Staff and Patient Education Materials

Transcription

1 North Carolina Hospital Association Staff and Patient Education Materials DNR ALLERGY FALL RISK DNR 27

2 Staff Education Training Tips Introduction The following section regarding staff education has been developed knowing that you may choose to do all of this, or part of it. We hope that we have made this section comprehensive without being overly burdensome. Make this plan work for you; use what you want and remember the goal is to communicate the changes with color-coded alert wristbands to your staff. This section was created with the following design objectives in mind: 1. Staff can be easily guided through the changes with color-coded alert wristbands. 2. The instructors are well-equipped to teach about these changes. 3. No new materials have to be created by staff; this should be nearly a turnkey education event. 4. Staff can feel confident that all hospitals in this state are hearing the same message and a similar implementation plan. This is important if staff work at more than one hospital. Who and how will this be done? This is a decision that needs to be made within your organization. It can be as simple or formal as you desire. Suggestions include staff meetings, formal education sessions, annual competencies whatever works for your organization. It should be done routinely at new employee orientations so the new staff are quickly brought up to speed on this initiative. 28

3 Key Preparation Before You Start Review your section under the Implementation Work Plan to be sure you have included all of your stakeholders in this process. Consider all of the stakeholders in your organization when it comes to color-coded wristbands and who is impacted in this system change. Thoughts to consider: 1. While ultimately the nurses are the people who usually band the patient, the health unit clerks are greatly involved in the system process. Include them in the training. They can better assist the nurses when they have this information. 2. Consider the housekeeping staff. They are often present in a patient s room when a patient is trying to get up or walk to the bathroom. If the housekeeping staff know a yellow wristband means Fall Risk, and they see a patient trying to get up, they can call the nursing staff, alert them, and potentially prevent a fall. 5. Who else? Take some time to quietly observe the activities of the day at one of the nurses stations. Just a 30-minute observation and you will probably see and hear things that make you remember another stakeholder. Include them in the education process. Once done, you can begin the actual training part. 3. What about the dietary technicians? A red wristband means there is an allergy and not just to medicines. Maybe it is a food allergy and the red band will alert them to check for that and note it in the patient s profile. 4. Don t make assumptions about the medical staff getting this information. Attendings, intensivists, residents, and interns need to know what these colors mean. Pull them into the process. This promotes safe healthcare for all providing and receiving it. 29

4 Getting Started North Carolina Hospital Association Staff Education Regarding: Color-coded alert wristbands Information intended for all staff, clinical and non-clinical. Most people will use this brochure as the main teaching material. It contains most of the pertinent information staff need to know for this initiative. We suggest you do not give out the brochure until the end of your training because people may start reading the brochure instead of listening to you. Pass it out at the end of the meeting, but tell them up front that there is a brochure with all of the information you are presenting and you will pass it out later. Here are the main points you want to make during your training session: 1 Start with a story Adults want to know why they should do something; simply telling them they need to start doing this because they do is not sufficient information to get high levels of compliance. Besides, isn t that what you would want to know, too? A story gives them information that makes the request relevant so they want to comply. This story is true. One panel of the brochure tells the story of when a patient was not coded due to a mix-up in the wristbands. The error was caught in time to quickly code the patient, but by telling this story, most staff will understand how this error could happen to anyone and they will be on board with this plan. The story goes like this: In 2005, a hospital in Pennsylvania submitted a report to the Pennsylvania Patient Safety Reporting System (PA-PSRS) describing an event in which clinicians nearly failed to rescue a patient who had a cardiopulmonary arrest because the patient had been incorrectly designated as DNR (Do Not Resuscitate). The source of the confusion was that a nurse had incorrectly placed a yellow wristband on the patient. In this hospital, the color yellow signified that the patient should not be resuscitated. In a nearby hospital, in which this nurse also worked, yellow signified restricted extremity, meaning that this arm is not to be used for drawing blood or obtaining IV access. Fortunately in this case, another clinician identified the mistake and the patient was resuscitated. However, this near miss highlights a potential source of error and an opportunity to improve patient safety by re-evaluating the use of colorcoded wristbands. We want to thank and acknowledge this hospital for its transparency and disclosure of this event. It could have happened anywhere, and it has served as a wake-up call to many of us. 30

5 2 Follow the story with data results Sharing with staff how hospitals in our state currently use wristbands makes the information more relevant and reinforces to them why they should want to comply and participate in this. Share this information with staff. It is on one of the panels in the brochure, too. A survey was conducted in February 2009 of North Carolina hospitals to evaluate our risk for such an event. The results showed that 9 different colors were being used to designate DNR status with patient wristbands. Our risk was apparent. We identified the need to standardize the colors being used for Allergies, Fall Risk, and DNR. Our answer is this project. 3 The Big Picture For many individuals, knowing that we are part of a bigger and unique situation fosters pride and, again, reinforces the developing motivation to comply. Tell staff how this state is part of a national effort to work together with the goal of using the same colors. Share this information with them: This initiative is being adopted by hospitals throughout the nation. This will make it safer for us as clinicians and as patients. Once achieved, it means whether you are traveling on vacation to these states or relocated to work in another state, participating hospitals will be using the following colors: RED means ALLERGY ALERT YELLOW means FALL RISK PURPLE means DNR 31

