'Do not resuscitate' orders lack standardization in hospitals

December 18, 2007

Methods to identify a patient with a Do Not Resuscitate (DNR) order are incredibly varied across hospitals, ranging from written documentation practices to the use of color-coded wristbands. According to a new study in the Journal of Hospital Medicine, a national effort to standardize color-coded wristbands, likely around a few specific indications (e.g., DNR status, allergy, fall risk, etc.), would remove current practice variations and the associated potential for errors.

There are currently no standards of color choice for hospitals using color-coded wristbands, and each hospital has a different set of colors for different indications. This lack of standardization creates the potential for errors. For example, some hospitals have used yellow to signify “Do Not Resuscitate,” leading to several near-misses with patients wearing yellow Lance Armstrong “Livestrong” bracelets. If a standard color choice existed for DNR orders, the potential for errors with either personal patient wristbands or those used by hospitals would be averted.

“Patients spend tremendous energy and effort in making decisions about the care they wish to receive, often through the completion of advanced directives. We hope our study findings generate a national effort to standardize the choice of colors for a defined set of indications when using patient wristbands to communicate critical information to front-line healthcare providers, where the information is needed most,” say Drs. Niraj L. Sehgal and Robert M. Wachter, co-authors of the study.

The authors note that, while several states have implemented statewide efforts to standardize color-coded wristbands, their color choices are not standardized with each other. A national effort is currently needed to look at the potential for errors involved under current practices and to designate standard colors for patient wristbands around a defined set of indications.

Source: Blackwell Publishing Ltd.

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