In the Viewpoint column in the March issue of AJN, a staff nurse at an oncology center argues that we can improve our use of color-coded wristbands to communicate patient DNR status. There’s also a short podcast interview with the author below, in which she explains that her motivation for writing this article was “a near-miss” on her unit several years ago.
A lot of attention has been paid lately to the reasons why clinicians don’t follow end-of-life preferences in advance directives. Overaggressive care by some physicians is one reason, as is the vagueness of the language used in advance directives to express treatment preferences.
Another major reason advance directives are ignored is lack of immediate access to a patient’s end-of-life preferences at critical moments, such as during a code. This month’s Viewpoint column, “Communicating Patient DNR Status Using Color-Coded Wristbands,” is by Blima Marcus, a doctoral student at the Hunter-Bellevue School of Nursing in New York City as well as an RN at the NYU Langone–Perlmutter Cancer Center. Marcus points out that a “patient’s choice of do-not-resuscitate (DNR) status is a major one, and communicating this status in the hospital is often the responsibility of nurses.”
However, she argues, paper and/or electronic chart documentation of patient end-of-life preferences isn’t always adequate, given clinical realities, and can leave “communication gaps that can lead to wrongful resuscitations and mistaken fatalities.”
Color-coded wristbands are, of course, increasingly used in hospitals as a more immediate form of bedside code status identifier. But the practice is not universal, their color scheme is not always uniform, and there are still objections to their use because of patient privacy and quality of care concerns. For a fuller picture of barriers to effective use of color-coded wristbands, what nurses can do to remedy this, and why it matters, read the short column, which is free.
(The accompanying podcast embedded above is a brief and engaging conversation with Marcus conducted by Amanda Anderson, a critical care nurse and, like Marcus, a graduate student at Hunter-Bellevue School of Nursing. Anderson is currently doing a graduate placement at AJN.)
—Jacob Molyneux, AJN senior editor