6 4 Introduce the Colors In the tool kit, you will find three sample wristbands that show the colors being used and demonstrate the text that is pre-printed on the wristbands. These wristbands are from the vendor, The St. John Companies, Inc. If your organization uses a different vendor (check with Materials Management), then you may want to check to see if its bands are available so you can show what you will be using. The colors should be the same since the vendors know the specifications for the colors that are being used. This is the time to show the bands so there is a visual of the information you are going to share. Review with staff the three bands, the colors, and the corresponding meaning. The text box below will walk you through that information. We are going to discuss the three different color-coded alert wristbands that are a part of statewide standardization. RED means ALLERGY ALERT YELLOW means FALL RISK PURPLE means DNR or Do Not Resuscitate Other alert wristbands that your organization uses may be introduced with this information, but are facility-specific, such as latex allergy or restricted extremity, etc. 5 FAQs about the colors selected. This is a companion document to the staff brochure. Research about colors and human association with certain colors contributed to the color selection process in this project. This is important for staff to know so they can feel confident with this process. The FAQ document reviews why the colors were selected and why other colors were not selected. At this time, hand out the FAQ sheet to staff and review it with them. Don t just hand out the FAQs. Make this interactive and ask each person attending to take a question (there are 12) and read the answer out loud. This will make the session more interesting. Also, by having staff read and hear the information, they will re-engage in the presentation. You are two-thirds done at this point. Let staff know this so they mentally relax. 32

7 6 Seven Risk Reduction Strategies In addition to the standardization of wristband colors in the state, we recommend seven other risk reduction strategies that should be initiated. These are suggested as a result of sentinel events that have occurred, near miss events, and common sense. This information is also in the staff brochure and can be cut out as a quick reference card and laminated, if you desire. Review these with staff now. Color-coded Alert Wristbands/ Risk Reduction Strategies Quick Reference Card 1. Use wristbands with the alert message pre-printed (such as DNR ). 2. Remove any social cause colored wristbands (such as Live Strong ). 3. Remove wristbands that have been applied from another facility. 4. Initiate banding upon admission, changes in condition, or when information is received during the 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 of care, and facility-to-facility transfer communication. The following information takes each risk reduction strategy and provides further detail and/or explanation of that strategy. 1. Use wristbands that are pre-printed with text that tells what the band means. a. This can reinforce the color-coding system for new clinicians, help caregivers interpret the meaning of the band in dim light, and also help those who may be color-blind. b. Eliminates the chance of confusing colors with alert messages. 2. Remove any social cause (such as Live Strong, Cancer, etc.) colored wristbands. a. Be sure this is addressed in your hospital policy. b. If that can t be done, you can cover the band with a bandage or medical tape, but removal altogether is best. 3. Remove wristbands that have been applied from another facility. a. This should be done when patients are processed to enter the facility and/or during patient admission. 4. Initiate banding upon admission, changes in condition, or when information is received during hospital stay. 5. Educate patients and family members regarding the purpose and meaning of the wristbands. a. Including the patient and family safeguards the hospital, healthcare professionals, and patient from potential errors. b. Remind patients and families that color-coding provides another opportunity to prevent errors. c. Use the patient/family education brochure located in the tool kit. 6. Coordinate chart/white board/care plan/door signage information/stickers with the same color coding red for allergies, yellow for fall risk, and purple for DNR status. 7. Educate staff to verify patient color-coded alert wristbands upon assessment, hand-off of care, and facility-to-facility transfer communication. 33

8 Additional points to make: 8. When possible, limit the use of colored wristbands for other categories of care, e.g. MRSA, special needs, etc. 9. Remember, the wristband is a tool to communicate an alert status. a. Educate staff to utilize the patient medical record information (physician order for DNR) as an additional resource for verification processes for allergies, fall risk, and advance directives. 10. If your facility uses pediatric wristbands that correspond to the Broselow colorcoding system for pediatric resuscitation, take steps to reduce any confusion between these Broselow colors and the colors on the wristbands used elsewhere in the facility. 34

