A Do Not Resuscitate (DNR) order is a formal medical instruction indicating that a person does not wish to receive cardiopulmonary resuscitation (CPR) or other life-sustaining measures if their heart or breathing stops. This instruction is part of a patient’s advance care planning, ensuring their end-of-life wishes are respected by healthcare providers. Because medical emergencies require immediate action, a clear physical identifier is necessary to quickly communicate this complex instruction to clinical staff. Color-coded wristbands in hospitals serve as a visual shortcut to alert personnel to a patient’s specific status or restriction. This standardized physical marker helps ensure that a patient’s preference to withhold aggressive interventions is honored.
The Standardized Color Protocol
The color most commonly used to denote a DNR status in standardized hospital settings is purple. The American Hospital Association (AHA) recommended this national standard for alert wristband colors following a major patient safety initiative. This effort, which began around 2008, aimed to eliminate confusion when staff moved between facilities with varied internal policies. The intent was to improve patient safety by making the visual cue instantly recognizable to any clinician.
Color Contrast and Safety
The choice of purple was deliberate, designed to contrast with other standardized alert colors used in the hospital environment. For instance, red is reserved for a patient allergy, while yellow signifies an elevated fall risk. Assigning a unique color to the DNR status reduces the risk of misinterpretation in an emergency. This visual flag alerts staff to pause and consult the patient’s medical chart before initiating any resuscitation measures. While not every hospital globally has adopted the AHA’s recommendation, the purple bracelet has become the recognized signifier of a patient’s preference to withhold resuscitation efforts in the majority of United States healthcare systems.
Distinguishing Between the Legal Order and the Physical Identifier
The purple DNR bracelet is solely a notification tool, not the legal consent itself. The physical identifier warns the healthcare team to look for the actual legal document. The DNR order is a formal medical instruction that must be signed by the patient or their legally authorized surrogate, as well as a physician.
This legal document, often part of a Portable Medical Order or Physician Orders for Life-Sustaining Treatment (POLST) form, holds the legal authority. The bracelet serves as a visible reminder that the official order exists within the patient’s medical record. If a bracelet is present without a corresponding, validly executed order in the chart, the order cannot be legally followed. The DNR order details the specific treatments to be withheld, including chest compressions, artificial ventilation, and defibrillation. The bracelet acts as a safety measure to prevent an inadvertent violation of the patient’s documented wishes. Healthcare professionals must always verify the order’s existence and validity in the patient’s file before withholding life-sustaining treatment.
Out-of-Hospital DNR Identification and State Variations
While purple is the standard for in-hospital settings, the identification for Out-of-Hospital (OOH) DNR orders is less uniform and varies significantly by state jurisdiction. OOH-DNR protocols govern the actions of Emergency Medical Services (EMS) personnel, who must rely on easily accessible and legally recognized identifiers outside of a hospital’s controlled environment. Many states have specific statutes dictating the acceptable physical forms of OOH-DNR identification for first responders.
These state-specific protocols often require a physical document and recognize alternative identifiers such as a necklace or a specific type of bracelet. For example, in Texas, an OOH-DNR order can be signaled by a plastic bracelet or a metal necklace or bracelet inscribed with the words “Texas Do Not Resuscitate – OOH.” These non-colored, engraved identifiers are preferred in the field because they provide a permanent, tamper-resistant record of the patient’s status. This variation exists because EMS must operate under state law, prioritizing clear, legally recognized text and identification numbers over a color that could be confused with personal jewelry.