DNR bracelet with DNR written on it. HIPAA???

[FireStarterRN]

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.

[jmgrn65, RN]

as far as a hippa violation I am not so sure that it is, heck they have a bracelet on them with their name, acct number, doctor and dob. I do think it is important to know easily if a patient is dnr or not. But not sure what the answer is, we don't bracelets on. But we do if they are a fall risk, and one for allergy so the poor patient can have 3 bracelets on.

[mauxtav8r]

Just a note . . . people aren't dumb. They will figure out what all those mysterious bracelets and colors are about. They know because THEY get hospitalized or they just plain ask. Either apply the bracelet or don't. Writing DNR on it won't make any difference. They are already "out" (as the respected poster from Australia observed).

[YellowFinchFan]

The facility I work at, we use yellow DNR bracelets. On the bracelet, there are three types, DNR, DNR-CC and DNR-CCA. We are to use a hole puncher to punch out which one applies, and then apply to the pt. What would happen if someone that is might not be partaking in that patients care happens to witness them code... a blank bracelet may not make them aware of what their code status is and begin coding the person.

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.......

[Katnip, RN]

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.......

If the passerby is an employee then they would start the code and while calling for help. I would hope so, anyway. And even housekeeping can initiate CPR until help arrives, so yes, it would be important for them to know code status.

I've seen codes started by a nurse walking into a patient's room that wasn't hers only to find out the patient was a DNR because there's no time to go running looking for a chart or finding the regular nurse to ask. Same with PT or OT. They two can call for help and start CPR when they're with a patient and won't necessarily know the code status. Or transport. They know CPR too, and they don't usually have access to charts.

[rita359]

What you are intending to do is communicate to health care workers that the patient is a DNR. Its all well and good if DNR is not written of the band and the patient codes on your unit. What if they go to xray or some other department . It is true that all employees SHOULD know what the bands are but it would sure be a lot easier if it were written on the band. I think it is a need to know thing and if a patient is coding I don't want to be looking at an arm and have any question about whether the patient is to be coded or not. As far as I&O sheets go I'm sure glad the hospital where my mother was hospitalized had her I&O sheet hung up. The nurses sure did not catch that she had no output for a whole shift with a fc and lasix ordered q8h.

[purple_rose_3]

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.)

We don't have any sheets of that nature hanging in our rooms for people to see!!

[classicdame, MSN, EdD]

we cut out all those colored bracelets. Too confusing and expensive and they get in the way. It is up to the appropriate staff to know about allergies and DNR orders, etc. This info is in patient chart and given in report and when handing off patient to another person (transport, etc) on an "as needed basis". But as to privacy, it is up to the patient at all times. So if they don't mind why should you? What about people who wear jewelry identifying them as diabetics or heart patient or with severe allergies?

[MNmom3boys]

The facility that I am at uses green bracelets for fall risk, along w/ ID bracelet and red drug allergy bracelet. How long before we 1)run out of arm space and or colors or 2) (and this I actually am concerned about-) someone forgets which color signifies what?

I know privacy is important, but if they have made the effort to make a decision and declare a DNR status it needs to be clearly marked somewhere what their wishes are. (Charts are not always accessible and/or w/ patient.)

[ayla2004, ASN, RN]

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

[chris_at_lucas_RN, RN]

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.

[FireStarterRN, BSN, RN]

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.

[Altra, BSN, 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.

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.