9 7 Teaching Patients - The patient education brochure is a companion document to the staff brochure. We know that how we say something is just as important as what we say. Patients and their loved ones are scared, vulnerable, and unfamiliar with hospital ways. We need to communicate to them in a respectful and simple way without being condescending. The following text was written to serve as a script for staff so all could be delivering the same information to patients and families. By having a consistent message, we reinforce the information this helps patients and families retain the information. Another benefit of having a consistent message is patients and families experience a sense of confidence in the healthcare system since we are all echoing each other. The text box below is taken directly from the staff brochure. This is the time to mention to staff there is a patient/family brochure that can be handed out (if your unit intends to do that). Tell staff you will hand out the brochure to them when you are done presenting the material so they can see what the patients will have. SCRIPT 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 healthcare 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. RED means ALLERGY ALERT If a patient has an allergy to anything - food, medicine, dust, grass, pet hair, ANYTHING tell us. It may not seem important to you, but it could be very important in the care he/she receives. YELLOW means FALL RISK We want to prevent falls at all times. Nurses review 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 saying this person needs to be assisted when walking or he/she may fall. PURPLE means DNR or Do Not Resuscitate Some patients have expressed an end-of-life wish and we want to honor it. 35

10 8 And finally. Review with staff the points listed below. These are the items that are listed on the competency so it is important to clarify that staff have a good understanding of these items. You should emphasize, this is what would impact your tasks every day and review those points. This is a good time to hand out your organization s P&P. Be sure your policy covers the areas listed below as they are also a part of the competency. If your policy does not address an item on the competency, then you should remove it from the form. 4 Color Code what do the three colors mean? 4 Who can apply the wristband to the patient? 4 When does the application of the color-coded wristband(s) occur? 4 Policy requiring patients to remove the social cause bands. 4 Patient education and how to communicate (script) the information with patients/families. 4 Need for re-application of band. 4 Communication regarding wristbands during transfers and other reports. 4 Patient refusal to comply with policy. 4 Discharge instructions for home and/or facility transfer. If you use the last copy of any of the implementation materials, you may go to At the home page, click on Resources, Toolkits, and then North Carolina. Find the file that contains the document you need. 36

11 Staff Education The Tools 20 minutes will tell you what to expect with the new changes Join us on the following dates for the training session about Color-coded "Alert" Wristbands. Day / Date / Time: Location: 1. Poster announcing the training session dates/times (Document Provided) The following poster was created to announce the sessions and the initiative. Post them in the staff lounge, communication boards, employee locker room, staff bathrooms any place where staff will see them. Day / Date / Time: Location: Day / Date / Time: Location: Questions? Contact: ext: Patient safety is sound clinical practice If you use the last copy of any of the implementation materials, you may go to to print additional copies. 37

12 20 minutes will tell you what to expect with the new changes Join us on the following dates for the training session about Color-coded Alert Wristbands. Day / Date / Time: Location: Day / Date / Time: Location: Day / Date / Time: Location: Questions? Contact: ext:

13 Got Color? DNR ALLERGY FALL RISK DNR Join us on the following dates for the training session about Color-coded Alert Wristband Standardization. Day / Date / Time: Location: Day / Date / Time: Location: Day / Date / Time: Location: Questions? Contact: ext:

14 MATCH GAME DNR YELLOW ALLERGY PURPLE FALL RISK RED Colors are FUN but patient safety is NOT A GAME Join us on the following dates for the training session about Color-coded Alert Wristband Standardization. Day / Date / Time: Location: Day / Date / Time: Location: Day / Date / Time: Location: Questions? Contact: ext:

15 Staff Education The Tools continued 2. Staff Sign-In Sheet (Document Provided) Sample Completed Staff Sign-In Sheet Use this form so there is a record of all staff who attended the training session. Make copies so you don t use the last one. If you use the last copy, go to Keep this sign in sheet with your staff session/training folder. The Joint Commission or other regulatory agencies may ask you for it. This is especially important if you are making this a mandatory participation session. 41

16 Staff Sign-In Sheet Date : Unit/Dept/Location Educator: Topic: Color-coded Alert Wristbands Objective: 1. To inform staff of the new process and colors of the Allergy, Fall Risk, and DNR wristbands. 2. Staff to demonstrate understanding of information through feedback of information. Name/Title: Shift: Name/Title: Shift: Name/Title: Shift: Name/Title: Shift: Name/Title: Shift: Name/Title: Shift: Name/Title: Shift: Name/Title: Shift: Name/Title: Shift: Name/Title: Shift: Name/Title: Shift:

17 Staff Education The Tools continued 3. Staff competency checklist (Document Provided) We recognize that some organizations will opt to use this form and some will not. Should you decide to use a competency checklist in your process, we hope this form will provide the documentation you need. This form also serves as a great checklist for the trainer so all of the important elements in the training are remembered and taught. If you do not use this as a staff form, consider using it as your form to help you remember every element you should be reviewing with staff about the changes with the color-coded wristbands. If you use the last copy, go to to print additional copies. 43

18 Staff Competency Checklist Purpose: These are the standards of the technical competencies necessary for performance and/or clinical practice. To meet competency standards, the employee must demonstrate proficiency in performing the technical procedures safely as evidenced by department-specific criteria. Methods to Use: A. Demonstration D. Skills Lab G. Other B. Direct Observation/Checklist E. Self Study/Test C. Video/PowerPoint Review F. Data Management Supervisor s initials signify competency was met. Employee Name Job Title Patient Color-coded Alert Wristband Process Date Method Used Supervisor s Initials Comments Color Code what do the three colors mean? Who can apply the wristband to the patient? When does the application of the wristband(s) occur? Policy requiring patients to remove the social cause bands. Patient education and how to communicate (script) the information with patients/families. Need for re-application of band. Communication regarding wristbands during transfers and other reports. Patient refusal to comply with policy. Discharge instructions for home and/or facility transfer. Signature Initials Signature Initials Employee Signature Date North Carolina wishes to acknowledge the Pennsylvania Color of Safety Task Force, which developed the initial form that is the basis for this document.

