergent situations. Other sources of confusion may include situations when patients are transferred among facilities or when patients are cared for by clinicians who work in multiple facilities. Facilities may consider prohibiting community wristbands in the healthcare setting. If patients do not consent to the removal of these community wristbands, covering them may be a viable alternative.

The Color of Safety Task Force’s Patient Safety: Color Banding Standardization and Implementation Manual standardizes the use of hospital color-coded wristbands and addresses consistency in wristband meanings. This manual also addresses hospital colored-coded wristband application and the potential problems that may arise.² The manual, other patient safety tools, and articles published in the Pennsylvania Patient Safety Advisory constitute a color-coded wristband toolkit available on the Authority’s Web site.

Notes

1. Use of color-coded patient wristbands creates unnecessary risk. PA PSRS Patient Saf Advis [online] 2005 Dec 2 [cited 2009 Aug 20]. Available from Internet: http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2005/
   dec14_2(suppl2)/Pages/dec14;2(suppl2).aspx.
2. The Color of Safety Task Force. Patient safety: color banding standardization and implementation manual [online]. [cited 2009 Aug 20]. Available from Internet: http://patientsafetyauthority.org/EducationalTools/PatientSafetyTools/wristbands/
   Pages/wristband_manual.aspx.