Colored patient identification wristbands are a tool used in most, if not all, areas of patient care, but reports have emerged of near misses and adverse events resulting from misinterpretation of patients' wristband colors.
In the healthcare setting, patient wristbands provide positive patient identification and other types of information, such as medical record number and date of admission. The information on the wristband may be written, imprinted, applied as a label or supplied through a barcode.
However, wristband colors are not consistent at U.S. facilities. For example, a purple wristband used to alert a caregiver about a latex allergy at one facility may indicate a DNR order at a facility across town. Confusion may arise when healthcare providers work at more than one facility and patient wristbands of different colors do not have a universal or standard meaning from one facility to the next.
Several states have initiated efforts to resolve issues with misinterpretation of patient wristbands. Some of these proposals include a standard coding system. For example: allergies/red, fall risks/yellow and DNR/purple. Other states are awaiting standardization of this system before implementing one.
A recent report described one situation: "A day shift RN was performing a routine morning assessment when she observed the patient was wearing a blue ID band. In this facility, a blue band indicated the patient had a DNR order. The nurse did not recall information regarding a DNR order from the handoff shift report or a DNR in the patient's plan of care.
"After she reviewed the patient's medical record and orders and could not locate a DNR order, the nurse spoke with the patient, who expressed the wish for a full code. The nurse then consulted with the patient's physician who also confirmed that the patient was a full code and that there was no DNR in place for the patient.
"Upon further investigation, it was learned that the patient had been transferred from another facility where the blue band indicated an allergy. At the current facility, an allergy was represented by a red wristband. The nurse removed the patient's blue band and confirmed the correct name and date of birth. The only noted difference between the wristbands was the medical record number.
"If the nurse had not questioned and further investigated the issue of the blue band, the patient's plan of care may have been handled differently, and the patient may have suffered adverse consequences."
To avoid confusion, all wristbands a patient is wearing when he or she arrives should be removed upon admission. The wristbands may be medical (such as a patient ID wristband from a nursing home) or nonmedical (such as one representing a social cause or charity).
New and emerging technology may help reduce the potential patient risk associated with color-coded wristbands. One example listed in medical literature is a barcode system, which allows information to be embedded on the wristband. The patient information then can be integrated into the facility's electronic health records. This step enables the wristband to be used with computerized order entry systems, specimen acquisition and labeling, and with a warning system if a potential labeling error is detected. It also helps provide correct patient identification. These important tools can be used throughout the patient care setting.
The Food and Drug Administration is interested to learn about patient care issues and obstacles occurring in healthcare settings across the U.S. The FDA encourages the reporting of these and other issues. The information then can be disseminated, which contributes to the improvement of patient care nationwide.
Cynthia Bushee, RN, BSN, and Crystal Lewis, RN, BS, are nurse consultants with the FDA.