19 Staff Education The Tools continued North Carolina Hospital Association Staff Education Regarding: Color-coded alert wristbands Information intended for all staff, clinical and non-clinical. 4. Tri-fold brochure called Staff Education Regarding: Color-coded alert wristbands (Document Provided) Most people will use this brochure as the main teaching material. It contains most of the pertinent information staff need to know for this initiative. We suggest you do not give out the brochure until the end of your session because people may start reading the brochure instead of listening to you. Pass it out at the end of the session, but tell them up front that there is a brochure with all of the information you are presenting and you will pass it out later. 45

20 How this all got started In 2005, a hospital in Pennsylvania submitted a report to the Pennsylvania Patient Safety Reporting System (PA-PSRS) describing an event in which clinicians nearly failed to rescue a patient who had a cardiopulmonary arrest because the patient had been incorrectly designated as DNR (Do Not Resuscitate). The source of the confusion was that a nurse had incorrectly placed a yellow wristband on the patient. In this hospital, the color yellow signified that the patient should not be resuscitated. In a nearby hospital, in which this nurse also worked, yellow signified restricted extremity, meaning that this arm is not to be used for drawing blood or obtaining IV access. Fortunately in this case, another clinician identified the mistake and the patient was resuscitated. However, this near miss highlights a potential source of error and an opportunity to improve patient safety by re-evaluating the use of colorcoded wristbands.* We want to thank and acknowledge this hospital for its transparency and disclosure of this event. It could have happened anywhere, and it has served as a wake-up call to many of us. *To view the entire report, go to patientsafetyauthor ity. org/ ADVISORIES/ AdvisoryLibrary/2005/dec14_2(suppl2)/Pages/ home.aspx What about North Carolina? North Carolina hospitals seek to provide safe and high-quality patient care. We accomplish this in several ways, one of which is to standardize the colors for alert wristbands. Most hospitals are adopting the same colors so, regardless of which hospital you work at today or tomorrow, the color for Allergy, Fall Risk, or DNR (Do Not Resuscitate) alert wristbands should be the same. The Big Picture This initiative is being adopted by hospitals throughout the nation. That means, whether you are traveling on vacation to these states or relocated to work in another state, participating hospitals will be using the following colors: RED means ALLERGY ALERT YELLOW means FALL RISK PURPLE means DNR North Carolina Hospital Association Staff Education Regarding: Color-coded alert wristbands Information intended for all staff, clinical and non-clinical.

21 Color-coded Alert Wristbands A Statewide Patient Safety Initiative The North Carolina Center for Hospital Quality and Patient Safety conducted a survey in February 2009 of North Carolina hospitals to evaluate our risk for such an event. The results showed that nine different colors/methods were being used to designate the DNR status with patient wristbands. Our risk was apparent. We identified the need to standardize the colors being used for Allergies, Fall Risk, and DNR. Our answer is this project. How to tell the patients what the different colors mean? How we say something is just as important as what we say. The next column is a script you can use to tell your patients/families about the color-coded alert wristbands and what they mean. If everyone says it the same, there is a better chance patients and families will understand what we are saying. SCRIPT 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 healthcare 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. RED means ALLERGY ALERT If a patient has an allergy to anything - food, medicine, dust, grass, pet hair, ANYTHING tell us. It may not seem important to you but it could be very important in the care he/she receives. YELLOW means FALL RISK We want to prevent falls at all times. Nurses review 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 saying this person needs to be assisted when walking or he/she may fall. PURPLE means DNR or Do Not Resuscitate Some patients have expressed an end-of-life wish and we want to honor it. Other Risk Reduction Strategies Staff Should Know Color-coded Alert Wristbands/ Risk Reduction Strategies Quick Reference Card 1. Use wristbands with the alert message pre-printed (such as DNR ). 2. Remove any social cause colored wristbands (such as Live Strong ). 3. Remove wristbands that have been applied from another facility. 4. Initiate banding upon admission, changes in condition, or when information is received during the 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 of care, and facility-to-facility transfer communication.

