Standardized Wristband Learning Activity

Submitter Information

Author: Gail Armstrong, ND, RN
Title: Assistant Professor
Institution: University of Colorado Denver College of Nursing
Email: gail.armstrong@ucdenver.edu

Competency Category(s)
Safety

Learner Level(s)
Pre-Licensure ADN/Diploma, Pre-Licensure BSN

Learner Setting(s)
Clinical Setting

Strategy Type
Case Studies

Learning Objectives

    • Demonstrate effective use of technology and standardized practices that support safety and quality.
    • Value the contributions of standardization/reliability to safety.
    • Participate appropriately in analyzing errors and designing system improvements.
    • Value vigilance and monitoring (even of own performance of care activities) by patients, families and other members of the health care team.
    • Value relationship between national safety campaigns and implementation in local practices and practice settings

    Strategy Overview

    This learning activity works very well in an earlier clinical course in a pre-licensure curriculum. Faculty at Colorado have found this activity fits best in Med/Surg I (which includes a 96 hour acute care rotation), because hospitals have been the most common implementation sites for the Colorado Hospital Association (CHA) Wristband Standardization Project.
    Before I assign this learning activity in the clinical setting, I review the Colorado Hospital Association Wristband Standardization Project with the class. The Colorado Hospital Association powerpoint file that outlines this project is attached. This powerpoint reviews the national trends around wristband standardization and provides a context for the determination of each color assignment in Colorado.
    Once students have reviewed the context of the Colorado Wristband Standardization Project, I give them the following assignment:
    During your clinical rotation, identify 20 patients that you will study closely to see the staff’s adherence to using the guidelines provided in the Colorado Wristband Standardization Project. Remember that whenever we collect data on any patients, this information must be absolutely free of any patient identifiers. The best way to organize your data is to label each patient by a number (Patient #1, Patient #2). Complete the following data mining on each patient:
    1. Determine for each of these 10 patients, the patient’s: Allergy status, DNR status, Fall risk assessment, Latex allergy, Restricted Extremity status.
    2. After determining the patient’s status for these five categories, check to see if the patient is wearing the correct wristband to reflect the status of each category. If a category is not known, figure out when this information is usually collected (with the admission database?). See if you can ask the patient for this missing information.
    3. Using your 20 patients as your sample, determine overall adherence to the recommendations of the Colorado Standardized Wristband Project on this unit. (E.g. Out of 100 categories [5 categories X 20 patients] there was a 95% adherence rate).
    4. Look for patterns around missing wristbands: Were there recurring staff names when information or a wristband was missing? Do you have a sense that your facility is still in the “education” mode around implementing this project? How thoroughly do you think the staff understand the recommendations? Is changing the color of a wristband a challenge for some staff (e.g. “We used to use blue wristbands for DNR, but now we have to use purple”) Is the missing wristband connected to a change in status during a hospitalization (e.g. a patient becomes less mobile while hospitalized, and his fall risk increases, or a patient changes his DNR status, or a restricted extremity is a result of a surgery) How is this change in status documented?
    5. Interview 5 patients who are wearing at least one colored wristband, and ask each what he/she understands about his/her wristband(s). If this patient understands the significance of the color, ask each how he/she believes the wristband has impacted the care they have received. If the patient has been educated about the wristband, ask the patient when this education occurred, If one of your patients who is wearing one or more colored wristbands is confused or is experiencing altered level of consciousness, feel free to interview a family member who has been present to this individual’s care.
    6. Write a paragraph noting your observations about the benefits that you observed from adherence to the recommended wristband colors. Did you detect any member of the health care team adjusting an aspect of care because of noticing a wristband on a patient? Have you noticed any improved communication among team members because of this standardization? Did you identify any unintended consequences from this project? What would you identify as the biggest asset of the Colorado Wristband Standardization Project?

    Submitted Materials

    87.WristbandLearning.ppt

    Additional Materials

    Evaluation Description

    Possible total points: 100

    Tracking of 20 patients, with deidentified patient data: 20 points

    Analysis of adherence to project recommendations: 20 points

    Analysis of missing wristbands: 20 points

    Write-up of patient perspective on project: 20 points

    Student’s insight’s about project’s benefits: 20 points