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Nurse specialists warn of 'disjointed' roll-out of enteral feeding devices

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Nutrition nurse specialists say they have seen a surge in emergency call-outs because of problems related to the “disjointed” roll-out of new enteral feeding devices.

They say delays in the availability of new ENFit equipment, difficulties in getting hold of different parts and adaptors, and an overall lack of information has caused a dramatic increase in their workload as patients and carers struggle to make use of the new devices.

The ENFit system – designed to address safety concerns related to the connectors on enteral feeding devices - has been introduced worldwide following the launch of new standards by the International Organization for Standardization.

In the UK, the transition to the new system – which was designed to be a phased introduction - started in October 2015.

However, community nutrition nurses in Hampshire, who are due to present a poster on their experiences at the annual conference of the National Nutrition Nurses Group (NNNG) next month, told Nursing Times they had been beset with problems relating to the roll-out so far in the UK.

”We experienced a big increase in the volume of calls to us – panic calls – because people had used their [old] stock up”

Hazel Jackson

“We were given a timeline by the companies of when all this was going to happen and patients were communicated with initially – so in our patch patients were sent a letter explaining the ends of their feeding equipment and the ends of their syringes would all be changed,” explained community nutrition nurse specialist Hazel Jackson, from Hampshire Hospitals Foundation Trust’s home enteral nutrition team.

However, she said a “huge gap” between new giving sets and new syringes becoming available, as well as problems getting hold of new ends for tubing, had led to confusion among patients and meant nurses had been rushed of their feet trying to resolve issues.

“Especially when the syringes came out we experienced a big increase in the volume of calls to us – panic calls – because people had used their stock up, then had a new delivery, opened the boxes and suddenly thought ‘What is this?’,” she said.

“The information they were given was so far in advance that they had forgotten so they then weren’t able to use them and therefore couldn’t feed or get their medication.

“We have had to treat it is as an emergency and drop everything to go and sort these patients out,” she added.

Issues included the fact hospitals and others were still using up old stock. Meanwhile some feeding device companies continued to supply adaptors that others had stopped providing, claimed Ms Jackson.

“It is difficult because we haven’t known how to order – we don’t know the codes, we don’t know the equipment names because they have changed”

Hazel Jackson

“The hospitals have had a huge backlog of old stock so if we had a patient in the community with new equipment and they’ve gone into a hospital with old equipment then it can’t be used,” she said.

“Or if they have had an old device placed in hospital and then have gone home, the equipment that is sent out is new and so won’t work with the old equipment,” she added.

Meanwhile nurses had struggled to get hold of information, such as the new names of devices, needed to order the right equipment.

“It is difficult because we haven’t known how to order – we don’t know the codes, we don’t know the equipment names because they have changed,” said Ms Jackson.

The roll-out of ENFit in the UK has been spearheaded by the Enteral Plastic Safety Group (EPSG), which represents leading UK enteral feeding device suppliers, with representation from clinicians and other healthcare and patient groups.

Barbara Dovaston of the NNNG – one of the clinical representatives on the EPSG – said she was aware nurses on the ground were experiencing problems and admitted she was frustrated by the way the process had been handled.

“We mentioned right at the very beginning that unless it was a smooth roll-out that these problems were going to happen,” she told Nursing Times.

”The industry would not give us photographs of their products until it was literally being launched”

Barbara Dovaston 

“We wanted it to be a one-stop shop so you could go from your current order on the one day to being able to order everything ENFit the next,” said Ms Dovaston.

Efforts to co-ordinate the roll-out had “started with good intent” but had been very much “industry-driven” she said, noting clinicians had not always been given advance specific instructions on how to transition between the old and new equipment.

“Believe it or not the industry would not give us photographs of their products until it was literally being launched – it was very cloak and dagger and one of the things I found most frustrating,” she said.

“Every company has now done that but it would have been better if they had done that at the beginning,” she added, though noting that at her own organisation, Heart of England NHS Foundation Trust the switch had been relatively straightforward.

“Overall it is fair to say it has been disjointed and frustrating and I think it has been industry-driven,” she added. 

“As an industry, we worked in partnership with healthcare professionals to agree a staged transition to the new ENFit connector”

Enteral Plastic Safety Group

However, feeding device suppliers maintain they have worked hard over a three-year period to ensure the roll-out went as smoothly as possible involving “extensive communication” with the NHS, industry partners, healthcare professionals and patients.

“The manufacture, introduction and availability of a new design standard across several hundred enteral feed devices is a complex process,” said a statement from the EPSG to Nursing Times.

“As an industry, we worked in partnership with healthcare professionals to agree a staged transition to the new ENFit connector and to implement this switchover as smoothly as possible. Open and comprehensive communications and updates were shared throughout the transition period,” said the body.

The EPSG said it acknowledged there was a delay to the second phase of moving over to the new equipment, due to the fact more testing was required of ENFit low dose enteral syringes.

”The quality and safety of enteral feeding device equipment is always our top priority,” said the body.

“We continue to work with our NHS partners including nursing teams, to complete the transition to the new safer ENFit system for all patients in their care, and when the process is complete to the satisfaction of healthcare professionals, the loose adaptors will be discontinued,” it added.

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