22 Staff Education The Tools continued North Carolina Hospital Association 5. Tri-fold brochure called Patient Safety: Understanding what your color-coded alert wristbands mean (Document Provided) Patient Safety: Understanding what your color-coded alert wristbands mean This brochure was created to hand out to patients and family members so they understand what the wristband colors mean and can confirm the information. Patients should have this information whether they need a color-coded wristband or not because new information may surface as a result of this education. For example, perhaps a patient has an allergy to a certain food but was thinking only about medications when first asked about allergies. During a family visit, a loved one could read this information brochure and bring up the food allergy. This can now be corrected and the patient is not at risk due to an oversight. If you use the last copy, go to to print additional copies. 48

23 Our hospital is proud to be a supporter of this collaborative work, making healthcare safer and better for patients and their families. North Carolina healthcare providers are working together to make patients safe. We accomplish this goal by working together on statewide projects in an endeavor to use the same methods or processes, like color-coded wristbands. North Carolina Hospital Association Patient Safety: Understanding what your color-coded alert wristbands mean

24 Statewide Patient Safety Initiatives North Carolina hospitals seek to provide safe and high-quality patient care. We accomplish this in several ways, one of which is to standardize the colors for alert wristbands. This initiative is occurring not just in our state, but in other states throughout the nation. What is a Color-coded Alert Wristband? Alert wristbands are used in hospitals to quickly communicate a certain healthcare status or an alert that a patient may have. This is done so every staff member can provide the best care possible, even if they do not know that patient. The different colors have certain meanings. The words for the alerts are also written on the wristband to reduce the chance of confusing the alert messages. What do the different colors mean? There are three different color-coded alert wristbands that we are going to discuss because they are the ones most commonly used. RED means ALLERGY ALERT ALLERGY If a patient has an allergy to anything food, medicine, dust, grass, pet hair, ANYTHING tell us. It may not seem important to you but it could be very important in the care he/she receives. YELLOW means FALL RISK FALL RISK We want to prevent falls at all times. Nurses review 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 saying this person needs to be assisted when walking or he/she may fall. PURPLE means DNR or Do Not Resuscitate DNR Some patients have expressed an end-oflife wish and we want to honor that. Involving Patients and Family Members It is important that you the patient and families know these colors and their meanings because you are an important source of information that can help us provide the best care. Keep us informed. If there is information we do not know, such as a food allergy or a tendency to lose balance and almost fall, share that with us because we want to ensure the safety of all of our patients. Also, if you have an Advance Directive, tell us so. An Advance Directive tells your doctor what kind of care you would like if you become unable to make medical decisions. We want to respect and honor a patient s wishes and that is done best when we have all of the information.

25 Nuestro hospital se enorgullece de apoyar este esfuerzo colaborativo, para lograr una mejor y más segura atención de salud para los pacientes y sus familias. Los proveedores de atención de salud de Carolina del Norte se esfuerzan unidos por la seguridad de los pacientes. Logramos este objetivo al trabajar juntos en proyectos a nivel estatal en un esfuerzo de usar los mismos métodos y procesos, como los brazaletes codificados por color. Seguridad del Paciente: Entendiendo lo que su brazalete de alerta por código de color significa. North Carolina Hospital Association

26 Iniciativas Estatales para la Seguridad del Paciente Los hospitales de Carolina del Norte buscan brindarle al paciente atención segura y de alta calidad. Esto lo logramos de varias formas, una de las cuales es el normalizar los colores de los brazaletes de alerta. Esta iniciativa está ocurriendo no sólo en nuestro estado, sino en otros estados a través de la nación. Qué Es un Brazalete de Alerta Codificado por Color? Los brazaletes de alerta se usan en hospitales para la rápida comunicación de ciertos estados de salud o como una alerta que pueda tener un paciente. Esto se hace para que todo personal pueda brindar la mejor atención posible, aún sin conocer al paciente. Cada color tiene un significado diferente. Las palabras de alerta también están escritas en el brazalete para reducir la probabilidad de confundir los mensajes de alerta. Qué Significan los Diferentes Colores? Existen tres brazaletes de alerta con diferentes colores que estaremos discutiendo por ser los más comúnmente usados. ROJO significa ALERTA DE ALERGIA ALLERGY Si un paciente es alérgico a algo alimento, medicina, polvo, pasto, pelo animal, LO QUE SEA díganos. Tal vez no le parezca importante a usted pero podría ser muy importante relativo a la atención que recibe. AMARILLO significa RIESGO DE CAÍDA FALL RISK Queremos prevenir caídas siempre. Las enfermeras evalúan los pacientes durante sus estadías para determinar si necesitan atención especial para prevenir caídas. A veces una persona puede debilitarse durante su convalecencia o después de una cirugía. Cuando un paciente tiene un brazalete de alerta de este color, la enfermera está avisando que esta persona necesita asistencia al caminar o podría caerse. PÚRPURA significa DNR o No Resucitar DNR Algunos pacientes han expresado deseos para el término de sus vidas que queremos honrar. Involucrando a Pacientes y Miembros de Familia Es importante que ustedes pacientes y familias conozcan estos colores y sus significados porque ustedes son fuente importante de información que puede ayudarnos a brindar la mejor atención. Manténganos Informados. Si, existe información que desconocemos, tal como una alergia a un alimento o una tendencia a perder el equilibrio y casi caerse, compártala con nosotros porque queremos asegurar la seguridad de todos nuestros pacientes. Además, si usted tiene una Directriz por Adelantado, díganos. Una Directriz por Adelantado le dice a su doctor qué tipo de atención usted desea si no pudiera tomar decisiones médicas. Queremos respetar y honrar los deseos del paciente y la mejor forma de hacerlo es teniendo toda la información.

