How changing connectors could improve safety

By Ikhlass Hassen, Vizient Sr. Clinical Manager, Clinical Solutions-Spend Management, Contracting Center of Excellence

When it comes to patient safety, the right connection can make all the difference.

Designed according to the International Organization for Standardization (ISO) standards and regulated by the Food and Drug Administration (FDA), the ENFit® connector is a standardized connector developed to help reduce medical tubing misconnections during the delivery of fluids, nutrition and medications. ENFit® connectors are used in enteral feeding medical devices, including enteral syringes, enteral feeding sets, enteral drainage sets, medication bottle adapters and other patient interface devices including access ports.

According to a 2023 Vizient ENFit® Enteral Feeding feedback survey, 59.4% of those who responded to the survey successfully completed the transition from legacy enteral feeding products to ENFit® enteral feeding products, demonstrating significant progress in the adoption process. But while the adoption of ENFit® connectors is gaining momentum, its full impact on clinical practice is still being assessed.

From 2011 to 2023, 96 new cases of tubing misconnections were documented, with 4 patient deaths and 6 instances of harm. However, tubing misconnections continue to be underreported or misreported. In support of this global initiative to reduce medical device misconnections, several standards organizations, federal partners, professional societies, advocacy groups, patients and other stakeholders including the Institute for Safe Medication Practices, Emergency Care Research Institute, American Society for Parenteral and Enteral Nutrition, American Society of Health-System Pharmacists and others have devised toolkits or guides to assist health entities with the adoption of ENFit® connectors.  

Understanding the potential risks associated with delaying adoption and, similarly, the potential value to adoption can help health entities determine whether ENFit® connectors are the right fit for them.

Potential risks to delaying adoption:

• Cost implication: Complications from misconnections can lead longer length of stays or readmissions affecting payer reimbursement or even malpractice lawsuits. Hospitals may also incur additional expenses by needing to maintain multiple inventories of different connector systems. Read more about how Customer experience isn't just an expense. It's a competitive advantage.
• Compliance: Late adoption of ENFit® connectors could lead to non-compliance with future industry standards and regulations.
• Disruption to supply chain operations: Should manufacturers cease production of legacy connectors, healthcare entities must be prepared to quickly transition to ENFit® connectors to prevent disruptions in patient care.
• Inefficiencies in clinician workflow: Pharmacy staff must carefully prepare medications using the correct system and nursing staff must navigate the intricacies of administering treatments through varying types of connectors. This increases the cognitive burden on healthcare professionals, leading to potential delays, miscommunications, and potentially compromised care.

Potential value from adoption:

• Standardization: According to the Global Enteral Device Supplier Association (GEDSA), ENFit® connectors offer a standardized system for enteral feeding devices, ensuring consistency across all enteral feeding devices. This standardization facilitates compatibility among devices from different manufacturers and minimizes the complexity of product selection.
• Domestic production and supply chain resilience: Adopting ENFit® connectors could boost domestic production capabilities, thereby reducing reliance on foreign suppliers and minimizing the impact of tariffs. By fostering the growth of local manufacturing and production, health entities can enhance the resilience of their supply chains and mitigate potential disruptions related to geopolitical conflicts.
• Transformative measures: Adopting these new standards aligns with high-reliability cultures and value-based care while addressing practice gaps in patient care areas. There is an opportunity for clinician and leadership engagement, fostering cross-collaboration across all departments and care settings.
• Reduce costs: The uniformity provided by ENFit® connectors simplifies inventory management and reduces the costs of maintaining multiple types of connectors and devices. Training for healthcare staff also is streamlined, as a single standardized system reduces the time and resources needed to educate personnel on different connector types.
• Regulatory mandate: Hospitals can leverage their buying power and economies of scale to advocate for federal regulatory mandates and secure insurance coverage through pharmacies and durable medical equipment providers. By working collaboratively with key stakeholders and engaging in lobbying efforts, health entities can drive policy changes and encourage industry-wide adoption. This proactive approach not only supports regulatory progress but also facilitates a smoother and safer transition for patients across healthcare settings.

The process of adopting ENFit® presents health entities with an opportunity to enhance their processes and highlights their dedication to upholding the highest standards of safety and quality in patient care. The Vizient clinical resource guide, Improving Patient Safety: Preventing Tubing Misconnections - ENFit®, provides valuable information based on the results of the 2023 Vizient ENFit® Feedback Survey. It provides insights on the significance of preventing tubing misconnections, highlights past legislative endeavors, discusses the advantages of supply chain standardization, outlines Vizient contracts, supplementary resources and offers best practices for successful implementation.

Disclaimer: The information provided in this blog is intended for informational purposes only and does not constitute any claims or endorsements. Healthcare entities are encouraged to conduct their own risk assessments and value analyses to determine the most appropriate solutions or approaches for their specific settings, patients and organizational needs.