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.

[kukukajoo, LPN]

Maintaining patient charts at bedside or outside of exam rooms, displaying patient names on the outside of patient charts, or displaying patient care signs (e.g., “high fall risk” or “diabetic diet”) at patient bedside or at the doors of hospital rooms.

Possible safeguards may include: reasonably limiting access to these areas, ensuring that the area is supervised, escorting non-employees in the area, or placing patient charts in their holders with identifying information facing the wall or otherwise covered, rather than having health information about the patient visible to anyone who walks by.

The above examples of possible safeguards are not intended to be exclusive. Covered entities may engage in any practice that reasonably safeguards protected health information to limit incidental uses and disclosures.

[firstaiddave908]

Thats a great idea to have a color coded band that states a pt is a DNR. the points that are made on this posting is great.

[tddowney]

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.)

Exactly. The Pt's choice has to be communicated to those that could follow/not follow it.

In the magic world inhabited by lawyers and commissions, every caregiver can remember the code status of Pts with perfect accuracy, along with their fall risk, allergies, which arm has a new, immature AV fistula, etc.

For a nurse on the floor, with 5 Pts that change every shift, such a world is laughable.

[RNperdiem, RN]

The whole job of that colored armband is to communicate. You should be able to randomly show that band to any employee and ask "what does this mean?"

If there is any confusion, and there often is everytime a new protocol rolls around with it's different colored armbands, symbols, then is fails as a communication tool.

I think I'll just have DNR tatooed on my chest when that time comes.

[rnmi2004]

Why not explain to the patient (or person making the decision on code status) the rationale behind the color coding & let them decide?

Some people may be uncomfortable with the idea that a discreet identifier on their name tag may be recognized by visitors. Others may say to heck with it, it's my choice & I don't want to chance that a staff member without immediate access to the chart may initiate CPR.

[woody436]

Isn't the same thing done with allergy bands? What's the difference?

[GreenCCURN]

We use a color coded bracelet at the facility that I work at, but we don't write anything on it. I think that a color should be enough, everyone knows what it means.

[SANDRA RN]

I think its a great idea. we have arm bands for allergies, fall risks and one to alert the nurse if pt needs a flu or pneumonia vaccine, but to know if the pt is a dnr you have to find the chart then find the order.

Having dnr written on the armband shouldn't be anymore of a hippa violation than having their name and medical record number on one.

[Virgo_RN, BSN, RN]

I think a color coded armband is a good idea, but what about limited code status? Also, isn't the code status of each assigned patient something a nurse should make a point of knowing at the beginning of the shift?

[SANDRA RN]

In the ICU I know the code status of my patients, but when census is low or the unit is closed, we are often asked to float to med-surg. If I walk into a patient's room on the med-surg floor and find them not breathing, it would be helpful to be able to tell immediately if the patient is a DNR or not.

[Pat_Pat RN]

Why couldn't the code status be placed on the patients ID bracelet? Everything on there is "protected" is it not?

We put red bracelets on patients who are or may receive blood, it has numbers to match them to the units they are matched to. Is this a violation?

[elthia]

Why couldn't the code status be placed on the patients ID bracelet? Everything on there is "protected" is it not?

We put red bracelets on patients who are or may receive blood, it has numbers to match them to the units they are matched to. Is this a violation?

http://www.hhs.gov/hipaafaq/administrative/200.html

For example, the Privacy Rule does not prohibit covered entities from engaging in the following practices, where reasonable precautions have been taken to protect an individual’s privacy:

Maintaining patient charts at bedside or outside of exam rooms, displaying patient names on the outside of patient charts, or displaying patient care signs (e.g., “high fall risk” or “diabetic diet”) at patient bedside or at the doors of hospital rooms.

HIPAA allows us to display pt care signs at the doorway. So a hospital could probably post a discreet DNR sign at the door or the head of the bed...so I am pretty sure a DNR armband is definitely NOT violating HIPAA.