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Band for life – a quest to standardise wristbands to improve patient safety

The UK’s watchdog for patients – the National Patient Safety Agency – has produced a set of guidelines which, if followed, will ensure that the patient is matched to the care intended for them and so reduce errors of treatment

Chris Ranger
Partnership development manager,
National Patient Safety Agency, UK

Errors in identifying patients accurately and matching them with care intended for them contribute to patient safety incidents in hospitals and can cause serious harm and patient deaths.
Wristbands which meet the UK’s National Patient Safety Agency (NPSA) recommendations and related guidance from other organisations are crucial to greatly reducing incidents caused by misidentification of patients.
The use of new technologies in wristbands also helps to avoid patient safety incidents, such as the administration of the wrong blood or medication. The suite of tools issued by the NPSA and other organisations is described here and the role they can play in the National Health Service (NHS) to make healthcare safer.
The NPSA was set up as a special health authority in England and Wales in July 2001 with the remit of reducing risks to patients receiving NHS care and improving patient safety. The impetus for the NPSA was an expert group chaired by Sir Liam Donaldson, the Chief Medical Officer, in 2000, which established that adverse events occurred in around ten per cent of NHS admissions or at a rate of about 850,000 patient safety incidents a year[1]. Around half of those incidents were preventable.

Patient identifiers
The expert group knew anecdotally that one factor contributing to patient safety incidents was misidentifying patients and mismatching them with the care intended for them. The NPSA’s Reporting and Learning System (RLS), through which the NHS reports patient safety incidents in healthcare, has given figures for such incidents. For the 12-month period February 2006 to January 2007, the NPSA received 24,382 reports of patients being mismatched to their care, of which more than 2,900 (12%) related to wristbands and their use. To ensure better matching of patients with care, it is vital that hospital inpatients wear wristbands which conform to NPSA recommendations, which include appropriate patient identifiers.
Technology is increasingly recognised as having an important role to play in safer – and more efficient – patient care. Some NHS organisations are using machine-readable barcodes on the wristband or a radio tag in the wristband to provide information about the patients and their care.
Thus, the advent of new technologies for matching patients with care does not make the wristband redundant, but in fact enhances its role and makes it increasingly important that wristbands with standardised and correct details are worn by all hospital inpatients.

Suite of tools
Six pieces of guidance make up the suite of tools for the NHS on patient wristbands and the use of technology to make patient care safer. Three are NPSA products and the other three are produced by other organisations, based on work by the NPSA or with NPSA support. On some of these projects the NPSA has worked jointly with NHS Connecting for Health and Informing Healthcare.

1. NPSA: Wristbands for hospital inpatients improves safety. November 2005

The NPSA issued this Safer Practice Notice (SPN) which recommended that all NHS organisations in England and Wales should have in place local policies that helped to ensure inpatients did wear wristbands, that the details on them were correct, that staff were appropriately trained and that there was ongoing monitoring and review of the procedures for this.
The SPN also said that alternative measures that were formally risk-assessed should be developed for those for whom wristbands were not possible or practical, such as pre-term babies, patients with certain skin conditions and those who might find wristbands unacceptable, such as patients with learning disabilities.

