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A Lutheran Hospital patient who is considered at risk for falling wears a wristband with a yellow sticker to alert medical personnel.
But a yellow wristband at Parkview Hospital means something different: It denotes a “restricted extremity,” alerting medical staff not to draw blood from or insert an IV into a patient’s arm because of swelling from surgery or another reason.
Lutheran Hospital and some other Lutheran Health Network hospitals follow a national standard for wristband alert colors, according to a hospital official, though some of those network hospitals are still in the process of adopting the stickers. The standard was set by the American Hospital Association, which recommends a uniform, color-coded system to eliminate confusion, especially for medical personnel practicing at multiple hospitals.
Parkview Hospital plans to adopt the system; some of its wristband colors, such as red for allergies, already match the national standard.
The planned changes spring from the first meeting of a regional coalition of hospitals that reach across competitive barriers to improve patient safety.
The Northeast Indiana Patient Safety Coalition, which met in November, is the fifth of its kind in the state. It’s modeled after an Indianapolis coalition, which first met in 2003. The first regional safety coalition, based in Evansville, met in 2002.
The coalitions are a critical component of a statewide safety strategy, said Betsy Lee, director of the Indiana Patient Safety Center, which was formed in 2006 by a non-profit trade organization representing hospitals, now called the Indiana Hospital Association.
Lee urged the formation of the area’s safety coalition, and the Indiana Patient Safety Center is a consultant to the coalition. Efforts to standardize best practices are boosted by collaboration, she said.
Dr. Jeffrey Brookes, chief quality officer for Parkview Health, doesn’t believe color-coding inconsistencies at area hospitals have led to errors within the health system.
But a Pennsylvania incident brought the issue to the fore nationally, and the Northeast Indiana Patient Safety Coalition made standardizing wristband alert colors at area hospitals its first project.
The Pennsylvania Patient Safety Authority raised the issue after a clinician nearly failed to rescue a patient in cardiopulmonary arrest, according to the Wisconsin Hospital Association, which has advocated standardized alert colors.
A nurse at the hospital had placed a yellow alert on the patient’s wristband signifying a restricted extremity, because that’s what yellow meant at a nearby hospital where she also worked.
But at the hospital where the patient had cardiopulmonary arrest, yellow meant “do not resuscitate.” Fortunately, another clinician recognized the mistake, and the patient was resuscitated.
As in Pennsylvania and Wisconsin, wristband alert colors mean different things at different hospitals in northeast Indiana.
“Even in our own 19-hospital coalition, there may be four different colors to say, ‘This patient’s at risk for fall,’ ” said Brookes, who initiated the first meeting.
Regional hospitals are urged to adopt the American Hospital Association’s recommended wristband alert colors: red for allergies, yellow for fall risk and purple for “do not resuscitate.”
But hospitals aren’t required to use wristbands. Patient risks are typically noted in their charts among other means of alerting personnel.
As for wristband alert colors, the Indiana Hospital Association also recommends green to denote latex allergies, pink for a restricted extremity, and white or clear for patient ID wristbands.
Even before the regional patient safety coalition met, Lutheran Health Network began adopting color-coding practices consistent with the national standard and has been transitioning hospitals. Its Tennessee-based parent, Community Health Systems Inc., emphasizes standardizing best practices.
So Mary Ellen Brill, chief quality officer for Lutheran Hospital, doesn’t anticipate major changes related to the patient safety coalition’s first project. But some network hospitals, including St. Joseph and the Rehabilitation Hospital of Fort Wayne, are still transitioning to the color-coded wristband stickers.
In addition to the national standard, Lutheran Hospital also follows recommendations from the Indiana Hospital Association, except it doesn’t use a green alert color. If it were to do so, it would affix the sticker – to denote latex allergies, as the association recommends – alongside the red sticker, generally denoting allergies. The hospital uses chart alerts and room signage to denote latex allergies.
Brookes said another potential project for the regional safety coalition could be devising a better system for listing a patient’s medications.
Patients routinely visit multiple physicians and pharmacies. When a patient is unsure about the medications he or she takes, compiling a comprehensive medication list can be difficult, he said.
The regional safety coalition also talked about screening for MRSA, or methicillin-resistant Staphylococcus aureus, Brookes said. The drug-resistant bacteria, which can cause life-threatening infection, have become more prevalent nationally and locally, according to research and anecdotal reports from physicians.
Local hospital policies on MRSA screening vary. Since last spring, Parkview Hospital and Parkview North Hospital have screened inpatients on admission for MRSA. Dupont Hospital will begin doing the same today.
At other Lutheran Health Network hospitals and other Parkview Health hospitals, screening isn’t universal. Instead, patients are screened if they are considered at higher risk for contracting the staph infection – whether because of the department where they are being treated or for other reasons.
Neither Brookes nor Lee knew how much it might cost hospitals to participate in the regional safety coalition and related projects. Indianapolis hospitals have funded their regional coalition and begun to seek external funding for projects. But other coalitions worked on a more voluntary basis, Lee said.
One thing is certain: The cost of making mistakes – or neglecting patient safety – is rising for hospitals. Medicare and some private insurers already deny reimbursement for extra care associated with certain medical mistakes and infections, and the no-pay list is expanding.
Reducing infections and medication errors is central to improving patient safety and reducing costly mistakes.
Brill said the coalition will allow hospitals to work side by side on patient safety issues. She says the formation of the coalition indicates the community’s commitment to safety.
At the same time, Brill and other hospital officials don’t think the coalition will hinder competition. But they do think it’s important to remove barriers – competitive or otherwise – that prevent collaboration.
“I don’t think patient safety should be one of those things we should compete on,” Brill said. “We should work together.”
