Hospital wristband color standardization

Evidence Rating  
Insufficient Evidence
Evidence rating: Insufficient Evidence

Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.

Health Factors  
Decision Makers

Color-coded wristbands are visual cues that inform health care providers about hospitalized patients’ circumstances such as elevated fall risk, allergies, or do-not-resuscitate (DNR) status, prompting providers to consult medical records for full details1, 2. Color-coded wristbands are often used as part of a multi-component approach to patient safety. In many hospitals, red signifies allergy, yellow elevated fall risk, and purple DNR status. Some also use pink to warn of a restricted extremity for blood draws or blood pressures1, 3. However, color codes vary across hospitals4, 5, 6

Expected Beneficial Outcomes (Rated)

  • Improved patient safety

Evidence of Effectiveness

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 colors1, 7, and a UK-based study suggests that color-coded wristbands that indicate target oxygen range for patients who receive supplemental oxygen can remind providers to monitor oxygen statistics, improving safe prescription of oxygen8. However, wristbands can be difficult to discern at a distance, in low light or when obscured, and can go unnoticed during a crisis; other visible cues may be more noticeable than wristbands in some situations5. Additional evidence is needed to confirm effects.

Experts suggest that providers routinely consult patients’ charts along with wristband cues2 and ensure wristbands are updated as needed to reflect patients’ medical status5.

Impact on Disparities

No impact on disparities likely

Implementation Examples

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 status9, 10

Implementation Resources

LHA-Wristband - Louisiana Hospital Association (LHA). Color-coded wristband standardization in Louisiana: Implementation tool kit. 2009.

Colors of Safety - Greater New York Hospital Association (GNYHA) and Continuing Care Leadership Coalition (CCLC). The colors of safety across the continuum of care. 2011.

Footnotes

* Journal subscription may be required for access.

1 AHRQ HCIE-PA wristband - Agency for Healthcare Research and Quality (AHRQ). Consortium of Pennsylvania hospitals adopts standardized wristband colors, leading to reduction in falls, allergic reactions at rehabilitation hospital. Rockville: AHRQ Health Care Innovations Exchange.

2 AHA-Wristbands 2008 - American Hospital Association (AHA). FDA quality advisory on implementing standardized colors for patient alert wristbands. Washington, DC: American Hospital Association (AHA); 2008.

3 Colors of Safety - Greater New York Hospital Association (GNYHA) and Continuing Care Leadership Coalition (CCLC). The colors of safety across the continuum of care. 2011.

4 Dixon-Woods 2016 - Dixon-Woods M, Pronovost PJ. Patient safety and the problem of many hands. BMJ Quality & Safety. 2016;25(7):485-488.

5 Wood 2011* - Wood SD, Bagian JP. A cognitive analysis of color-coded wristband use in health care. Proceedings of the Human Factors and Ergonomics Society Annual Meeting. 2011;55(1):281–5.

6 Sehgal 2007* - Sehgal NL, Wachter RM. Identification of inpatient DNR status: A safety hazard begging for standardization. Journal of Hospital Medicine. 2007;2(6):366–71.

7 AHRQ HCIE-Severson - Severson S. Statewide standards for color-coded wristbands are adopted by vast majority of Arizona hospitals. Rockville: AHRQ Health Care Innovations Exchange.

8 Forster 2016 - Forster S, Smith S, Daniel P, et al. Optimising prescription and titration of oxygen for adult inpatients using novel silicone wristbands: Results of a pilot project at three centres. Clinical Medicine. 2016;16(4):330-334.

9 ICSI-Degelau 2012 - Degelau J, Belz M, Bungum L, et al. Institute for Clinical Systems Improvement (ICSI). Health care protocol: Prevention of falls (acute care). 2012.

10 AHRQ-RAND Ganz 2013 - Ganz DA, Huang C, Saliba D, et al. Preventing falls in hospitals: A toolkit for improving quality of care. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); 2013.

Date Last Updated