The Institute for Safe Medication Practices (ISMP), an organization devoted to medication error prevention, released its position that transition adapters for ENFit® syringes can defeat the purpose of ENFit itself.
Hospitals that have not yet fully transitioned to ENFit are receiving ENFit administration sets with transition adapters. According to this position statement, improper use of transition adapters can cause choking hazards, allow for the risk of inadvertent IV injection of oral liquids, and can cause inaccurate liquid dosing of small volume liquids in patients.
ISMP issued a Medication Safety Alert in September that states:
“ISMP stands behind the need for full conversion to ENFit devices to reduce the risk of accidental connection of syringes and administration sets meant for other routes of administration. Transition adapters for feeding tubes must be considered a temporary measure only. Adapters for syringes add risk, especially when the adapter allows compatibility between Luer-tip syringes that should never be used for preparing or administering oral liquids or suspensions. As soon as possible, full conversion should occur to feeding tubes and administration sets that use only integrated ENFit connectors. In the meantime, all risks, even if temporary, should be fully explained and outlined to staff.”
NeoMed President, Aaron Ingram, stated, “Some manufacturers appear to be positioning these ENFit transition connectors as long-term product offerings. As a result, the use of ENFit transition connectors potentially reintroduces the risk of misconnection, challenging the spirit of ISO 80369-3:2016, and compromising compliance with The Joint Commission Sentinel Alert recommendations. NeoMed’s NeoConnect® family of ENFit products provides an integrated ISO 80369-3:2016 solution without depending on ENFit transition connectors, potential unexpected volume losses, and other unanticipated consequences.”
NeoMed develops innovative enteral collection and delivery products supporting the specialized feeding and medication dosing needs of the low birth weight, neonatal, and pediatric patients. We are committed to improve patient outcomes through product designs that meet safety, clinical, and regulatory guidelines while supporting cost containment objectives.
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