Author:
Date:
19 April 2009
Doc Ref:
1.8
Contents
Background
1. Why is it important to standardise wristbands?
2. Why do we need a second NPSA Safer Practice Notice on wristbands?
3. Have staff and patients been consulted about standardising wristbands
and the NPSAs recommendations?
4. Are patients allowed to wear their own wristbands, for example to denote
no blood products?
5. What is the procedure if the organisation does not feel it can comply with
the Safer Practice Notice or elements of the Notice?
The design of wristbands
6. What kind of wristbands should we use?
7. Where do I get a wristband that meets the NPSA design guidance?
8. Does the NPSA recommend the use of technologies such as barcoding
and radio frequency identification (RFID) on wristbands?
Patient identifiers
9. Are the core patient identifiers for wristbands mandatory?
10. Do the patient identifiers also apply to newborns?
11. Why isnt gender one of the core patient identifiers for wristbands?
12. The NHS Number isnt available on most of our patient records, how do
we check notes against the wristband?
13. Is there a standard layout and format for the identifiers on a patient
wristband?
14. Where should any additional identifiers (including hospital number) be
located?
15. What should I do if one or more of the four identifiers is missing?
16. Why is it a requirement of the Safer Practice Notice for Welsh
Organisations to include first line of address as a core identifier on a
patients wristband?
17. Why is it recommended that wristbands are white with black text weve
always used yellow bands because they show up well?
Processes for producing, applying and checking wristbands
18. Is there NPSA guidance on processes for issuing, checking and changing
wristbands?
19. Where should the patient and member of staff sign to say the information
on the wristband is correct, or that the wristband has been changed for a
specified reason?
The use of coloured wristbands
20. Why is the NPSA concerned about colour coding wristbands?
21. Our Trust currently uses red wristbands to identify if a patient has an
allergy. The system has been in place for over 10 years and is recognised
practice, so why should we stop it?
22. How will staff who move jobs know if their new healthcare organisation is
using a system of a red wristband for known risks?
23. What patient risks should I use red wristbands for?
24. We currently use green wristbands for patients at risk of falls, how do we
protect these patients now?
25. What about food and nut allergic patients?
26. We need to know when patients are radioactive, so why cant we use a
coloured wristband?
Appendix 1: Algorithm for the safe identification of unknown, unconscious or
incapacitated patients on the same NPSA webpage as this guidance
Background
This document was developed originally to help NHS organisations implement the
NPSA Safer Practice Notice (SPN) 24 Standardising wristbands improves patient
safety. Further work has been done by the NPSA to develop the related information
standard on core patient identifiers approved by the Information Standards Board for
Health and Social Care, for which NHS Connecting for Health (NHS CFH) is the
sponsor and longer-term developer. A key output is the development of
supplementary organisational and behavioural guidance to support full
implementation of the core identifiers in the NHS. Implementation of the Patient
Identifiers for Identity Bands standard is dependent on implementation of the related
NHS Number Standards DSC Notices 31&32/2008. This guidance should be read
in conjunction with NHS Number Implementation Guidance available at the NHS
Number Programme website http://www.connectingforhealth.nhs.uk/systemsandservices/nhsnumber. Both sets of
guidance are consistent.
1. Why is it important to standardise wristbands?
Between February 2006 and January 2007, the NPSA received 24,382 reports of
patients being mismatched with their care. More than 2,900 of these related to
wristbands and their use. Standardising the design of patient wristbands, the
information on them, and the processes used to produce and check them will
improve patient safety. There is increasing evidence to show that standardising
elements of patient care, such as these, contributes positively to patient safety1. Also,
wherever staff work in the NHS in England and Wales, they will know what to expect
on wristbands as patient identifiers.
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Patients who wish to wear their own wristbands in hospital should be permitted to do
so, but advised of the dangers of confusion for staff.
5. What is the procedure if the organisation does not feel it can comply with the
Safer Practice Notice or elements of the Notice?
The Safer Practice Notice represents the view of the National Patient Safety Agency,
which was arrived at after consideration of the evidence available. It is anticipated
that healthcare staff will take it into account when designing services and delivering
patient care. This does not, however, override the responsibility of individual
healthcare staff to make decisions appropriate to local circumstances and the needs
of patients and to take appropriate professional advice where necessary. If an
organisation decides not to implement this guidance it should undertake a full risk
assessment of the proposed alternative and be assured that the alternative is at least
as safe.
Shape - There should be no sharp corners, profiling or edges that can irritate or
rub the skin.
