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Hospitals must standardise patients' wristbands to reduce risk of wrong care

Hospitals in England and Wales must standardise the design of patients' wristbands and the information recorded on them to reduce the risk of providing the wrong care, says new guidance from the National Patient Safety Agency.

More than one in 10 reported cases of patients being mismatched to their carelast year were related to wristbands, the agency warned. Such mismatches occurred in more than 2900 of the total 24 382 reports of patients receiving the wrong care from February 2006 to January 2007.

Standardising the design of patient wristbands, the information on them, and the processes used to produce and check them, will improve patient safety,advises the agency.

From July 2008 all NHS organisations in England and Wales that use wristbands will need to ensure that they meet the agency's design requirements. This means that wristbands should come in a range of sizes to fit all patients, from the smallest newborn babies through to overweight patients and patients with oedema and those with intravenous lines and bandages. They must be comfortable for patients, easy to keep clean, and secure.

Wristbands must record core patient identifiers, including the patient's surname, first name, date of birth, and NHS number (a temporary one should be used if their number is not immediately available). In Wales the first line of the patient's address should be added. Information should be easy to read and durable throughout the patient's stay.

A review of the evidence available on patient wristbandsgathered from existing literature, workshops run by the agency, and a survey of NHS trustsshowed that non-compliance with use varied from 3% in cardiac, 4% in surgical, and 5% in orthopaedics units to 29% in paediatric departments.

Further information showed that the key errors that contributed to problems occurred in the process of creating and issuing wristbands to patients. These errors included clerical errors, such as transposing digits in hospital numbers, failure to verify information, and difficulties in communication, often resulting from the patient's illness or lack of English.

The survey of NHS trusts showed that most trusts recorded a patient's first and last name and hospital number, but not all recorded date of birth, and only about a third recorded the NHS number.

There was much variation in who issued wristbands to patients and who checked the information as well as in     colour coding. For example, red bands could have eight different meanings, ranging from drug allergy to does not have English as a first language.

At the workshops NHS staff and patients agreed that some sort of standardisation in the design and specificationsincluding colour codingof wristbands would be useful.

The author of the review report, Nick Sevdalis, from the agency's research and development department, concluded, Taken together, these reviews suggest that patient misidentification does occur, that wristband-related errors contribute to it, and, finally, that the consequences of such errors are potentially devastating (especially in surgical specialties).

To reduce these errors the agency's new guidance requires NHS trusts to develop clear and consistent processes, to be set out in trust protocols, specifying which staff can produce, apply, and check wristbands, how they should do it, and what sources of information they should use.

Trusts should use only white wristbands with black text, says the guidance. Those wishing to have a system for identifying known risk (such as an allergy or to indicate patients who do not want to receive blood or blood products) should use a red wristband with patient identifiers in black text on a white panel on the wristband.

By 18 July 2009 all wristbands should be generated and printed from the hospital demographic system (for example, the patient administration system) at the patient's bedside, wherever possible.

The recommendations apply to all hospital inpatients in general and community settings. Although it is hoped that emergency departments should try to follow the recommendations, the agency recognises that this may be difficult, because of the high turnover of patients, delayed registration as a result of the need to treat urgently, and the limited information that may be available when a patient arrives.

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