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Best Practice Spotlight - Get Fit with ENFit®

12 Jan 2018 11:24 AM | Deleted user

Get Fit with ENFit®

Author: Sarah Bledsoe, PharmD, CPHIMS
Assistant Director of Pharmacy, 
Children’s Mercy Kansas City

Make it your New Year’s resolution to pump up your pharmacy muscles by learning about the new enteral connections standards, ENFit®. A new novel enteral tubing system called ENFit® was designed to make enteral tubing and supplies incompatible with other traditional luer lock systems. The Joint Commission previously reported over 100 errors and 21 deaths have been attributed to the administration of enteral nutrition through intravenous lines.1 To prevent these errors from occurring, the Global Enteral Device Supplier Association (GEDSA), a nonprofit trade association, was formed to establish a voice for addressing issues that face manufacturers, suppliers and distributors and to facilitate communication to healthcare facilities across the globe on enteral tubing changes through the Stay Connected 2014 initiative.2

The initiative will result in practice changes for healthcare organizations and providers that care for patients with enteral tubing. Examples of enteral tubing include nasogastic (NG), nasojejunal (NJ) and g-tube sites. While many patients use enteral systems for nutrition, some may also use it to administer medication. With the ENFit system design, patients will need their medications prepared in special ENFit compatible syringes in order to administer medications. It will be especially important that health-systems pharmacists engage their organization in planning for, educating and supporting these patients. GEDSA has shared that based on feedback from manufacturers, they estimate 28% of hospitals in the United States have already made the transition to ENFit® products. 3 To help you get started on your ENFit® journey, we have recommended some essential steps every healthcare organization should take to prepare for ENFit®.

Step 1 – Identify your needs and key stakeholders

  • Each healthcare organization should do an assessment of their current enteral tubing practices. This includes creating a line item inventory of all current enteral supplies.
  • Because enteral tubing is typically utilized in multiple healthcare settings including inpatient and ambulatory practices, key stakeholders should be contacted to represent all areas. Based on our experiences with hospitals that have successfully implemented ENFit®, a project team should consistent of the following key members: medical staff champion, pharmacy, nursing, supply chain, home care, discharge planning, quality, safety, patients and families.
  • Transition checklists are available on the GEDSA Stay Connected website www.stayconnected.org to help guide key stakeholders on steps to take in their focus area.

Step 2 – Plan for your practice change

  • Multiple vendors are available for ENFit® products. Health care providers and supply chain will need to perform a value based assessment of available products and select vendors for individual ENFit® products to replace their current enteral supplies.
  • Throughout the process of learning and evaluating the new ENFit® products, health care organizations may find that they need to revise their standard operating procedures for tube cleaning, medication preparation and discharge planning.
  • Transition adapters between the old and new enteral tubing systems are available. While these adapters are necessary during the transition, ISMP alerted in their September 2017 Acute Care Newsletter that transition adapters will be eventually eliminated and defeat the purpose of ENFit itself. 4 Healthcare organizations should carefully evaluate the role of transition adapters in their short term and long term conversion plans to ENFit®.

Step 3 – Get ready to go ENFit

  • Education is key for a successful ENFit® transition and each health care organization will need to develop a strong education plan that encompasses all health care providers which may interact with enteral tubing supplies.
  • GEDSA has ENFit® interactive demonstration stations available for order by sending an email request to info@gedsa.org. The GEDSA Stay Connected website also offers a variety of videos and handouts from hospitals that have successfully implemented.
  • Implementation should be carefully coordinated across the healthcare organization. Adequate resources for switching supply rooms, changing patient tubes, preparing medications, assisting front line staff and educating patients should be available.

To learn more about GEDSA, ENFit® and the Stay Connected initiative, please visit www.stayconnected.org

References

1. Sentinel Event Alert. Issue 53. The Joint Commission. 8/20/2014 http://www.jointcommission.org/assets/1/6/SEA_53_Connectors_8_19_14_final.pdf
2. GEDSA Stay Connected 2014. http://stayconnected.org/about/. 9/30/2015
3. GEDSA. September 2017.
4. ISMP.http://www.ismp.org/newsletters/acutecare/issues/20170921.pdf. Vol 22. Issue 19. September 2017.

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