Washington Hospitals Set New Standard in Patient Safety: Consistent Practices Reduce Human Error

SEATTLE - Nurses and doctors often make split-second decisions to save a patient's life. What if something as simple and preventable as the wrong color wristband or a confusing emergency code call led them to make the wrong decision? Washington's hospitals are implementing standard systems to minimize the possibility of human error and stop preventable mistakes in their tracks.

"Washington State hospitals are dedicated to providing safe care, and we want to remove variations that have the potential to result in harm to patients," said Carol Wagner, vice president for patient safety at the Washington State Hospital Association. "With many physicians and staff working in multiple hospitals, making sure all hospitals use the same emergency code calls, isolation precautions, surgical checklists, and wrist bands, is a powerful tool for preventing dangerous mistakes."

Emergency Code Calls

Code calls are used to summon immediate assistance in case of an emergency. "When we surveyed hospitals across the state, we were surprised to discover at least eight different codes were used to call for help when a patient's heart stopped. Harm could occur if staff who work in multiple hospitals us another hospital's terminology to call for help. Clearly, this was variation we had to eliminate," said Wagner.

"When someone calls a ‘code blue' for a patient going into cardiac arrest, it is vital that the crash team and not the security guards race to the patient's room," said Dr. Larry Schecter, chief medical officer at Providence Regional Medical Center in Everett. "A missing child is an exceptionally rare, but very dangerous situation - all hospitals need to know that when ‘Amber Alert' is called, each and every staff person must be on the lookout for anyone leaving the hospital with a child."

Isolation Precautions

Currently, hospitals use a variety of different signs and colors on patient room doors to indicate the necessary precautions for a patient with a contagious disease. The Centers for Disease Control and Prevention identifies isolation precautions as one of the most important strategies for reducing the spread of Methicillin-resistant Staphylococcus aureus and other infections.

Washington hospitals are adopting standardized isolation precaution signs and corresponding patient education sheets. "Our new signs convey specific actions health care workers, family, and visitors should take to keep patients safe and prevent the spread of infection," said Marion Ray, director of infection prevention and control/employee health of the Franciscan Health System in Tacoma. The hospital association has also developed education sheets for patients, families, and visitors to accompany the signs. MultiCare Health System is translating the educational materials into five different languages.

"The work Washington hospitals have done to standardize isolation precaution signage is pioneering," said Dr. Arjun Srinivasan of the Centers for Disease Control and Prevention. "Implementing this change will help protect patients from the spread of infection."

Surgical Checklist

All Washington hospitals conduct a "time out" before starting surgery and have implemented some form of a surgical checklist, however, these efforts have varied from hospital to hospital. To ensure that every patient gets the proper care with each surgery, hospitals worldwide are encouraged to adopt a surgical safety checklist initiated by the World Health Organization and endorsed by the Institute for Healthcare Improvement. The hospital association is participating in a collaborative effort with the Surgical Clinical Outcomes Assessment Program to implement a checklist that optimizes safe surgery in Washington State. The checklist will ensure that surgical teams double-check important details, which will significantly increase patient safety, reduce medical errors, and streamline surgical procedures.


Some hospitals use color coded wristbands on patients to communicate important information about their condition, such as risk of falls or allergies, but the colors are not standardized. Hospitals and health care providers across the country got a wake-up call in 2005 when a nurse in Pennsylvania incorrectly placed a yellow "do not resuscitate" wristband on a patient who later had a heart attack. The nurse worked in two hospitals and at the other hospital, a yellow wristband signified "restricted extremity," meaning the arm should not be used for intravenous access. Fortunately, another nurse caught the mistake in time to resuscitate the patient. To avoid a similar error, Washington State has adopted three standard wristband colors: purple for do not resuscitate, red for allergies, and yellow for fall risk.

The hospital association's board of trustees has asked all hospitals to implement the new standards by October 2009. Many hospitals are already changing their procedures and educating staff, patients, and families. Samples of all the standardization materials are available at: http://www.wsha.org/page.cfm?ID=0208.

The Washington State Hospital Association represents all of Washington's 98 community hospitals. The association takes a major leadership role in issues that affect delivery, quality, accessibility, affordability, and continuity of health care. It works to improve the health status of the residents of Washington State. Additional information available a: www.wsha.org.

Editors: The Washington State Hospital Association can connect you with hospitals implementing these initiatives and with those who helped develop the standards. Please contact Beth Zborowski at [email protected] or 206-577-1807.