Hospital wristband color standardization

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 details (AHRQ HCIE-PA wristband, AHA-Wristbands 2008). 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 pressures (AHRQ HCIE-PA wristband, Colors of Safety). However, color codes vary across hospitals (Dixon-Woods 2016, Wood 2011*, Sehgal 2007*). 

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 colors (AHRQ HCIE-Severson, AHRQ HCIE-PA wristband), 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 oxygen (Forster 2016). 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 situations (Wood 2011*). Additional evidence is needed to confirm effects.

Experts suggest that providers routinely consult patients’ charts along with wristband cues (AHA-Wristbands 2008) and ensure wristbands are updated as needed to reflect patients’ medical status (Wood 2011*).

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 status (ICSI-Degelau 2012, AHRQ-RAND Ganz 2013). 

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.

Citations - Evidence

* Journal subscription may be required for access.

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.

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.

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.

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.

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.

Citations - Implementation Examples

* Journal subscription may be required for access.

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.

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.

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