Edges The edges of wristband material must be soft and smooth to ensure
comfort over prolonged use. This includes any edges that are produced when
cutting the wristband to size.
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patients identity at any stage of their care or treatment, even if they are transferred to
another hospital. The development of technologies including barcoding, radio
frequency identification (RFID) and biometrics (for example, fingerprints and iris
scanning) is improving patient identification and the matching of patients to their care.
The Department of Health has issued a guidance paper on the use of simple
technology for safer patient care, with examples of the use of barcoding and RFID to
promote safer patient identification7. Wristbands should therefore allow the
incorporation of new technologies that may be used to assist patient identification
e.g. RFID tags or barcode technologies, whilst still fulfilling the other requirements.
Patient identifiers
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combination with Last name, First name and Date of Birth it will enable safer patient
identification. Nationally NHS Number availability varies between about 70% and
98%, so the verified NHS Number should be available for use for most patients. The
availability of NHS Numbers will vary across the country, depending on the quality of
demographic data collection at Trusts, which impacts on the ability to trace the
Number, and the system of automatic matching and clearance of non matches. Initial
primary care data collection is important as poor data collection can impact on match
rates. Some areas of the country are taking the initiative to improve NHS Number
coverage and also their data collection processes through effective data quality
improvement programmes within the NHS. Availability of the NHS Number is
compounded by the catchment area of the Trust and the percentage of patients who
are overseas visitors, immigrants, or asylum seekers, who are less likely to have a
NHS Number or for it to be easily available. If the verified NHS Number is not
immediately available, a local hospital number should be used until it is and the NHS
Number space on the band left blank.
13. Is there a standard layout and format for the identifiers on a patient
wristband?
Standardising the layout and format of these identifiers will increase legibility and
clarity. The following requirements relate to the layout of information on a wristband:
The space available for patient data should be adequate for the patient identifiers
to be recorded clearly and unambiguously.
The same layout, order of information and information style should be used on all
wristbands across the organisation to encourage standardisation. This helps
make wristbands easier to read and avoid errors.
Pre-defined spaces for each identifier or a pre-printed format can help encourage
standardization e.g. consider using a title or box for each identifier (see figure 1),
but without reducing the space available for the patient identifiers.
The related information standard on patient identifiers for identity bands, specifies
some aspects of format and layout that must be used and these are included in the
text below which follows figure 1, and defined by use of the word must.
14. Where should any additional identifiers (including hospital number) be
located?
The NPSA says in the SPN (24) on standardising wristbands, that only the four core
patient identifiers should be used on wristbands. However, there may be
circumstances where it is thought necessary to have one or more additional
identifiers on the band. If any additional identifiers are thought to be necessary, they
must be formally risk assessed in terms of why they are necessary, how they are
distinguishable from the four specified identifiers and how they are located on the
identity band so that the four identifiers remain clear and unambiguous. They should
not be placed where they could be confused with any missing core identifiers. The
NHS Number space on an identity band should only be used for a verified NHS
Number. If the verified NHS Number is not available, this field should be left blank.
If a hospital or local number has to be used, it is best to label it as such.
15. What should I do if one or more of the four core identifiers is missing?
If one or more of the four core identifiers is missing, it may be necessary to use
another or other identifiers depending on the circumstances. If the missing identifier
is the verified NHS Number, please see the advice for 14 above. If the identifiers are
missing because the patient is unknown, incapacitated please see the algorithm in
1a
Last
Name
First
Name
Date of
Birth
NHS
Number
1b
Last
Name
First
Name
Date of
Birth
NHS
Number
1c
If pre-defined spaces are not used, pre-printed lines can be used to help
make information easy to read. This is particularly useful for write-on
wristbands.
The suggested layout shown in figure 1 shows the patients name on one line,
in the order LAST NAME, First name. If it is not possible to display the names
on one line, a compromise would be to add the titles (as shown in figures 1a
and 1b), to help differentiate last and first names, which otherwise would only
be indicated by the use of upper case for last name.
Date of birth must be recorded in the short format, in the style recommended
by the NHS Connecting for Health Common User Interface Design Guide9 as
follows:
DD-Mmm-YYYY e.g. 07-Jun-2005
Where DD is the two-digit day
Mmm is the abbreviated month name (e.g. Feb)
YYYY is the four-digit year
Day values less than 10 must appear with a zero in the first position e.g. 08
Month names must be abbreviated to the first three letters
Day, month and year separators must be hyphens
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Priority should be given to the patient name in that they are displayed above
the other identifiers.
