When it comes to adopting new products that directly impact patient care processes and protocols, change typically doesn’t happen quickly or easily. Clinicians are wary of any change that could result in an interruption in the delivery of patient care or quality. Additionally, change in one product or process usually has a ripple effect across an organization, compounding any existing perceived barriers to change. Adoption and implementation of the new ENFit® enteral connectors is an example of a change that, if not properly managed, could be more of an organizational tidal wave than a ripple.

Last September, the FDA released a statement advising health care professionals to use enteral devices that meet new International Organization for Standardization (ISO) design standards to avoid medical device misconnections that could lead to patient harm.

“Years prior to the development, recognition and publication of new ISO design standards for enteral connectors, Vizient began awareness campaigns to help members understand the consequences of medical device misconnections and the importance of preventing them,” said Stephanne Hale, PhD, RN, director, clinical solutions for sourcing operations at Vizient.

In a recent blog, Hale noted the common drivers of successful implementations by several Vizient member hospitals: executive leadership support, establishing an implementation team and change champions, and communication. Taking a deeper dive on the implementation process, Hale now shares how to create an effective transition plan for your individual organization.

Lead with value analysis

“Starting with a value analysis approach is one of the best ways to create the implementation plan,” said Hale. The review process should include the following steps: identify departments and patient care areas that will be impacted, identify all products that will be affected, develop a communications strategy and determine measures of success.

When identifying the implementation impact, the conversion team should identify what enteral products are being used, where they are being utilized and who is using them. This will guide the team and help to prioritize care delivery areas to educate and convert first. Additionally, a review of all policies and procedures related to enteral delivery must be reviewed for required updates.

Each care delivery area using enteral products should conduct a detailed review of current enteral products by manufacturer. A review of internal and external systems and product item masters should be included and a clinical crosswalk, from current enteral products to the new connectors must be developed and verified by the internal team leads.

The value analysis team will need to develop a thorough and effective means to educate and communicate the strategy. Key audiences will generally include staff, patients and families, case workers and supply chain.

“In any change strategy, evaluating your success is important,” said Hale. “Decide early in the process how success will be measured and who will be responsible for measuring it. You should also set up a process for identifying conversion and implementation issues in an effort to ensure they are addressed and corrected.”  

Get the pharmacy team involved early

“In addition to enteral nutrition, medication may also be given via enteral tubes, making the pharmacy department an integral part of the conversion team,” said Hale. “Additional considerations for the pharmacy department include delivery of controlled substances, syringe prefill process (in-house or third party) and syringe storage requirements."

Hale noted the pharmacy lead should also review relevant policies and procedures and work to develop education and communication strategies to share any changes with interdisciplinary/interdepartmental departments and stakeholders.  

Collaborate with supply chain

The supply chain department’s responsibility will be to ensure current inventory is assessed and managed, and new inventory is available as the implementation rolls out.

“This requires close collaboration with the conversion team to avoid unintentional interruptions in patient care by avoiding the existence of two unlike or incompatible enteral product systems in the patient care area simultaneously,” said Hale.

In addition to an assessment of current enteral products, the supply chain should perform a validated product crosswalk to establish historical usage data. This data should be communicated to the supplier and/or manufacturer of the new connectors. Product utilization and purchase order information should also be communicated with the facilities’ distributor partner. This will help ensure adequate products are ordered, delivered, and on hand, to support the initiative.

Plan for the required clinical education

“The clinical education team lead will be tasked with determining the clinical education strategy for the facility. They will need to understand where enteral connectors are used in the facility and what staff directly interacts with the connectors. This will enable the education team to develop the most effective clinical education materials and communications strategy based on the level and complexity of the conversion and on the patient care setting, whether it’s acute, non-acute or outpatient,” said Hale.

The education team will need to consider and be prepared to address the following:

  • Who needs to receive product education and who will be responsible for delivering it?
  • What educational resources are required to implement a conversion and communicate the initiative (posters, newsletters, videos, email)?
  • Will live and on-demand training be implemented?
  • At what point in the implementation process will the education need to be provided?  
  • How will success be measured and who will be responsible for measuring it?
  • Will ongoing and recurring educational sessions be required and/or needed?

While the areas and process steps described above may not be all encompassing, they can serve as an important first step in developing a successful conversion initiative for your organization. Interested in learning more about tubing misconnection prevention? Access the Vizient clinical resource guide for more information.

Published: January 17, 2019