'Do not resuscitate' orders lack standardization in hospitals

December 18, 2007

San Francisco, Calif. - December 18, 2007 - Methods to identify a patient with a Do Not Resuscitate (DNR) order are incredibly varied across hospitals, ranging from written documentation practices to the use of color-coded wristbands. According to a new study in the Journal of Hospital Medicine, a national effort to standardize color-coded wristbands, likely around a few specific indications (e.g., DNR status, allergy, fall risk, etc.), would remove current practice variations and the associated potential for errors.

There are currently no standards of color choice for hospitals using color-coded wristbands, and each hospital has a different set of colors for different indications. This lack of standardization creates the potential for errors. For example, some hospitals have used yellow to signify "Do Not Resuscitate," leading to several near-misses with patients wearing yellow Lance Armstrong "Livestrong" bracelets. If a standard color choice existed for DNR orders, the potential for errors with either personal patient wristbands or those used by hospitals would be averted.

"Patients spend tremendous energy and effort in making decisions about the care they wish to receive, often through the completion of advanced directives. We hope our study findings generate a national effort to standardize the choice of colors for a defined set of indications when using patient wristbands to communicate critical information to front-line healthcare providers, where the information is needed most," say Drs. Niraj L. Sehgal and Robert M. Wachter, co-authors of the study.

The authors note that, while several states have implemented statewide efforts to standardize color-coded wristbands, their color choices are not standardized with each other. A national effort is currently needed to look at the potential for errors involved under current practices and to designate standard colors for patient wristbands around a defined set of indications.
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This study is published in the November/December issue of the Journal of Hospital Medicine. Media wishing to receive a PDF of this article may contact medicalnews@bos.blackwellpublishing.net.

Robert M. Wachter, M.D., is a bestselling author and national leader in the fields of patient safety and healthcare quality and considered to be one of the most influential physician-executives in the United States. Dr Wachter is Professor and Chief of the Division of Hospital Medicine; Associate Chairman, Department of Medicine; and Chief of the Medical Service, UCSF Medical Center at the University of California, San Francisco. He is a member of the Board of Directors of the American Board of Internal Medicine and is on the healthcare advisory boards of several companies, including Google. Dr. Wachter can be reached for questions at bobw@medicine.ucsf.edu.

Niraj L. Sehgal, M.D., MPH, is an Assistant Professor, Division of Hospital Medicine; and Medical Director, Mount Zion Medical Service, at the University of California, San Francisco. He serves in a clinical-educator role on the inpatient medical service, a clinical-investigator role with interests in patient safety and quality improvement, and a clinical-administrator role as Director of the Mt. Zion Hospital Medicine Service. Dr. Sehgal can be reached for questions at nirajs@medicine.ucsf.edu.

The Journal of Hospital Medicine is the premier publication for dissemination of research and education for the specialty of hospital medicine; the fastest growing specialty in the history of American medicine. The Journal advances excellence in hospital medicine as a defined specialty through the dissemination of research, evidence-based clinical care, and advocacy of safe, effective care for hospitalized patients. For more information, please click here.

Blackwell Publishing Ltd.

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