The ENFit Enteral Connector Transition: Ready When You Are

Patrice Hatcher, MBA, BSN, RNC-NIC / August 2019

Sometimes the community decision has been made for your hospital to transition to ENFit enteral connectors after months of discussion and inclusion of multiple departments.

Now what? Where to begin?

Are you ready? It’s time to roll up your sleeves and put together a plan.

When developing a transition plan across the organization, there are resources to tap into and strengthen the plan. Evaluate available published sources, regulatory recommendations, and data to assist with guiding the path. No need to travel this journey alone! Consider other hospitals in the county, state, or metropolitan area and learn from their journey. Partner with a manufacturer that has the bandwidth to support your goals, especially when it comes to the NICU.

How it all started

In the early stages of developing a transition plan it is so important to keep firmly in mind why your organization is embarking on the ENFit journey. Change is not easy. It is vital to uphold why you’re taking this transition journey in the first place: to prevent enteral misconnections and the associated risk of severe and adverse patient injury!

In 2008, The Joint Commission published a position statement on enteral feeding safety concerns with misconnections.1 Later in 2014, The Joint Commission released a Sentinel Event Alert notifying health care professionals of the potential for adverse events related to enteral feeding misconnections.2 In both reports, The Joint Commission defines the risks and concerns associated with enteral misconnections for severe patient injury and death associated with tubing misconnections.

In the 2014 report, The Joint Commission urged healthcare organizations to be vigilant in planning to transition to the International Organization for Standardization (ISO) small bore enteral connector standard, ISO 80369-3.2 The new ISO standard design with reverse orientation and locking connection, and incompatibility with other small bore connectors, was named ENFit®.

In 2015 and 2018, the Food and Drug Administration (FDA) published letters on its concerns related to misconnections between enteral devices, other medical devices, and patient injury. In the most recent document, they reported staggering statistics related to enteral misconnections:3

  • 2 deaths
  • 24 serious injuries
  • 32 device malfunctions

Getting started with your ENFit plan

The FDA recommends that “hospitals and clinicians use enteral devices with connectors that meet the ISO standard designated to reduce the risk of misconnections.”3

After reaffirming the reason for change, those available resources will be helpful with developing, executing and implementing a successful transition plan.  Available resources that offer guidance on what to do and when, such as:

  • The Joint Commission published an extensive list of actions to take in organization preparation for transitioning to ISO connector standards/ENFit.2
  • GEDSA’s Stay Connected website provides tools for an organization adopting ENFit, including transition chats and an ENFit implantation toolkit.4
  • ECRI Institute provides guidance for a large healthcare system transitioning to ENFit, and provides a list of implementation challenges with the goal of preventing undue stress.5

Your organization does not have to do it alone. Consider a partner in your transition.  Partner with an enteral manufacturer that has experience with enteral feeding products, and provides comprehensive enteral feeding solutions that include products, accessories and equipment for your specific patient population.  If your hospital has or you manage or work in a neonatal/pediatric unit, be discerning with vendors and look for those that provide high quality products for your patient population. 

Look for enteral manufacturers that have knowledgeable sales consultants who are well-educated on enteral safety, ENFit and best practices.  Important to consider the team beyond the sales team, it is beneficial for the sales team to have clinical representation and specialists focused on education and enteral product management; a team of accessible experts. Give some thought to the customer service as well. Do they have a team that is available, knowledgeable, and friendly?

The ECRI Institute advises and encourages evaluation of several important factors when evaluating a vendor first, including the availability of ENFit connector enteral supplies if you want to reduce the risk of implementation challenges. Before selecting a supply company, inquire if they offer the following:5

  • Clinician training
  • A team of clinical resources
  • Educators that provide evidence-based research
  • Meet organizational timelines for systems with multi-hospital transition, and availability of temporary adaptor and associated costs.

Preparation is crucial to successful implementation, however it is not a guarantee that nothing will go wrong.  With all the best laid plans, unexpected challenges or process complications may occur.  Here is where it is most important to have a vendor that is a partner, one that is accessible and responds. This means they show-up and provide resources and solutions that genuinely assist with moving beyond the unexpected.

Medela is ENFit ready when you are! Learn more about our ENFit products.

Do you have questions about Medela ENFit products? Request more information.

References

  1. Gunther P, et al. Enteral feeding misconnections: A consortium position statement. The Joint Commission Journal of Quality and Patient Safety. May 2008. 34(5); 285-292.
  2. The Joint Commission.  Sentinel Event Alert: Managing risk during transition to New ISO Tubing Connector Standards. Issue 53. August 20, 2014. Retrieved from  www.jointcommission.org
  3. The U.S. Food and Drug Administration. The FDA encourages use of enteral device connectors that reduce risk of misconnection and patient injury. Retrieved from https://www.fda.gov/medical-devices/general-hospital-devices-and-supplies/medical-device-connectors
  4. StayConnected.  Enteral feeding connectors: ENFit design changes, research, tools for Implementation. Retrieved from http://stayconnected.org/enteral-enfit/
  5. ECRI Institute. Implementing the ENFit Initiative for Preventing Enteral Tubing Misconnections. 2017. Retrieved from https://www.ecri.org/components/HDJournal/Pages/ENFit-for-Preventing-Enteral-Tubing-Misconnections.aspx?tab=2

About the Author

Patrice Hatcher, MBA, BSN, RNC-NIC

Patrice Hatcher, MBA, BSN, RNC-NIC, began her practice more than 24 years ago as a neonatal nurse working in NICU. She has experience in various nursing leadership roles including neonatal transport nurse, outpatient nurse manager, and administrative nurse manager overseeing operations of large intensive care units. She has special interest in quality improvement and improving clinical outcomes for neonates. Patrice currently works full-time as a Clinical NICU Specialist for Medela LLC.

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