2. NPSA: Standardising wristbands
improves patient safety. July 2007
Following the issue of the 2005 SPN, it was clear that patient safety incidents related to misidentifying patients and mismatching them with care were being made more likely by lack of standardisation of wristbands across healthcare organisations. Patient identifiers, colour coding used for allergies and other patient risks, and the processes used to produce wristbands and check details with the patient varied greatly between healthcare organisations. Another concern was the NHS’s limited adoption of technologies with the potential to make patient identification safer.
The NPSA issued a second SPN on wristbands which sought to standardise wristbands so that any member of staff working in the NHS would know what information to expect on a patient wristband and where to find it. The core patient identifiers – which are last name, first name, date of birth and NHS Number – should all be on a wristband. Any other identifiers deemed necessary should be risk assessed before their inclusion. The recommendation is backed up with design requirements for wristbands.[2]
The SPN emphasises the need for clear and consistent processes for producing, applying and checking wristbands, and the colour of wristbands – they should be white with black text. Where a healthcare organisation feels they must use colour to identify a patient risk, the wristband should be red with black patient identifiers. The NPSA advised relevant NHS organisations to implement these recommendations by 18 July 2008.
The SPN also required all NHS organisations in England and Wales that used patient wristbands to generate and print these from the hospital demographic system – such as the Patient Administration System (PAS) – and next to the patient so that details could be checked with the patient.
Wristbands must not be printed before patients arrive in hospital, as that would increase the risk of wristbands getting mixed up or wrongly allocated. Healthcare organisations were given one year longer to implement this particular recommendation and action should have been completed by 18 July 2009.

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3. NPSA: Risk to patient safety of not using the NHS Number as the national identifier for all patients. September 2008
The NHS Number is a recommended core identifier for the patient wristband. The NPSA, in conjunction with NHS Connecting for Health and Informing Healthcare, produced an SPN which strongly recommended that the NHS Number should be used as the national patient identifier for all patients.
The recommendations specified that:

  • The NHS Number, and its bar-coded equivalent, should be used in/on all correspondence, notes, patient wristbands and patient care systems to support accuracy in identifying patients and linking records.
  • The NHS should put processes in place to ensure that patients can know their own NHS Number and are encouraged to make a note of it.
  • Primary care organisations should inform patients about their NHS Number in writing whenever they register as a new patient.

The deadline for implementation of the recommendations was 18 September 2009.

4. Information Standards Board (ISB) – mandatory standard for the NHS in England. Data Set Change Notice 04/2009
The NPSA and NHS Connecting for Health worked together to develop this mandatory standard for the NHS in England which was approved by the Information Standards Board in March 2009. The standard specifies that the four identifiers set out in the SPN ‘Standardising wristbands improves patient safety’ (and related design and formatting requirements) must be used on NHS patient wristbands, so that identity information is clear and unambiguous.
The ISB requires suppliers to the NHS to conform with the standard from 31 December 2010. The standard will ensure that identifiers are printed consistently and clearly, hence supporting safe clinical practice. The standard means that the NHS will need to update those computer systems that do not yet print wristbands in the recommended format.

5. GS1 UK – Guidelines for Automatic Identification and Data Capture for Patient Identification on the wristband.
December 2008
This document was developed, with support from the NPSA, to help hospitals and solution providers to implement the use of automatic identification and data capture (AIDC) techniques such as bar-coding on the patient wristband for safe and certain patient identification. The suggested guidelines were based on the core identifiers required by the NPSA to be printed on the wristband in human readable form and were intended to support the early implementations of patient identification using AIDC.

6. Information Standards Board – Advance Notification: AIDC – Bar Code for Patient Identifiers on the Identity Band.
October 2009
This is the ISB’s advance notification of approval of a requirement for a new information standard. The proposed standard defines the procedures necessary to bar-code patient identifiers on the wristband in all healthcare settings where patients wear wristbands.
This standard also applies to IT system suppliers who develop and implement systems that result in the production of a patient wristband. Subject to the approval of the full standard by the ISB, NHS organisations and those organisations delivering NHS commissioned services deploying bar coding systems for patient identifiers on the identity band will be expected to comply with the standard by 1 July 2011.

Ongoing compliance
The NHS now has a suite of tools available on wristbanding, to help eliminate or greatly reduce errors in identifying patients and giving them the right care. These tools also address the wider use of electronic patient identification systems, based on barcoding and RFID technologies in patient wristbands. For greater patient safety, the NHS needs to ensure ongoing compliance with the wristband recommendations and wider and faster adoption of electronic patient identification systems.

1. An Organisation with a Memory, Department of Health, 2000.
2. National Patient Safety Agency. Your guide to implementing standard wristbands, 2007;