Summary: This article delves into the significance of color-coded hospital wristbands, their history, implications, and the need for standardization.

Hospitals rely on colors to indicate someone's status and procedures at the hospital. Think color codes (code blue, pink, red, etc). A lot of people have wondered if different hospital sock colors also signify something. You can read in detail the blog here, but the answer is generally no besides yellow socks for fall risks. 

In doing some research, we've come across another area where we've seen colors being used as a valuable tool indicator: hospital wristbands. 

A hospital wristband is a tool that helps with patient identification and is a communication device for healthcare workers to receive information regarding the patient’s condition through color. It benefits patients while helping to improve workflow between hospitals and staff. 

Although patient charts are the number one way for any health provider staff to learn valuable information about a patient, hospital wristbands have been used to alert staff of things to know early on, especially when dealing with a transfer patient or travel nurse. 

We've seen some issues in the past with standardizing hospital wristband colors, because every administration is different. It's extremely tough to get everyone rallied on the same processes when it comes to both hospital color codes and color wristbands. 

See below for a visual representation of different wristband colors and their meanings.

Hospital wristbands are often provided to patients during triage, when staff assess patients’ severity of injury or illness after they arrive. As mentioned previously, the following hospital wristband definitions are not standardized across all hospitals, but they are ones we have seen hospitals trying to adopt the most from online research. 

Yellow hospital wristbands: Yellow indicates a patient is fall risk. Wristbands are most likely given out to patients experiencing dizziness, are old and unstable on their feet, or have been given a lot of narcotics. Beyond wristbands, even hospital attire, like socks, can play a role in patient safety and comfort.Yellow hospital socks are also often given out to indicate who is a fall risk patients. See hospital socks from Dr. Socko here.

Red hospital wristbands: Several hospitals use red to denote allergies today. Red also implies extreme caution, so healthcare staff are prompted to stop and double check  if the patient is allergic to the food or medication being provided.

Pink hospital wristbands: A pink wristband indicates the patient has a restricted limb or an extremity that should be handled with care. The idea here is to avoid medical procedures such as taking blood pressure, drawing blood or starting an IV in an area that can potentially result in harm or injury to the patient.

Purple hospital wristbands: There was a push to standardize a purple wristband as the go-to indicator for a patient who is DNR, but this continues to be up for debate and is a controversial topic people do not agree on. Out of all the hospital wristband colors, this one seems to be the least used in the field due to ongoing concerns.

This patient identification clinical policy from UCONN Health effective in Jan 2022 has the above hospital wristband definitions in place with the exception of purple meaning something else.

There are two scenarios that prompted for a nationwide push towards hospital wristband standardization of the above colors

• In 2005, a clinician nearly failed to rescue a patient who had a cardiopulmonary arrest because the patient had been incorrectly designated as “DNR” (do not resuscitate). The source of confusion was that a nurse had placed a yellow alert on the patient's hospital wristband. In this hospital, the color yellow signifies that the patient was a DNR. In a nearby hospital in which this nurse also worked, yellow hospital wristbands signified “restricted extremity” meaning that this arm is not to be used for drawing blood or obtaining IV access. Fortunately, another clinician identified the mistake, and the patient was resuscitated.
• In another event, a young man experiencing serious heart problems was transported from Hospital A to Hospital B for advanced heart care. Upon arrival at Hospital B, a nurse commented on his “DNR” hospital wristband. The patient was horrified to learn that the patient name-band placed on his wrist at Hospital A  was the same blue color as Hospital B’s wristband to indicate a status of DNR. Luckily, this misinterpretation was immediately clarified and the hospital wristband removed before any life sustaining care was withheld. 

These are considered "near miss events" and were a catalyst for several health associations and hospitals to re-evaluate the use of color-coded hospital wristband alerts. 

In addition to this, a survey was performed across Colorado hospitals in 2006 to gather info about usage of different colored hospital wristbands. They found out that 

• Allergies: Five different hospital wristband colors were being used to designate an allergy.
• DNR: Five different hospital wristband colors were being used to designate a DNR.
• Fall Risk: Six different hospital wristband colors were being used to designate a fall risk.
• Latex Allergy: Six different hospital wristband colors were being used to designate a latex allergy. 

It's shocking how hospitals and administration deal with having no standardization!

The American Hospital Association (AHA) issued a statement in September 2008 asking that all U.S. hospitals adhere to standardized colors for hospital wristbands. A New York Times article from 2008 notes 

“While the new color-coding has been quickly embraced by at least 20 states and endorsed by the American Hospital Association, the purple bands, typically embossed with the letters D.N.R. to reinforce the message, are meeting with some resistance.

The nation’s leading hospital-accreditation agency, known as the Joint Commission, has expressed caution about the new system, citing concerns about branding patients by their end-of-life choices, or inadvertently broadcasting those choices to family and friends who have not been consulted.

The commission also said that children who do not understand the system had been prone to trade the wristbands like baseball cards.”

Those in favor of more obvious DNR identifiers like hospital wristbands tend to argue the following 

• Historically, staff relied on hospital charts to see if a patient was DNR. The difference today is less and less workers are employed and dedicated to one hospital where they are embedded into the culture and rules of the one hospital. 
• We continue to move towards travel nursing and nurses working for multiple locations, where staff are no longer as familiar with how to access or where to find valuable information, especially in a dire emergency environment. 
• When staff have seconds to decide whether or not to save a life, as in a code situation, having something quick to indicate a patient is DNR is necessary. 

Those NOT in favor of more obvious DNR identifiers like hospital wristbands tend to argue the following 

• There is insufficient evidence supporting the argument that wristband color codes improves patient safety. Wristbands can be difficult to see from a distance, in poor lighting, and can easily go unnoticed. 
• Instead, staff should always look at the chart to gain the 100% truth into a patient’s medical history. Relying on a wristband that can be ripped off, easily passed to another patient, or mistaken with another hospital’s unique color coding system is a poor choice and precedent that is bound to have significant mistakes. 

Even the FDA became involved in 2021 with a notice to medical device manufacturers that they should avoid using any purple bracelet or wristbands to identify device implants due to concerns of a mix-up with DNR status. 

We saw a brief push towards standardization after the two incidents shared earlier, but it seems to have reached it’s peak and slowed. From 2005-2009, there seemed to be a big effort for hospital wristband color code standardization in Kansas, Arkansas, Oklahoma, Texas, Wisconsin, Colorado, Minnesota, Arizona, and Pennsylvania with the number of states involved recorded at roughly 39. 

In an industry that deals with life or death scenarios, rallying an entire country to follow the same rules is a daunting task. It’s unlikely that we will see a nationwide mandate when state hospital associations continue to have divided opinions on patient safety. 

In conclusion, while hospital wristband colors play a critical role in patient care, there's a clear need for nationwide standardization. As healthcare continues to evolve, prioritizing patient safety through clear communication tools remains paramount.

While wristbands play a crucial role in patient safety and communication, another essential aspect of hospital stays that often goes overlooked is the comfort and functionality of hospital attire. Did you know that even something as simple as the socks patients wear can make a significant difference in their hospital experience? That's where Dr. Socko comes in.

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