Safe Practices in Hospital Settings: The Importance of Wristbands for Patient Safety
The importance of patient safety in hospitals cannot be overstated, and few moments illustrate this more powerfully than a recent incident involving a newborn in a Canadian hospital. The baby was fitted with an identification wristband made of paper-based components. Despite its intended purpose, the infant managed to detach fragments of the band, which were later found in their mouth—posing a significant choking hazard. This case highlights the urgent need for best practices in patient identification, particularly the use of non-paper or non-soluble materials.
Another alarming example of patient misidentification occurred at PeaceHealth Southwest Medical Center in Vancouver, Washington. In 2021, a patient was mistakenly taken off life support after being misidentified as his hospital roommate. This devastating error resulted in the wrongful death of the patient and caused significant emotional trauma to both families involved. Such cases highlight the catastrophic consequences of misidentification and reinforce the need for strict patient identification protocols to prevent similar tragedies.
Historical Perspective and the Growing Focus on Patient Safety
Hippocrates (460 to 370 B.C.) introduced the principle *primum non nocere*, meaning “first, do no harm.” Since then, figures such as Florence Nightingale, Ignaz Semmelweis, and Ernest Codman have contributed significantly to advancing patient safety, emphasizing infection control, disease transmission prevention, and quality assurance in healthcare. Over the past decade, patient safety has become a global priority, with institutions worldwide implementing measures to prevent adverse events and improve the overall quality of care.
In Canada, patient safety gained national recognition with the establishment of the Canadian Patient Safety Institute (CPSI) in 2003, now part of Healthcare Excellence Canada. This was in response to alarming statistics showing that approximately 1 in 17 hospital admissions in Canada involved at least one harmful event. In 2022 alone, 146,000 such incidents were reported.
Predictive data suggests that patient safety incidents will occur every minute in the next ten decades, and without proper intervention, the number of preventable deaths could reach 30,000 annually in the next 30 years (Healthcare Excellence Canada, 2003). To address this, healthcare institutions must invest in quality-driven initiatives aimed at strengthening a culture of safety among both patients and healthcare teams.
Wristbands as a Critical Component of Patient Safety
The World Health Organization (WHO) has outlined six International Patient Safety Goals, with correct patient identification as the number one priority (WHO, 2007). Identification wristbands play a crucial role in ensuring that patients receive the correct treatment, medication, and medical procedures. However, as the case of the newborn illustrates, improper materials can introduce new risks instead of mitigating them.
To ensure safe wristband use, best practices should include:
Material Considerations: Bands should be non-paper, hypoallergenic, flexible, waterproof, and resistant to body fluids, soaps, and alcohol-based sanitizers.
Placement: For newborns, bands should be secured on the ankle instead of the wrist to prevent accidental removal.
Durability: The wristband must be designed to withstand hospital conditions without degrading or posing a hazard.
Identification Accuracy: Information such as patient name, date of birth, and other critical details must be clearly printed using electronic printing methods to prevent misidentification.
Concerns About Thermal Wristbands and Chemical Exposure
Thermal wristbands, which are commonly used in hospitals, pose an additional health risk due to the pervasiveness of bisphenol A (BPA) and bisphenol S (BPS). These substances are used to make paper thermally printable, similar to the thermal paper used in restaurant, grocery, and retail receipts. BPA and BPS are classified as forever chemicals and hormone disruptors, exposing both patients and healthcare staff to potential health risks. Unless the wristband is UV-coated, there is direct exposure to these substances through skin contact.
BPA and BPS have been banned in Switzerland, and both California and the European Union have issued directives to eliminate them where possible and practical. Given these health concerns, hospitals should prioritize wristbands that have a protective UV coating, ensuring that patient safety is upheld not only in identification but also in material composition.
Implementation of Safer Identification Standards
The NHS in the United Kingdom has established wristband standards that emphasize:
Proper sizing for different patient categories, including newborns.
Use of durable, non-toxic, and non-soluble materials.
A standardized white band with black printed text.
Electronic printing for unambiguous, easily readable identifiers.
Following these guidelines, hospitals must prioritize the use of materials that do not pose a safety risk, especially to vulnerable populations such as infants. The recent case of the newborn in Canada underscores the dangers of failing to do so, reinforcing the necessity of switching to safe, durable wristbands.
Conclusion
Hospital wristbands are a critical aspect of patient safety, ensuring proper identification and reducing the risk of medical errors. However, these tools must be designed and implemented with safety in mind. The use of non-paper, durable materials and the placement of wristbands on newborns' ankles rather than wrists can prevent avoidable hazards, such as choking incidents. Additionally, reducing exposure to BPA and BPS-containing thermal bands is essential to minimizing exposure to harmful chemicals for both patients and healthcare staff.
Healthcare institutions must adopt these best practices in alignment with WHO guidelines to create safer hospital environments for all patients. By committing to high-quality wristbands and stringent safety standards, hospitals can significantly improve patient care and eliminate unnecessary risks, particularly for newborns and other vulnerable patients.
References
World Health Organization. Joint Commission Resources. Joint Commission International. Patient Safety Solutions. Solution 2: patient identification [Internet]. Geneva; 2007 [cited Jan 30, 2025]. Available at: http://www.jointcommissioninternational.org/WHO-Collaborating-Centre-for-Patient-Safety-Solutions
Norris B, Ranger C. Standardising Wristbands Improves Patient Safety: guidance on implementing the safer practice notice (SPN 24, July 2007) and the related information standards approved by the Information Standards Board for Health and Social Care in March 2009 [Internet]. London: National Patient Safety Agency; 2009 [cited Jan 20, 2025]. Available at: http://www.npsa.nhs.uk/
Environmental Defence Canada. BPA and BPS in Receipts: Health Risks and Exposure from Thermal Paper [Internet]. 2019 [cited Feb 15, 2025]. Available at: https://environmentaldefence.ca/report/bpa-and-bps-in-receipts/
People Magazine. Patient dies after hospital asks wrong family about removing life support [Internet]. 2023 [cited Feb 15, 2025]. Available at: https://people.com/patient-dies-after-hospital-asks-wrong-family-about-removing-life-support-8774738
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