PA PSRS Patient Saf Advis 2006 Sep;3(3):3.
Letters to the Editor: Color-Coded Patient Wristbands

Mercy Hospital

This is really an excellent and much needed project with a great deal of hard work invested. However, I am concerned that we need to have a nationwide standard rather than a standard for Pennsylvania.

First, here in the Delaware Valley, many physicians (including moonlighters and residents) work in more than one state as they can be a mere 15 minutes away from their patients in New Jersey or Delaware. Likewise, in the western part of the state, physicians can also work in Ohio. Since this blurring of the borders applies to many other states, it will not help to have separate standards for each state.

Second, with all the work that has gone into this, those hospitals in Pennsylvania who adopt the color coding mentioned here may have to change it if a national standard is adopted that is different than the one mentioned here.

Do you think this should be a nationwide standard? If so, what is the best national patient safety organization or federal agency for the initiators/authors to take this project and raise it as a national issue?

Sandra Sacks
Director, Patient Safety and Risk Management
Mercy Hospital of Philadelphia

Editor’s Note

Ms. Sacks raises important questions. We agree that a national standard would be ideal. Subsequent to the original Patient Safety Advisory on the use of color-coded patient wristbands (Vol. 2, Sup. 2, Dec. 2005), the Patient Safety Authority has been in contact with the Maryland Patient Safety Center, the New Jersey Department of Health and Senior Services, and the New York State Department of Health about a uniform standard. New York is reported to have pending legislation on the issue.

The Authority has made those contacts aware of the work of the Color of Safety Task Force. The Task Force, in turn, has been in contact with a collaboration to standardize color-coded wristbands initiated by the Arizona Hospital and Healthcare Association and involving the Western Regional Alliance for Patient Safety (WRAPS), consisting of Arizona, California, Nevada, New Mexico, Oklahoma, and Utah.

The Color of Safety Task Force and WRAPS initiatives differ only a little—in the color for DNR (blue vs. purple). The Authority has shared the PA-PSRS survey instrument and findings with the Hawaii Patient Safety Task Force and the Missouri Center for Patient Safety . We are optimistic that this grass-roots effort, precipitated by a single incident (near-miss) report in PA-PSRS, and initiated by the Color of Safety Task Force, will ultimately result in consistent standardization across the states and will become a de facto national—and perhaps international—standard. 

Excela Health

This is a great initiative. I do have a suggestion regarding patients who are in isolation. Currently, we use a green bracelet to identify patients who are under isolation precautions. This visual alert communicates to staff that the patient is under some type of isolation precautions. This has worked very well for us and is a reminder to staff to check what type of transmission based precautions the patient has been placed on. I would recommend the group consider isolation patients too.

Lisa D'Amico
Director, Infection Prevention & Control
Excela Health

Editor’s Note

No doubt a number of institutions have preferences for whom should get wristbands and what colors should be used. The advantage of a consensus is consistency. The current consensus provides a framework for a minimum set of reasons for wristbands and the primary colors reserved for them. Hopefully, as the consensus grows, the number of institutions agreeing to a common minimal standard will grow—not the number of reasons and colors for wristbands. Other reasons and their colors will have advocates. Ideally, the reasons can be considered by those adhering to the consensus for inclusion in the essential list, along with an appropriate primary color. Hopefully, the advocates for those reasons and colors not on the consensus list of minimum reasons and primary colors will not only use secondary colors or patterns that are not confused with the primary color scheme, but will also try to be consistent in their designations as well.

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