Patient bracelets, their colours indicating the condition of the patient, are raising concerns over privacy and sensitivities in US.
New York's 11 public hospitals are at the forefront of a national movement to standardize color coding of hospital wristbands to designate patient conditions, in which purple — the color of amethyst — means "Do Not Resuscitate." Red, or ruby, indicates allergies, while yellow — call it amber — marks someone at risk for falling.
The goal is to prevent potentially dangerous mistakes, like giving the wrong food to an allergic child, or allowing a patient with balance problems to walk unescorted down a freshly waxed hallway. The drive was spurred, in part, by a notorious 2005 Pennsylvania case in which a patient nearly died because a nurse used a yellow band thinking it meant "restricted extremity" (don't draw blood from that arm), as it did at another hospital where the nurse sometimes worked, when at this hospital it meant DNR (Do not resuscitate), reports Anemona Hartocollis in New York Times.
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.
"You need to strike a balance between the need for patient safety and accuracy and the whole privacy concern and sensitivity and compassion for the patient," said Roxanne G. Tena-Nelson, executive vice president of the Continuing Care Leadership Coalition, a group of long-term-care providers in New York.
In most places, the new bracelets replace colored ones that have been used for decades without uniformity: a survey by the Greater New York Hospital Association last year found nine different colors used to denote patients with DNR orders, five to indicate allergies and nine to highlight risks of falling.
In New York, the Roosevelt Hospital division of St. Luke's-Roosevelt Hospital Center, near Columbus Circle, began using the yellow and red bracelets this month, but is still debating whether to add purple. In Arizona, one hospital embossed its purple bracelets with a white dove carrying an olive branch, rather than D.N.R., while another chose the initials A.N.D., for "allow natural death," as a gentler alternative.
Attuned to the sensitivities, hospitals have cautioned their staffs that wearing the color-coded bracelets is voluntary, and that patients are allowed to opt for some other method instead, like colored dots — or just old-fashioned notations — on medical charts.
Some hospitals have also had problems with colored bracelets that patients bring from home, like the ubiquitous yellow Lance Armstrong "Livestrong" bracelets. Most hospitals are asking patients to cut these off, but if they refuse, the popular bangle can be covered with tape instead.
Proponents of the new system argue that standardized colors are essential to patient safety, especially since nurses and doctors often move among several hospitals.
The color-coded system could be seen in full flower the other day on Yau N. Wan Gong, 77, who was recovering from gallstone surgery at Roosevelt.
Mrs. Gong was taking her afternoon promenade in the post-surgical ward wearing hospital-issued yellow slipper-socks, to denote that she was at risk of falling, along with two plastic bracelets on her right arm, one yellow, like the socks, the other pink. Pink has been adopted by some hospitals to indicate that a limb is somehow compromised and should not be used for procedures like drawing blood or inserting an intravenous line. (Mrs. Gong recently had surgery on her right side, so that arm is weak.)
Roosevelt also uses green bracelets, to mean "no blood transfusions," usually at the request of a patient with religious beliefs that conflict with transfusions. But in Minnesota and Colorado, as in New Jersey, green indicates a latex allergy.
In Mrs. Gong's case, the hospital staff had allowed her to continue wearing a green jade bracelet, which her son, Peter Gong, who was accompanying her on her walk, said gives his mother comfort because in Chinese culture it is supposed to ward off arthritis pain.