DNR bracelet with DNR written on it. HIPAA??? - page 3

by FireStarterRN 20,317 Views | 87 Comments

I was at a committee meeting today. We discussed color coded bracelets that our hospital is considering. One of them is a blue bracelet for DNR patients. It was mentioned that they also want to write 'DNR' on it. I feel... Read More


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    pt will only have a max of 2 braclets
    white = id
    white/red id but the pt has an allergy which is in the notes
    orange= infection mrsa/c.diff being the most common. infection is not named on braclet
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    Quote from jlsRN
    I was at a committee meeting today. We discussed color coded bracelets that our hospital is considering. One of them is a blue bracelet for DNR patients. It was mentioned that they also want to write 'DNR' on it.

    I feel strongly that this is a violation of patient privacy. It advertises to any visitor that the patient has made the decision to be a DNR. I was very vocal about my feelings regarding this. I was the only bedside nurse in the meeting. I think this is basically 'outing' the patient to the world. Many members of the public know what DNR means. It can cause dissension between family members, it can cause people with more extreme views regarding extension of life to make trouble for decision making family members, and it's making visable to any visitor the private information of the patient.

    I feel strongly that a blue bracelet should suffice to communicate with members of the healthcare team and that adding DNR to the bracelet is wrong.

    Any imput on this would be appreciated.
    Confidentiality expires with the patient.

    If the patient (or their MPOA) want to be certain that when the patient codes no one misses that the patient is not to be resuscitated, then why not put it on the band so there is no question? Fewer mistakes would be made if the indicators were clearer. After all, we list allergies on the allergy band don't we, pretty much for the same reason? So no one makes a mistake that can cause bad things to happen?

    I'm for being clear about things. We put patients' names on their doors, we talk on the phone in the nurses' station and can be heard--there are limits to confidentiality, and one good one is the benefit of the patient.
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    I'm not sure if I was clear in my post. I'm not against the bracelet, but I think putting DNR on the bracelet is going too far. If the employees of the hospital are not able to learn that blue means 'no code' then they are probably not qualified to start a code.

    Putting DNR on the bracelet is also broadcasting the patient's code status decision to visitors.
  4. 0
    Quote from chris_at_lucas_RN
    If the patient (or their MPOA) want to be certain that when the patient codes no one misses that the patient is not to be resuscitated, then why not put it on the band so there is no question? Fewer mistakes would be made if the indicators were clearer. After all, we list allergies on the allergy band don't we, pretty much for the same reason? So no one makes a mistake that can cause bad things to happen?

    I'm for being clear about things. We put patients' names on their doors, we talk on the phone in the nurses' station and can be heard--there are limits to confidentiality, and one good one is the benefit of the patient.
    Quote from jlsRN
    Putting DNR on the bracelet is also broadcasting the patient's code status decision to visitors.
    I had mixed feelings about this as I read through the thread, but then these 2 posts crystalized it for me.

    In HIPAA theory, a hospitalized patient would have visitors who may know nothing about the patient's condition other than what the patient tells them. In the real world, this simply is not the case. Visitors to a hospital room see the patient in bed, see bedside monitors, see IV fluids, meds, and blood running ... even a lay person can gather a great deal of information just by being in the room for 2 minutes. I accept that unless we are going to ban hospital visitors, with great negative consequences for patients, we cannot absolutely maintain as private all details of a patient's condition.

    If your family member is sick at home, don't you know whether he/she is coughing, vomiting, etc.? Don't even lay people draw some conclusions from just observing those symptoms?

    A patient who has made some advance decisions about his/her end of life care has hopefully done so after careful thought and/or appropriate discussions with physician(s), nurse(s), family and/or spiritual adviser. To mistakenly violate those wishes because of confusion about whether or not someone has a DNR order is, IMO, a far bigger violation of a person's right to self-determination than anything covered by HIPAA.
  5. 0
    Quote from Kunzieo
    This is NOT a HIPAA violation...(think of I/O sheets, lab-draw sheets, charge sheets, etc that hang in the room...legally, it's akin to that.)
    However, ethically...it's stupid to write DNR on the bracelet. I agree with the OP, the colored band is appropriate and sufficient.
    NONE of these things should be visibly posted ANYWHERE someone else could see them INCLUDING a patient room!! It most definately is a HIPPA violation! Nothing with the pt's status, name or anything should be visible. I think whomever delas with compliance in your facility should be getting on the bandwagon asap and educating staff and updating P&Ps.
  6. 0
    doh...

    see complete post below. (Hit Post button mid-thought...)
    Last edit by MNmom3boys on Nov 29, '07
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    Quote from jlsRN
    If the employees of the hospital are not able to learn that blue means 'no code' then they are probably not qualified to start a code.
    Agreed, and blue is pretty intuitive. (Code blue, et al)

    However, what about confusion for travelers, new hires, nurses working for two (or more) healthcare systems, etc. that may be used to a different color "system" ie the yellow bracelet discussed earlier in the thread. I'm not saying they can't learn, I'm concerned that their inital "move now" (or not) response may be slowed down because they are looking for a different color. FWIW
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    this is a hipaa violation ..everything you have mentioned here is in violation of confidentiality. anyone can walk in these rooms and get information if they are just left hanging around. not to long ago anything that had the patients name on it had to come down at my job including the names outside the door, names on the outside of the charts and anything else that could identify a patient.




    Quote from kunzieo
    this is not a hipaa violation...(think of i/o sheets, lab-draw sheets, charge sheets, etc that hang in the room...legally, it's akin to that.)
    however, ethically...it's stupid to write dnr on the bracelet. i agree with the op, the colored band is appropriate and sufficient.
  9. 0
    Quote from YellowFinchFan
    But it wouldn't be up to the 'passerby' in the room to make the actual call that this patient is a code or no code.

    The passerby would alert someone (RN/nursingasst....anyone healthcare related in the area) that something's wrong. I've seen t his happen many times (family.visitor,security guard even) We all know the code status of our patient's, charge RN knows it...and we refer to chart/computer also for written comfirmation.

    Your bracelet thing is interesting (the diff colors and punches) but what if someone makes a mistake (it happens) I still wouldn't rely on a name band only to call a code or not....I'm sure you don't probably.

    We have the chart in the room/the computer up...all references to CODE status wishes known to MDs/RNs.

    I do think it's a Hippa violation to put DNR written on nameband. We aren't even allowed to post signs in room (I&O's) Fall risk sheets in the 'open' everything has to be covered up...hippa etc.......
    You have a good point that it isn't up to the passer by, we should all know the pt's code status... but what about when the patient is off the floor for say an xray or something, a bracelet would be good in this instance for someone who doesn't know the patient well, or sees numerous pt's over the course of the day.
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    When and if a pt goes bad, there often is not the time to discern color codes, you absolutely have to know, without a doubt, what this pt's wishes are. We do use a blue bracelet, with DNR or No Code written on it, with two nurse's signatures next to it, in order to ascertain without a doubt what the Dr.'s order, and the pt and or family's wishes were. I have attended many codes, and they happen quickly, and not all staff are that well versed in the meaning of bracelet colors, and when a code is called, many people come quickly. This is not a HIPPA violation as far as I am concerned, it is ensuring the pt will not suffer undo trauma in the event of death. What would be more tragic, and I have seen this, is the uncertainty of the pt's code status, and the family is devastated when their family member has broken ribs, and brain damage, due to people with adrenaline rushes NOT checking what the bracelets had written on them. In that event, the family is left to make choices they did not want to have to deal with.
    Scrubby and Altra like this.


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