First and last name must be clearly differentiated by using lower case letters
for first name (with upper case first letter) and UPPER CASE for last name,
and must be presented in the order: LAST NAME, First name9 e.g.
SMITH, John
There should be enough space to include long names, multiple names and
hyphenated.
Identifiers should be in a font size and style that is easy to read. Avoid italic,
simulated handwriting and ornate typefaces9. Use a common sans-serif
typeface like Arial, Helvetica or Frutiger Roman 11, 13. Use a minimum font size
of between 12 and 14 point (equivalent to a height of 2-2.3mm) 11, 12, 13.
Black text on a white background should be used to ensure the wristband is
clearly legible in reduced lighting conditions (such as wards at night) and by
those with visual impairments 11, 12.
The NHS Number consists of 10 digits the first nine digits constitute the
identifier and the tenth is a check digit that ensures its validity. The format for
display of the NHS Number must be 3 3 4, because this format aids accurate
reading and reduces the risk of transposing digits when information is taken
from a screen14.
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the member of staff applying the wristband and the patient receiving it to
sign the patient record (or a relative or carer where the patient is unable to
do so) to verify that the details are correct;
re-applying wristbands that have been removed for clinical procedures,
taken off for some other purpose, or have fallen off;
updating the information on wristbands and re-applying if there is a need to
amend any of the identifiers, such as when an NHS Number is verified and
the band reprinted with updated information.
establishing correct patient identification prior to any treatment or care and
at handover, such as by asking the patient (where possible) to state their
first name, last name and date of birth, and checking these details against
the wristband and the clinical records.
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19. Where should the patient and member of staff sign to say the
information on the wristband is correct, or that the wristband has been
changed for a specified reason?
The NPSA recommends that casenotes are the most logical place for the
member of staff and the patient to sign that the information on the wristband is
correct, or that the band has been changed for a reason that should be specified
such as when an NHS Number is verified and the band reprinted with updated
information. This is because casenotes (either temporary or permanent) are
available at the point of admission to the hospital, and are usually kept with a
patient as they move through different services.
21. Our trust currently uses red wristbands to identify if a patient has an
allergy. The system has been in place for over 10 years and is recognised
practice, so why should we stop it?
The NPSA believes that it is safest only to use a white wristband with black text
(and only one wristband per patient) so that there is no colour coding. However,
the response to our consultation about the draft Safer Practice Notice showed
that a significant proportion of respondents favoured the use of one colour to
represent particular patient risks. In response to that, the Notice provides for
those who want a colour coding system to identify a known risk to use a red
wristband for patients, with a white panel which will display patient identifiers in
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black text (see also question 15). This would be used instead of the white
wristband, as only one wristband should be worn.
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22. How will staff who move jobs know if their new healthcare organisation
is using a system of a red wristband for known risks?
New staff inductions should include providing information about whether patient
wristbands should be white only, or whether the healthcare organisation is using
a red wristband where there is a known risk. There should still be only one
wristband per patient i.e. the red wristband is not an additional band but
includes the patient identifiers. Staff moving between organisations should always
ensure they are aware of the organisations policies on wristbands before they
provide care to patients.
23. What patient risks should I use red wristbands for?
The NPSA believes that it is safest only to use a white wristband with black text
(and only one wristband per patient) so that there is no colour coding. If a
healthcare organisation wants to use colour coding, the NPSA recommends only
one colour, which is red, to be used for identifying a known risk. The type of risk
will need to be established from the patient record. Where a red wristband is
used to indicate a known patient risk no other wristband will be used, so this
should allow the patient identifiers to be presented in black text on a white panel
on the wristband. If labels are used these must comply with requirement that they
are durable for throughout the patients stay.
24. We currently use green wristbands for patients at risk of falls, how do
we protect these patients now?
Please see the previous questions and answers about colour coding and why the
NPSA believes it is safest only to use a white wristband with black text, but is
providing for those who want a colour coding system to identify a known risk to
use a red wristband for patients, with a white panel which will display patient
identifiers in black text. For guidance on reducing falls by hospital patients, please
see Slips, trips and falls in hospital, February 2007 (pdf) at
www.npsa.nhs.uk/alerts
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Other queries
If you have queries about the Safer Practice Notice which are not answered in
this guidance or in the separate Design Guidance (www.npsa.nhs.uk/alerts)
please send them to spn@npsa.nhs.uk
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Change Record
Date
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31 July 2008.
10th Dec 2008
Author
Version
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23rd March
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