Thursday, September 25, 2008

Check my bracelet, please

From today's NY Times:
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, while 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 D.N.R.

"Good morning Ms Smith. I'm Dr Buckeye and your internist wanted me to see you regarding some abdominal pain you've been having.."
"Well hello Dr Buckeye. Ive been waiting breathlessly for you. Breathlessly."
"Um... ok. Before we begin, I can't help but notice that you have hundreds of little plastic bands around both your arms."
"Oh these? These are my color coded hospital wristbands that will hopefully reduce the risk of me suffering from some medical error that you guys are notorious for."
"Oh. Interesting. I see this red one indicates a penicillin allergy, but I must say, I don't recognize most of the others. I didn't realize there were so many designations."
"It's a new thing. And I'm very specific in my desires and goals. You can't be too careful when you're in a hospital. Did you realize that medical errors are the seventh leading cause of death in this country?"
"Um, that's not true, actually.."
"For instance, this mauve one indicates that I'm a germophobe. You're going to have to put on that body suit and airtight helmet before you touch me."
"That looks very hot and uncomfortable."
"Oh it is. And this periwinkle band means I have a sensitive rectum so they need to change the toilet paper to triple ply Charmin and make sure the bedside commode has a padded seat. Speaking of accomodations, this plaid band means I have allergies to most fabrics and textiles; all my hospital gowns have to be from either the 2008 or 2006 Vera Wang line."
"Not 2007?"
"God no. Those are embarassing. I can't stand tackiness. Along those lines, this checkered black and white band requires someone to adjust my television set so that there is no chance of the channel alighting upon a NASCAR race. And this Aquamarine band reminds the nurses to play Barbra Streisand continuously as a soothing background music. Achooo!!!"
"Opsy, looks you didn't see the burnt siena band; indicating to you that I prefer 'God Bless you' when I sneeze."
"God bless you then."
"Thank you. And make sure you note the red, white, and blue band. That will remind you to write an order for an American flag to be unfurled every morning at 7 so I can recite the Pledge of Allegiance. Wait a second, what are you doing?"
"I was just going to listen to your lungs."
"Is that stethoscope pre-warmed?"
"Obviously you didn't see the Navy wristband. Cold stethoscopes against my skin give me the Willies. And the yellow ochre band reminds the maintenance people to keep my ambient room temperature between 72-75 degrees fahrenheit. Ow! Why are you touching me there?"
"I was just examining your abdomen."
"Well someone wasn't paying attention to this wristband right here."
"It's a crude drawing of a human body., What am I supposed to do with that?"
"Duh. It's supposed to remind you to review my chart before examining me so you know where my trigger points are from my fibromyalgia."
"I see. What about this green one?"
"That's hunter green. It signifies that I'm environmentally conscious. All paper products that are used on me have to be recycled."
"And why does this one have a picture of Colonel Sanders on it?"
"I'm allergic to fast food and anything made in a hospital. People with this wristband are supposed to get a special diet delivered from the higest rated (per Zagat's) Italian trattoria within ten miles of the hospital. My baked ziti is supposed to be here any minute, by the way"
"Sounds delicious. What about this purplish one with a broken wedding band on it?"
"That's Han blue, actually. And it's a warning to keep any doctors away who look anything at all like my cheating, good for nothing ex-husband. 6'2", salt and pepper hair, wonderful moustache, a tendency to rub his chin when he's thinking..."
"Fortunately I'm quite short. And sans facial hair."
"And the carmine bracelet, which is right next to the Han blue, is a warning that I'm at extremely high risk for breaking down and crying for hours at a time if any hospital personnel resembling my ex's secretary enter my room; young, blonde, perfect calves...."
"Um, what about the one with the giant eyeball."
"That just means I've had hidden cameras installed in every corner of the room. My people are watching your every move, even as we speak."
"Terrific. What about this one around your ankle? It appears to be filled with pentagrams and other symbols of demonology."
"Oh. You're weren't supposed to see that one. That's why I keep it under the covers. It has my attorney's phone number written in Wiccan so only I can read it. You know, just in case any of those "never events" I read about happen to me."
"How convenient. Fortunately it doesn't appear that you have appendicitis. I guess I'll be seeing you. Good luck with everything."
"Thank you Dr Buckeye. Make sure you take off that body suit before you leave."


Anonymous said...

"and my highlighter yellow bracelet indicates my incredulity at the status quo's resistance to common sense safety measures"

"oh and this one transparent one? that would remind my doctors to remember Semmelweis and compulsively protect me from undue harm from preventable sources"

HudsonMD said...

That had better be one of my High-Reimbursing Kaiser patients. I just might have to "Make Rounds From The Door". You know: "Pt seen. NAD. Heart Regular. Lungs Non-Labored. Continue current management."

Jeffrey Parks MD FACS said...

Anon- As the NY Times article implies, color coded wristbands can actually be very confusing and can paradoxically compromise patient safety, rather than improve it. And my post was meant to be a satire of that. But thanks for stopping by. I agree with your sentiments regarding the obligation of a physican to protect his/her patients.

Bongi said...

reading this post i realised you could probably summon up your lawyer by drawing a pentagram on the floor and chanting. i'm sure black candles help as well as a living sacrifice.

Lorelei Armstrong said...

And a gray bracelet indicates the staff member is colorblind?

Bianca Castafiore? said...

It is striking how much this post, purportedly about the silliness of the "hospital....movement" to color code wristbands to the nth degree of meaninglessness, sways under the weight of considerable latent anger... toward the patient.
The standardization movement targets medical errors and that, I suppose, brings to mind how much dislike there is of... the patient? Or are you thinking of the legal twit undoubtedly lurking in the background, anxious to sue as soon as his client is injured? It's really hard to discern with any clarity who you so want to vilify... the patient, the invisible-yet-tangible attorney, or... what was that other thing? Oh, yes: the color-coded armbands that lead to more confusion than error prevention. Title this baby "Latent Anger." I thoroughly enjoy your blog, by the way! Please note that nowhere do I say you're not *entitled*...

Jeffrey Parks MD FACS said...

Bianca- Ha! Maybe you're right. As soon as I score a gig writing for the New Yorker my editor will be able to keep me on the right track. Anyway, I agree; not one of my more coherent posts, rushed it together in the office. Just an amateur satirist here.

But no Latent Anger. I'm a pretty happy guy.

Anonymous said...

I mostly notice those armbands when we're cutting them off trying to get lines started. My hospital has already re-named code blue and code red anyway. So far they have a fairly rational approach to allergies and DNR status, though: a uniform location in the chart and on the computer that every sentient member of the staff knows to look at if the question arises. I suppose that would be too low-key for the NY hospitals.

DrB said...

Being a hand surgeon... in New York... my favorite is when the kind nurses put these little flags on the hand which I am about to do surgery. Then, we have to go through the rigmarole of taking them off, and reapplying them on the other wrist. (This always takes much longer than it ever should.)