Hospital wristband color standardization

There is insufficient evidence to determine whether standardizing the color codes of hospital wristbands improves patient safety. Anecdotal reports suggest that the potential for provider confusion decreases and patient safety increases following standardization of wristband colors^{1, 2, 4}. Lack of standardization can introduce patient safety issues when health care providers work in multiple facilities (e.g., travel nurses, students on medical rotations) with conflicting color codes, such as the possibility of a do-not-resuscitate (DNR) status being misidentified⁵. However, some experts express concerns regarding the use of color-coded wristbands, which can be difficult to discern at a distance, in low light or when obscured, and can go unnoticed during a crisis⁶. Additionally, approximately one in 12 men and one in 200 women suffer from color blindness⁷, and health care providers with color blindness can find it challenging to use color-coded information in medical care⁸. Additional evidence is needed to confirm effects.

Experts suggest that providers routinely consult patients’ charts along with wristband cues¹, ensure wristbands are updated as needed to reflect patients’ medical status⁶, and verify wristbands during all provider shift changes². To aid in implementation, wristbands should be included in standard trainings during new staff orientation and annual education for current staff, wristbands should be stored in plain sight at nurses’ stations as a reminder for use, and there should be periodic random spot checks of wristband accuracy². Furthermore, cause-related wristbands (i.e., Livestrong bracelets) should be removed upon admission to reduce the possibility of provider confusion⁴.

A UK-based study suggests color-coded wristbands that indicate the targeted oxygen range for patients receiving supplemental oxygen can remind providers to monitor oxygen statistics, improving the safe prescription of oxygen⁹.

As of 2023, at least 20 states use the wristband color-coding recommendations from the American Hospital Association (AHA): yellow for fall risk, red for patient allergies, and purple for do-not-resuscitate (DNR) patient preferences⁵.

The Texas Hospital Association (THA), in collaboration with the Texas Organization of Nurse Executives, Texas A&M Health Science Center Rural and Community Health Institute, and the TMF Health Quality Institute created the Color-coded Wristband Standardization Project in Texas toolkit, which features a work plan for implementation, wristband specifications for vendors, and staff and patient education materials¹⁰. THA follows the colors recommended by the AHA¹⁰, as does the Wisconsin Hospital Association¹¹, and Jefferson Regional Medical Center in Arkansas, which provides information for patients about the safety implications of color-coded wristbands on their website¹².

The Institute for Clinical Systems Improvement (ICSI) and the Agency for Healthcare Research and Quality (AHRQ) multi-component fall prevention efforts are two examples of widely used efforts that include color-coded wristbands. These programs also use signs on patients’ doors and white boards, notes above beds, and color-coded, nonskid socks (yellow for fall risk, red for high fall risk) to indicate fall status¹³.