Color Coded: Hospitals Standardize to Minimize Human Error

Tom Banse
02/17/2009

Hospitals in Oregon and Washington are standardizing overhead calls and color codes to reduce the risk of confusion or human error. The move follows a survey that found wide variation in the emergency codes among the region's hospitals. This matters because many doctors and nurses now work at more than one place. Correspondent Tom Banse reports.

TRANSCRIPT

If you've spent any time in a hospital, you know that the staff sometimes speak in code.

Overhead page: "Code blue in ER one. Code blue..."

Here at Capital Medical Center in Olympia, "code blue" means a patient's breathing or heart has stopped. But at a few hospitals, code blue means "get security." So now imagine a scenario involving a doctor or nurse who's recently switched hospitals. Her patient goes into sudden cardiac arrest. She instinctively calls for code blue. But instead of the resuscitation team, the security guard comes running. This really happened at an unnamed Washington hospital. It is one reason Capital Medical Center's chief nursing officer favors standardization.

Lisa Moylen: "When temporary personnel come, within the first hour they're here they're oriented to the codes because that's very important. It would certainly be a lot easier if there were some universal components."

Lisa Moylen says the use of temp nurses and traveling nurses has gone way up since she started in medicine 40 years ago.

Lisa Moylen: "And also, in today's economy, more staff work at more than one place. I have nurses that work here for me, but on their off days, they might work at the hospital across town."

Moylen says her hospital will have to change some of its overhead codes to match the agreed–on universal standard. For example, the old code white goes to code gray. Code yellow changes to silver.

Lisa Moylen: "There is a risk of confusion."

At Moylen's hospital, workers have a "cheat sheet" printed on the back of their ID badges to help them keep their colors straight.

Sound: "Code blue, all clear."

Surgical checklists and hospital wristbands are being standardized too. Henceforth, a yellow wristband will always mean the patient is at high risk to fall. Heaven forbid anyone confuse it with its sometimes former meaning of "do not resuscitate." That's now purple. The Washington and Oregon hospital associations are asking all of their members to voluntarily get in sync by this coming fall. I'm Tom Banse in Olympia.

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