27 Staff Education The Tools continued 6. FAQ handout for staff (Document Provided) This handout was created to offer further clarification regarding the changes being made. You can use this as a handout or to post in staff areas as well. If you use the last copy, go to to print additional copies. 53

28 FAQs about Color-coded Alert Wristbands Q # 1. In the past, we never used wristbands. Why should we consider it now? A. While there is much discussion regarding the issue of to band or not to band, a literature review to date has not identified a better intervention conclusively. One may say, In the good old days, we just looked at the chart and didn t band patients at all. However, those days consisted of a workforce base that was largely core staff employed by the hospital. Now, an increasing number of healthcare providers are not hospital-based staff, so it is imperative that current processes take this into consideration. Q # 2. We don t use wristbands for DNRs at this hospital. Why should we consider adopting this? A. Wristbands are used in many hospitals to communicate an alert. Registry staff, travelers, non-clinical staff, etc. may be unaware of where to look in the medical record if they are new to your hospital. By having a wristband on the patient, a quick warning is communicated so anyone can know about this alert. It is also a means to communicate to the family that we are clear about their end-of-life wishes. By not having a band on the patient, errors of omission could potentially result. Q # 3. Why not use Blue for DNR? A. The work group considered the work in Arizona, and the over 30 other states that have subsequently adopted purple to standardize DNR, and the rationale behind their decisions. It also took into consideration that a majority of North Carolina hospitals call a code by announcing Code Blue. By also having a blue DNR wristband and a code blue call, there was the potential to create confusion. Clinicians might ask, Does blue mean we code or do not code? To avoid creating any second-guessing in this situation, the decision was made to adopt the same guideline as in the majority of states purple to designate DNR. Q # 4. Why didn t you select Green for DNR? A. Again, we considered this color as well; however, due to color-blindness concerns, it was decided to avoid it altogether. Also, in other industries, the color green often has a Go Ahead connotation, such as traffic lights. We again want to avoid any possibility of sending mixed messages in a critical moment. Q # 5. So, if we adopt the purple DNR wristband, then do we still need to look in the chart? A. Yes. Code status can change throughout a hospitalization. It is important to know the current status so the patient s and family s wishes can be honored. Always validate that there is an order by a physician for the DNR designation. Q # 6. Why did you select red for Allergies? A. Red was selected because the October 2007 survey indicated that 56% of hospitals that use a wristband to signify allergies have selected red. Red also is the color selected in all 12 states that have already adopted standardized colors. It makes sense to continue with a color that is already established in North Carolina and well on its way to becoming a national standard. Q # 7. Besides that, are there any other reasons for using red for Allergies? A. Yes, there are. Research of other industries tells us that red has an association that implies extreme concern. The American National Standards Institute (ANSI) has designated certain colors with very specific warnings. ANSI uses red to communicate Stop! or Danger! We think that message should hold true for communicating an allergy status. When a caregiver sees a red allergy alert band, he/she is prompted to STOP! and double check if the patient is allergic to the medication, food, or treatment he/she is about to receive. 54

