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

Nurses HIPAA

Published

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.

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.

Specializes in orthopedics, ED observation.

doh...

see complete post below. (Hit Post button mid-thought...)

Specializes in orthopedics, ED observation.
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. :twocents: FWIW

Specializes in ICU, PICC Nurse, Nursing Supervisor.

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.

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.

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.

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.

Specializes in Emergency/Trauma/Education.
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

Haven't seen a bracelet yet for isolation patients. Hmm..

We also "band" our pediatric patients with the color that corresponds to their appropriate Broselow color.

Specializes in Emergency & Trauma/Adult ICU.
We also "band" our pediatric patients with the color that corresponds to their appropriate Broselow color.

I'm not too keen on being bracelet-happy and color-coding people for every little thing ... but if you're going to use bracelets ... I like this idea.

I like it for the same reason that I don't have a problem with DNR on a bracelet -- these bracelets become functional in critical, time-dependent situations when seconds could make a difference. If the Broselow cart can be cracked & opened immediately with the step of laying the kiddo next to the Broselow tape already done, all the better.

Not to be rude but...so what? What's wrong with patients making their wishes known to the entire world? I would think that's what the patient wants, that if they were to code in such a manner that required intubation or "heroic measures," they would want the world to know to let them go peacefully without the threat of trauma or lengthening their life with no added quality to it. If those were my wishes and my ability to make this decision while of sound mind were all I had left, and my will and legacy depended on it, I would want everyone to know it, regardless of whether they were part of a health care team or not.

Here in MD we have a bracelet we place on pts. who are being transported to another facility that has written DNR in small lettering along with a legal document that states the same.

One of the more frightening things for my dad (when he was alive) was something happen and he die out on the street and someone would try to resusitate him. He half laughingly talked about getting NCB or DNR tattooed on him.

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.

Well, at our facility the patient's chart goes with the patient for any testing - code status (if DNR or versions of such) are in front of chart when opened. ALso, computer would have status...and most likely if your patient was off floor for ultra sound - and a code blue is called - the RN or charge from our floor would respond to that area.

It's not a perfect system-but it's a huge deal on our floor to know the code status of our patients since we see so many....unfortunately.

I'm not too keen on being bracelet-happy and color-coding people for every little thing ... but if you're going to use bracelets ... I like this idea.

I like it for the same reason that I don't have a problem with DNR on a bracelet -- these bracelets become functional in critical, time-dependent situations when seconds could make a difference. If the Broselow cart can be cracked & opened immediately with the step of laying the kiddo next to the Broselow tape already done, all the better.

Even if we used a bracelet system like this for DNR on our unit we still MUST see the legal document in the chart - with the MD in charge and RNs confirming code status - legally even the DNR in the computer it still must be backed up with signed paper document.....in a court room the color of the patient's bracelet wouldn't hold up.

We had a potential code this week - unpleasant in that not all of the family was comfortable with the DNR status completely and we spent a great deal of time going over the MD notes/DNR to make sure things were all legal- while we worked on patient and family stood outside room -- thanks to our rapid response and interventions short of intubation and drugs needed the patient survived to live another day.

Have you ever seen a code run on a pt that a nurse forgot to put the DNR bracelet on? I have, and the hospital is still in litigation over this. A doctor's order says DNR, and two nurses sign the order and the bracelet, unless the nurse is negligent. This is very sad, and happens all the time.

+ Add a Comment