The Yellow-Red-Black Bladder Diary: Red-Yellow-Black is Not Just for Wounds
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Abstract: The Red-Yellow-Black (RYB) wound classification system was introduced to the US in the late 1980s for the purpose of simplifying wound assessment and guiding treatment. Although the color system was found to have limitations for wound care, the colors (in revised order) may be useful for a bladder diary. Colored pencils are used to record fluid intake and voided output. For fluid intake, yellow signifies nonirritants (water); red, low bladder irritants (alcoholic, artificially sweetened, carbonated, or citrus beverages); and black, high bladder irritants (caffeinated beverages). For voided output, yellow denotes continent voids and red, incontinent voids. Output quantity is measured using a commode “hat”. The completed diary allows the practitioner to tabulate the colored daily rows and quickly assess progress weekly or monthly and provide appropriate treatment/advice. The YRB diary was used successfully by a 78-year old woman with urge incontinence without evidence of stress incontinence. Modifications to the YRB diary can be made when additional data need to be collected. Studies to evaluate optimal usage criteria of bladder diaries are needed.
Dr. Faller is a board-certified ET Nurse/Clinical Specialist in private practice. Please address correspondence to: Nancy Ann Faller, RN, PhD, ET Nurse, 380 Wilson Street, Carlisle, PA 17013; email: firstname.lastname@example.org.
The Red-Yellow-Black (RYB) wound classification system was introduced to the US from Europe in the late 1980s1 by Marion Laboratories (now Marion Merrell Dow) (see Figure 1). The colors were heralded for simplifying wound assessment to direct wound treatment. This system had at least two problems from its inception. First, the RYB assessment only includes the wound bed. Additional variables — ie, wound depth, size, undermining, and tunneling; wound shape, dimensions, and volume; wound edges and surrounding skin; wound exudate and odor; and wound stage (if a pressure ulcer) are not included. Furthermore, this system does not accommodate for the presence of foreign bodies (eg, mesh, prosthesis, and sutures) or underlying structures (eg, tendon and bone) in the wound nor does it facilitate assessment of wounds with various tissue in the wound bed.2,3
Second, the colors and suggested treatments are problematic. Red wounds (see Figure 2a) were described as being in one of three reparative phases of healing (reactive, regenerative, or reconstructive). This description does not allow for either a healthy muscular wound bed immediately post dehiscence or debridement (see Figure 2b) or an unhealthy stagnant granulating wound bed months post dehiscence or debridement (see Figure 2c). Yellow wounds were described as infected or fibrinous and not ready to heal (see Figure 3a), not taking into consideration the healthy wound bed with Cardiff Cover as described by Harding4 (see Figure 3b), nor the unhealthy wound bed with cream, beige, brown, green, or gray tissue (see Figure 3c,d). Black wounds were described as covered with a dehydrated eschar; the suggested intervention was debridement, an intervention not necessarily appropriate for all wounds or for all patients (eg, patients with dry heal pressure ulcers or arterial ulcers)5-7 (see Figure 4a,b).
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