29 FAQs about Color-coded Alert Wristbands continued Q # 8. Do we write the allergies on the wristband, too? A. No - it is our recommendation that allergies be written in the medical record according to your hospital s policy and procedure. We suggest allergies not be written on the wristband for several reasons: 1. Legibility may hinder the correct interpretation of the allergy written on the wristband. 2. By writing allergies on the wristband, someone may assume the list is comprehensive. However, space is limited on a wristband. The risk is that some allergies would be inadvertently omitted leading to confusion or missing an allergy. 3. Throughout a hospitalization, allergies may be discovered by other caregivers, such as dieticians, radiologists, pharmacists, etc. This information is typically added to the medical record and not always a wristband. By having one source of information to refer to, such as the medical record, staff of all disciplines will know where to add newly discovered allergies. Q # 9. Why is a separate standardized color to designate latex allergy not part of the recommendation? A. There was concern that, if too many standardized colors were used, staff would have difficulty remembering all of them. With red used to alert staff to the patient having an allergy, it will prompt them to confirm the allergy with the patient and/or check the medical record regardless of the specific type of allergy the wristband is used to designate. Q # 10. Does this mean we can no longer use red or R on bands to designate blood bank information? A. No, although it is important to thoroughly educate staff about the difference between your current blood bank bands and any newly implemented red bands to designate allergies. This is another reason text is recommended to be placed on the red bands to designate Allergy Alert or Allergy as another way to differentiate these two bands. The product decision made by your hospital should consider the style and hue of red used for current blood bank wristbands and make sure new products implemented to designate allergy are easily differentiated from blood bank bands. Q # 11. Why did you select yellow for Fall Risk? A. Our research of other industries tells us that yellow has an association that implies Caution! Think of the traffic lights; proceed with caution or stop altogether is the message. The American National Standards Institute (ANSI) has designated certain colors with very specific warnings. ANSI uses yellow to communicate tripping or falling hazards. It fits well in healthcare, too, when associated with a Fall Risk. Caregivers want to be alert to and use caution with a person who has a history of previous falls, dizziness or balance problems, fatigability, or confusion about his/her current surroundings. Q # 12. Why even use an alert band for Fall Risk? A. According to the Centers for Disease Control and Prevention (CDC), falls are an area of great concern in the aging population. According to the CDC: 1. More than a third of adults aged 65 years or older fall each year. 2. Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes. 3. Of those who fall, 20% to 30% suffer moderate to severe injuries that reduce mobility and independence, and increase the risk of premature death. 4. The total cost of all fall injuries for people age 65 or older in 2000 was $19 billion (in current dollars). 5. By 2020, the cost of fall injuries is expected to reach $54.9 billion (in 2007 dollars). Hospital admissions for hip fractures among people over age 65 have steadily increased, from 230,000 admissions in 1988 to 320,000 admissions in The number of hip fractures is expected to exceed 500,000 by the year As the aging population enters the acute care environment, one must consider the risk that is present and do all possible to communicate that to hospital staff. For more information about falls and related statistics, go to: 55

30 FAQs about Color-coded Alert Wristbands continued Q # 13. What is an organization to do if it uses the Broselow color-coding system for pediatrics? A. If your facility uses wristbands for pediatric patients that relate to the Broselow color-coding system for pediatric resuscitation carts, consider the potential for confusion between the Broselow bands (which are most likely used in the Emergency Department, Pediatrics, and Neonatal Intensive Care) and the other color wristbands your facility uses. We don t believe this system conflicts with the recommendations of this project. The colors and bands used for the Broselow-Luten system are clearly identified and used for broadly-defined conditions for pediatric emergency treatment that should be easily differentiated from bands used for Allergy, Fall, or DNR as part of this project. As recommended when any other color-coded processes are used in a healthcare setting, staff and patient education is imperative and a discussion about any color-coded products or systems used should be included in any education provided related to this initiative as well. Q # 14. Who decided on these colors? A. The North Carolina project is modeled after the original work by Arizona, which has subsequently been adopted in a series of other states. By adhering to this model, we hope eventually to see standardized colors across all states. For questions or comments regarding this project, please direct to: Carol Koeble Director, North Carolina Center for Hospital Quality and Patient Safety PO Box 4449 Cary, NC Phone: (919) ckoeble@ncha.org 56

31 Staff Education The Tools continued 7. PowerPoint (with speaker notes) (Document Provided) This presentation was created to provide alternate teaching methods for the trainer. It can be used in large and small groups. Please check our Web site periodically as we will update the presentation as needed. To do that, go to The CD in your tool kit also contains this PowerPoint presentation. 57

32 Executive Summary Background: In Pennsylvania there was confusion regarding wristband color that resulted in a patient being labeled DNR erroneously In a survey conducted by the North Carolina Center for Hospital and Patient Safety, 86% of respondents stated that their facilities use patient wristbands to communicate clinical information other then the patient s identity. 1 2 Executive Summary Executive Summary Nine different colors are being used throughout North Carolina to convey Do Not Resuscitate What about staff impact? Over 500,000 North Carolinians work in healthcare Statewide clinical nurse vacancy rate is 7.5% Average turnover rate for all positions is 16% Most hospitals are using contracted labor or registry RNs to staff vacant positions 3 4 Executive Summary Executive Summary What does this mean? Potential for confusion exists Opportunity to reduce potential for harm and improve patient safety 5 AHA Quality Advisory Implementing Standardized Colors for Patient Alert Wristbands As a National Advocate for America s hospitals, the AHA is asking all hospitals to consider using three standardized colors for alert wristbands. These colors, which have been adopted as a consensus in numerous states are: RED for patient allergies YELLOW for a fall risk PURPLE for do-not-resuscitate 58

33 Executive Summary Executive Summary What did we do? Taskforce organized Review current standardization models in use Consensus to standardize three condition alerts Do Not Resuscitate Allergy Fall Risk Develop work plan and implementation Tool Kit Insanity: doing the same thing over and over again and expecting different results. ~ A. Einstein The Tool Kit contents include: 1. The colors for the alert designation 2. The logic for the colors selected 3. A work-plan for implementation 4. Staff education including competencies 7 8 Executive Summary Executive Summary The Tool Kit contents include (cont.): 5. FAQs for general distribution 6. Sample policy and procedure 7. Vendor information for easy adoption Standardization of patient color-coded wristbands for DNR, Allergy and Fall risk endorsed by the NC Quality Center and NCHA Boards of Trustees 8. Patient education brochure 9 10 Executive Summary Our safety as a state and success in this effort will depend on the participation and adoption of each and every hospital in this state

