Successfully Navigating the Path to ENFit Transition

Lori Wood, MSN, CNS, RNC-NIC, IBCLC / November 2018

Change is never easy. We hear this all the time. But change is often worth the effort in the end. What if knowing and understanding that the needed change would potentially save a life, improve quality of life, keep a family intact, or save a career? Would this change seem important then, even if you had never seen a problem with the “old way”?

ENFit – A New Connection

The name ENFit is making its way around the U.S. and around the globe. Multiple and continued misconnections of medications and feedings meant for oral or enteral use have been given via IV, tracheostomies, and other parenteral sites. These misconnections can obviously be lethal, or cause harm. When I speak to groups of medical providers, nurses, and respiratory therapists about this need and the medical mistakes that happened, I often hear someone question, “Who could make such a mistake?”

I could make this mistake, and you could make this mistake. Experienced clinicians are making misconnections. Staff working with multiple lines, dim lighting conditions, calls from family and doctors, in busy, often chaotic conditions, can make a mistake.

A new connection has been designed to reduce the likelihood of making such a mistake, with fitting designed to connect to enteral devices only: naso/orogastric tubes, G-tubes and J-tubes, Salem sumps, oral/enteral syringes, and kangaroo feeding bags.

California is currently the only state to mandate healthcare change to these new enteral-only connections. The Joint Commission (TJC) has worked with the Global Enteral Device Supplier Association (GEDSA) to create the design.

Now it’s up to us at each inpatient, outpatient, home health, and long term facility to make the change.

How to begin

Transition takes time. Begin with a concentrated group to lead the change. Keep your group small and then take questions and decisions out to the department leads and clinical people using the devices.

My hospital began with a group of 4 people: our Director of Purchasing, our Manager of Purchasing, a person from our corporate purchasing, and me (the Educator/Clinical Nurse Specialist for the Neonatal Intensive Care).

  • Involve staff from pharmacy and quality to help ensure that all supplies are correct and policies are created
  • All patient care areas will need to be involved:
    • Adult care areas
    • Emergency
    • ICU
    • Pediatrics
    • Perinatal
    • Surgery both inpatient and outpatient
    • GI Lab
  • All caregivers need to have input. Maybe an interested group can be created:
    • Nursing Directors and Charge Nurses
    • Bedside Nursing staff
    • Pharmacists (they’ll be drawing up meds)
    • Surgeons
    • Trauma Surgeons 

Next Steps

Our Purchasing team members created a spread sheet of all enteral tubes, syringes, and sizes that we currently used. We were able to exclude items we hadn’t used over time, and also discuss decreasing the number of suppliers we used to standardize our merchandise. We invited our reps in to present their supplies for our review. Individual team members took questions back to unit leaders, and we were able to reduce duplication and secure the best products for our needs.

Pharmacy was a big piece of our decision making and education. Many factors were involved in the syringes used for medication administration, especially with low volume doses such as in the NICU. We met with our key pharmacists to ensure that all patient delivery and safety needs were met.

Nursing Education

Ensuring that everyone involved had knowledge of why we needed to make this change and the opportunity to touch and explore the new products was a vital part of the change. Our Educator group went floor to floor and shift to shift to show the products and make the case for the change. We engaged interested charge nurses who helped to spread education.  “Story Boards” and flyers were created. Supplies were brought to unit skills days so staff could “practice.”

Change over

We began with the NICU as we had been preparing for this change for over a year and had the opportunity to have multiple education days. We had a big commitment to protect the tiniest of patients, especially where we have enteral feedings taking place hour by hour! Once we fine-tuned our ENFit conversion, we followed with the rest of the hospital. Due to forward thinking, prep, education, and planning, we were ready and all transitions were successful.

Ready, set, go!

Start planning and make the change now, before problems occur. With a small concentrated team, you can roll out big change!

 

Watch Lori Wood present more on this topic in the recorded webinar, Successfully Navigating the Path to ENFit. Use promotion code EDmW72Re for 50% off!

 

Learn more about Medela ENFit products for the NICU: ENFit feeding tubes, ENFit syringes, and ENFit extension sets.

 

References:

Global Enteral Device Supplier Association (2018). ENFit medical guidelines/Research and position statements. http://stayconnected.org/enfit-medical-guidelines/

Institute for Safe Medication Practice (2015). ENFit enteral devices are on their way… Important safety considerations for hospitals. www.ismp.org/resources/enfit-enteral-devices-are-their-wayimportant-safety-considerations-hospitals

The Joint Commission (2014). Managing risk during transition to iso tubing connector standards.  https://www.jointcommission.org/assets/1/6/SEA_53_Connectors_8_19_14_final.pdf

About the Author

Lori Wood, MSN, CNS, RNC-NIC, IBCLC

Lori Wood is a Clinical Nurse Specialist at Desert Regional Medical Center, Palm Springs, CA. Lori is certified as a RNC-NIC in Neonatal Intensive Care Nursing and is an International Board Certified Lactation Consultant. She is also a consultant for Medela, LLC.

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