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Patient Bracelets Changing

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The New York Times

Published: September 25, 2008

NEW YORK - At hospitals, as at Tiffany's, ruby-colored bracelets are far preferable to amethyst.

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, and 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.

Although 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 DNR 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.

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