5 Enteral Feeding Regulatory Recommendation Priorities

Patrice Hatcher, MBA, BSN, RNC-NIC / September 2016


These are dynamic times in healthcare, with a high focus on improving patient outcomes through quality measures and implementing best practices. Enteral feeding safety has improved; however, there is still work to be done.

There are regulatory associations diligently making additional improvements toward decreasing the risk of misconnections. Some of these improvements include implementation of ENFit, or small bore ISO standard changes. This will be a huge leap forward in improving patient safety, and light years toward becoming safer for patients and clinicians. Despite these recent advances, misconnections continue to remain at the top of the priority list and a hot topic for all patient populations, especially for the tiniest patients in the NICU.

I recently read the May/June issue of the Neonatal Network. In that issue, Debbie Fraser, Editor-Chief, articulately emphasized the importance of developing a culture of safety—specifically on taking responsibility together.1 I am inspired by the national progress that has been made in some areas to have a safer patient environment, and her acknowledgment of nurses and their contribution to the progress that is being made across the country improving patient safety and decreasing harm. I could not help thinking about how this editorial applies to decreasing harm with enteral feeding in the NICU. There are ongoing challenges that are being faced today and every day in the NICU that impact enteral feeding.

Joint Commission and the American Society for Parenteral and Enteral Nutrition (ASPEN) are two essential regulatory agencies that are viewed as resources in this area. They have published the following articles as guides for improving clinical practice: In 2008, the Joint Commission Journal on Quality and Patient Safety released a consortium position statement addressing enteral feeding misconnections.2  Later, in 2014, the Joint Commission’s Sentinel Alert #53 outlined strategies for managing risk of tubing misconnections during the transition to a new ISO Connector Standards.3  And ASPEN Enteral Nutrition Practice Recommendations is an excellent resource filled with expertly compiled, evidence-based research and best practices on the provision of enteral nutrition.4

I have been a NICU nurse for more than two decades, and spent half of that time in a leadership role. I can relate to the challenges of being on the frontlines managing a safe environment for care, all while addressing many of the complex operational details and multiple quality initiatives. It is critical for nurses, nurse leaders and quality teams that play a key role in impacting enteral feeding to review practice recommendations and stay current with regulatory recommendations.

Here are five solid ways to use Joint Commission and ASPEN enteral feeding recommendations to influence enteral feeding safety:

  1. Know the issues associated with enteral feeding as identified by the Joint Commission Journal on Quality and Patient Safety.
  1. Review the enteral recommendations from both Joint Commission and ASPEN.
  1. Compare your enteral feeding current practice guidelines to the ASPEN Enteral Nutrition Practice Recommendations to ensure your unit has adopted best practices and protocols.
  1. Conduct regular opportunities to evaluate enteral feeding practice. Consider using an interdisciplinary clinical team or an established unit council to review and address practice challenges that may develop.
  1. Stay informed on the most up-to-date and accurate information regarding the ISO Connector standards that can be found on the gedsa.org and StayConnected.org websites.


  1. Fraser D. Culture of safety: Safety 360 taking responsibility together. Neonatal Network. 2016;35(3):123-124.
  2. Joint Commission. Sentinel event alert #53. 2014.  www.jointcommission.org
  3. Guenter P, Hicks RW, Simmons D, et al. Enteral feeding misconnections: a consortium position statement. Jt Comm J Qual Patient Saf. 2008;34:285-292.
  4. A.S.P.E.N. Enteral Nutrition Practice Recommendations. J Per and En Nutr. 2009;33(2)122-167.


About the Author

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, Inc.