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.
I'm Australian, and we don't have HIPAA itself, but we do have privacy laws. Due to these laws, we cannot make any indication, even in 'code' like a coloured bracelet, that a patient has decided to become NFR (not for resus). We have the NFR order in the notes and it is handed over each shift so the nurse caring for the patient is aware, but we don't make any other indication.
In regards to the bracelets, even if you don't have DNR on them, what would you say to a family member if they asked you why their mum or dad had this extra blue bracelet on?
Family members should probably directed to the one closest to the patient, who would make that decision about explaining it, if the patient hasn't said they don't want others to know. However, care must be taken now, that lead isn't in the colouring of the bracelet - not that missing an IQ point wouild bother a moribund patient, but many hospital workers have to touch them when identifying the patients, and it would be nice if we retained as much IQ as we can......
DNR is something that belongs in the chart.
Don't feel bad that Australia hasn't got HIPPAA! It's a bad joke here, as the true purpose of the thing, is to trick people into signing permission for medical information to be given to any government agency, insurance company, etc. How it hasn't offended more people, is confounding to me, that our government thinks we're stupid enough (and many of us are) to think patients have to sign something, for someone else to keep their oath of confidentiality that is intrinsic to their profession.
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.
That being the case any arm band displays personal information. Allergy, fall precautions, blood bank, and the id band. We can carry hippa too far.
There are some drawbacks to a DNR arm band but you did not mention any real ones. I am sorry but DNR armbands with DNR written on them are used many places (most place I have worked) I have never run up against any of the problems that you argue.
I did work acute care for 22 years and I am aware that the need exists for some ready access. However:
My mother is 89 years old, has alzheimers and is in a nursing home. I've had a terrible cold and haven't been to see her for 6 days until yesterday.
Clearing out her closet I found her "stash" of found objects (all hers according to her). 3 water pitchers belonging to others. 1 man's hat I have no idea where it came from, but it had her name on it in magic marker, and one name band that had the previous (deceased) resident's name on it. I clean out her closet and chest of drawers every time I go. Now I wonder in the above situation, if she were to "find" a blue band and put it on because it is a pretty color???..... and I do know ECFs are different from acute care.
I did work acute care for 22 years and I am aware that the need exists for some ready access. However:
My mother is 89 years old, has alzheimers and is in a nursing home. I've had a terrible cold and haven't been to see her for 6 days until yesterday.
Clearing out her closet I found her "stash" of found objects (all hers according to her). 3 water pitchers belonging to others. 1 man's hat I have no idea where it came from, but it had her name on it in magic marker, and one name band that had the previous (deceased) resident's name on it. I clean out her closet and chest of drawers every time I go. Now I wonder in the above situation, if she were to "find" a blue band and put it on because it is a pretty color???..... and I do know ECFs are different from acute care.
Your mom sounds like she might be DNR..... Is she? So unless there is another colored bracelet for patients who are to be resuscitated, if she found a band that indicated DNR, no harm done.
Also, I'm an advocate of family conferences with clergy when DNRs have been signed, so even if a few relatives are against it, they've had their say, and know the choice isn't theirs......
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.
It might help, if patients are to be on the same unit for at least 3 - 4 days, if the names of those who are DNR got on a list in the "crash" cart, by the ambou bag and that would warn off anyone who thought they needed CPR. Also if at each shift change, the list was read at report (it can't be that long), staff would become familiar with those names.
I'm not as concerned about privacy (after all, it's the speaking/ sharing of written patients' information that's not allowed), as I am about the unintended breaking of fragile ribs during compressions, of those who perhaps for that reason, want DNR. If the patient survived, and subsequent pain from the broken ribs made their last days intolerable, someone in the family could cry "lawsuit!":uhoh21:
Mama is actually cpr only. No intubation. So for all purposes she's DNR. But she still walks on her own with a rolling walker, plays Bingo etc. keeps track of her hair appts, draws-both pencil and pen and ink. And takes ONE med-a vitamin. But the point is just the bracelet isn't sufficient. Perhaps the admitting band could be blue, thus have the name, unit re. #, adm # etc.
Whenever I have been hospitalized here I always get my bracelet and it's orange (fall precautions).
But at MUSC when I had an ercp, orange was for the GI dept.and fall risk was purple. So everyone would need to be one the same sheet of music.
I guess my main concern is for the dignity of my patients, no matter what their stage of life is. There is something dehumanizing and inpersonal about slapping a bunch of bracelets on people, and then inscribing DNR is kind of like marking a tree in the forest to be cut. It just strikes me as wrong.
Karen, thanks -that was an intersting article - I am going to pass it onto the unit manager here - we use pink bands. They do not indicate code status, but rather that something is different about it, and that you need to check the orders for complete details.
The color should be enough. And even so, it wouldn't be long before the word got out what the color coded band meant. But still the letters DNR would not be there for all the world to see.
lamazeteacher
2,170 Posts
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Family members should probably directed to the one closest to the patient, who would make that decision about explaining it, if the patient hasn't said they don't want others to know. However, care must be taken now, that lead isn't in the colouring of the bracelet - not that missing an IQ point wouild bother a moribund patient, but many hospital workers have to touch them when identifying the patients, and it would be nice if we retained as much IQ as we can......
DNR is something that belongs in the chart.
Don't feel bad that Australia hasn't got HIPPAA! It's a bad joke here, as the true purpose of the thing, is to trick people into signing permission for medical information to be given to any government agency, insurance company, etc. How it hasn't offended more people, is confounding to me, that our government thinks we're stupid enough (and many of us are) to think patients have to sign something, for someone else to keep their oath of confidentiality that is intrinsic to their profession.