What ENFit Means for NICU and Pharmacy

 

Hospitals across the country are moving forward with implementing the industry recommended ENFit enteral feeding connector design.

Has your hospital been looking at this solution?

Here is a quick reminder of the changes the ENFit connector provides:

1. Male/Female connections are switched
2. It is a locking system
3. Color is not mandated

 

ENFit in the NICU

Many hospitals are standardizing ENFit throughout their facility using one vendor. Progressing with one resource is not at all unusual.

However, ENFit has specific issues that must be addressed for the NICU population, and it’s important to know what they are.

Here are a few things to remember and/or look for:

• The ENFit male/female connection reversal has made the end of syringes female, and the end of the OG/NG tube male.
• Low dose ENFit syringes have been developed and approved to address the increased dead space in the ENFit designs. The approved accuracy rate for syringes is +/-10% at 0.2ml.
• Low dose syringes with a male/female tip have reduced the dead space to 0.02ml. This gives the approved accuracy rate.
• Low dose syringes with the male/female tip have a “moat” area around them. Medication can become trapped in this moat, especially if drawing up from a cup. Recommendations are to purchase and use approved pharmacy straws for drawing up medication when it can become trapped in the moat area.
• The low dose syringe has a much larger tip. Many clinicians express concern over placing such a large tip in an infant’s mouth when giving PO medications. Adapters are on the market to make this larger low dose tip easier to give PO medications and reduce tip size. Adapters may increase dead space and must be flushed to avoid under-dosing.
• Syringes above 5 mL don’t have the low dose tip. When inverting the syringe to connect to an NGT, the fluid or medication in the tip can spill out. It is recommended to reverse what you do when making a connection: bring the tubing to the syringe, not the syringe to the tubing, to connect.

 

Pharmacy considerations

Another ENFit consideration is in the pharmacy. Pharmacy must also address this change because of medications given enterally.

Today, PO syringes are sent up to the NICU and can be used for PO or enteral administration. Those PO syringes will not fit in the ENFit gastric feeding tube. Pharmacy can purchase ENFit syringes to be used for enteral or PO administration; they come just as the old PO syringes did – bulk packaged and non-sterile.

Low dose syringes are also available for the accuracy of +/-10% at 0.2ml. While this sounds like “problem solved” for the pharmacy, there are other considerations.

Here are the 3 main issues that the pharmacy needs to address:

1. Cost – Potential increase when moving to ENFit
2. Product Changes – Pharmacy draws up medications for the NICU in unit dosing, so they need various new adaptors for vials, bottles, cups, and other items. Examples are straws, caps, and tamper-proof seals for these NICU draws.
3. Pharmacy Technician Impact – PO syringes are currently a slip tip, and are easy to draw up medications. The new ENFit locking system has a twisting motion to connect. Pharmacy technicians can draw up hundreds, even thousands, of medications per day. This has ergonomic issues for the technician. One article from Premier’s “Advisor Live” had data from Children’s Hospital in Philadelphia stating that they drew up 2,500 oral medications per day!1 This would be a significant number of twisting motions for any pharmacy tech.

These products need to be recognized and addressed by a clinical team before implementing ENFit.  Many hospitals implement an “ENFit Task Force,” especially when considering ENFit within the NICU.

It’s also important to include pharmacy in such a task force, or with any related decisions, as they will be impacted by a transition to ENFit.

ENFit was designed with safety in mind: to avoid misconnections. This is important to remember as healthcare makes this transition.

Understanding the design changes, and the impact to the NICU (and Pharmacy for NICU) is important in order to make the right decisions before moving forward.

 

References:

1. “Advisor Live^®: Transitioning to ENFit Connectors: A Safer Enteral Feeding System,” Premier Inc. Accessed November 2017, http://offers.premierinc.com/rs/381-NBB-525/images/071416%20Advisor%20Live%20-%20Safer%20Enteral%20Feeding.pdf