34 Do Not Resuscitate Do Not Resuscitate Recommendation: DNR - Purple It is recommended that hospitals adopt the color PURPLE for the Do Not Resuscitate designation with the words embossed/printed on the wristband, clasp or label, DNR. Calling CODE BLUE! Is used by the majority to call a code team If North Carolina selected the color blue for the DNR wristband, the potential for confusion exists. Does blue mean I code or I do not code? Recommendation - 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, etc. 2. Why not green? Color-blind Go ahead confusion 3. If we adopt purple, do we still need to look in the chart? Yes! Code designation can and does change during a patients stay Allergy Allergy Recommendation: Allergy - Red It is recommended that hospitals adopt the color RED for the ALLERGY ALERT designation with the words embossed/printed on the wristband, clasp or label, ALLERGY. Allergies Quick Adoption By adopting red for allergy alert, the standardization for this is easily achieved since 64% of NC hospitals already use red for allergy alert. Recommendation - RED for the Allergy Alert 1. Why Red? 64% of North Carolina hospitals currently use red 2. 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 issues Allergy list may change Patient chart should be the source for the specifics Fall Risk Fall Risk Recommendation: Fall - Yellow Allergies Recommendation - YELLOW for Fall Risk Allergies It is recommended that hospitals adopt the color YELLOW for the Fall Risk Alert designation with the words embossed/written on the wristband, clasp or label, Fall Risk. Falls account for more than 70 percent of the total injury-related health cost among people 60 years of age and older. 1. Why Yellow? Associated with Caution or Slow Down (Stop Lights and School Buses) American National Standards Institute (ANSI) All health care providers want to be alert to fall risks as they can be prevented by anyone

35 Work Plan Documents A suggested Work Plan for Facility Preparation, Staff Education, and Patient Education that includes: 1. Organizational Approval 2. Supplies Assessment and Purchase 3. Hospital Specific Documentation 4. Staff and Patient Education Materials and Training Following the Work Plan is a Task Chart for each plan that provides cues for methodical and successful implementation Sample Work Plan Document Sample Task Chart Staff Education Tools for Staff Education: Poster announcing the training meeting dates/times Staff Sign-In Sheet Staff competency check list Tri-fold Staff education brochure about this initiative FAQs hand out for staff Tri-fold Patient education brochure about color coded wristbands PowerPoint presentation

36 Staff Education Staff Education Tri-fold Staff education brochure that includes: 1. How this all got started The Pennsylvania story 2. Why we need to do this in North Carolina 3. The National picture 4. What the colors are for Allergy, Fall Risk and DNR 5. Script for any staff person talking to a patient or family about the wristbands 6. Quick Reference Card cut out that lists 7 other risk reduction strategies Color Coded Alert Wristbands / Risk Reduction Strategies A Quick Reference Card ==================================== 1. Use wristbands with the alert message preprinted (such as DNR ) 2. Remove any social cause colored wristbands (such as Live Strong ) 3. Remove wristbands that have been applied from another facility Staff Education Staff Education Color Coded Alert Wristbands / Risk Reduction Strategies A Quick Reference Card =================================== 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 arm bands upon assessment, hand- off of care and facility transfer communication. Why 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 is information is not correct. 4. By following a script, patients and families receive consistent message which helps with retention of the information. 5. Patient Education brochure also available for staff to hand out Staff Education Staff Education SCRIPT 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 care status, condition, or an 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 most commonly ones used. ~ continued on next slide~ SCRIPT for any staff person talking to a patient or family RED means ALLERGY ALERT If a patient has an allergy to anything - food, medicine, dust, grass, pet hair, ANYTHING- tell us. It may not seem important to you but it could be very important in the care the patient receives. YELLOW means FALL RISK We want to prevent falls at all times. Nurses assess patients all the time to determine if they need extra attention in order to prevent a fall. Sometimes, a person may become weakened during their illness or because they just had a surgery. When a patient has this color coded alert wristband, the nurse is indicating this person needs to be closely monitored because they could fall. ~ continued on next slide~

37 Staff Education SCRIPT for any staff person talking to a patient or family PURPLE means DNR Or Do Not Resuscitate Some patients have expressed an end-of-life wish and we want to honor that Policy & Procedure Excerpt from Refusal Form A template Policy & Procedure has been provided. Make modifications to it so it fits your organization s process and culture. Includes a Patient Refusal to Participate in the Wristband Process process. The 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 health care team. I understand the risk 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 Live Strong and others). The risks of refusing to remove the Social Cause colored wristbands have been explained to me by a member of the health care team. I understand that by 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 / Time Date / Time Signature / Relationship Witness Signature / Job Title National Efforts