Proliferating bracelets could pose hazards for patients

Potential confusion over the brightly colored wristbands has raised safety concerns at some hospitals.

By Andis Robeznieks — Posted Jan. 3, 2005

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The worlds of fashion, fund-raising and patient safety have collided, and the result is a rainbow of colored bracelets that can indicate either support for scientific research or the contents of a patient's living will.

At issue are bracelets that show support for a cause and are the same color as the bracelets hospitals use to identify patients with do-not-resuscitate orders or for other designations. There are concerns about patient safety because, even though the bracelets are made of different materials, the similar colors might cause confusion during an emergency.

Such a concern was first publicly raised within the four Morton Plant Mease Health Care hospitals on Florida's West Coast, which are part of the nine-hospital BayCare Health System. BayCare facilities use a yellow plastic bracelet to indicate a patient's DNR status. The popular LIVESTRONG rubber bracelets sold by the Lance Armstrong Foundation are almost exactly the same color.

"About a month ago, one of the nurses in our health system identified that the Lance Armstrong yellow bracelet could be confused with our DNR yellow bracelet," said Lisa Johnson, RN, Morton Plant Mease Health Care vice president, patient services.

Johnson said the decision was made to ask patients either to remove the LIVESTRONG bracelet or to put white tape over it. So far, she said, patients have understood the issues and complied without complaint.

"Seconds count in a decision whether to resuscitate someone or not," Johnson said. "In the highly charged environment of a cardiac pulmonary arrest, we don't want any confusion whatsoever."

The Lance Armstrong Foundation did not comment on the patient safety issue raised by people wearing its bracelets. Since its "Wear Yellow, Live Strong" campaign was launched last May, more than 20 million of the $1 bracelets have been sold at a rate of around 150,000 a day. Proceeds benefit programs to help people with cancer "live strong."

Johnson said the hospitals' policy should not be seen as a negative response to the foundation.

"Morton Plant Mease Health Care supports the Lance Armstrong Foundation's mission, and we understand our patients' support and passion, but patient safety is our highest priority."

Red and purple also in use

In addition to the yellow DNR bracelets, the BayCare hospitals use red bracelets to indicate patients with allergies and purple to indicate a patient at risk for falling.

At another West Coast Florida facility, Tampa General Hospital, DNR status is indicated with a purple bracelet -- the same color as the American Cancer Society's "Celebrate Hope" wristband. Despite the similarity, the ACS bracelets are not yet as popular as the LAF bracelets, so Tampa General spokesperson Ellen Fiss said no policies had been developed about their impact on patient safety.

"Purple bracelets are not an issue right now, but if they became as popular as the Lance Armstrong bracelets, we would look into it," Fiss said. "We would look at anything that would affect our patients' safety."

ACS spokeswoman Amy DiLeo said the society had not heard about any cases in which the organization's wristbands had been confused with a hospital's color-coded bracelets. But she added that the bracelets could be considered jewelry, and it's always a good idea to remove any jewelry before being admitted to a hospital.

Charlene D. Hill, media relations manager for the Joint Commission on Accreditation of Healthcare Organizations, said JCAHO had not received any field reports or complaints about confusion from colored bracelets. Nevertheless, she compared them to the potential hazards caused by look-alike and sound-alike drugs.

"Staff would need to be acutely aware of the dangers and the potential for confusion and take steps, if necessary, to avoid any confusion," she said.

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