Dr. Michael Smith (Host):  Welcome to Transformational Pediatrics. I’m Dr. Mike Smith, and today our topic is Enteral Connectors: Improving Quality and Safety. My guest is Dr. Ruba Abdelhadi. She’s the director of GI Resident Education for the Pediatric Residency Program. She’s also the director of Nutrition Services Program and assistant professor of pediatrics at the University of Missouri, Kansas City. Dr. Abdelhadi, welcome to the show. 

Dr. Ruba Abdelhadi (Guest):  Thank you very much. Thank you for having me. 

Dr. Smith:  Sure. So it’s my understanding that all the syringes and tubings that are used for enteral feeding, administering medications, they’re changing this year. What exactly is changing, and why is the change being made? 

Dr. Abdelhadi:  So, what is exactly changing is the design of any medicine or formula that are intended for delivery through the digestive system is not going to be compatible by design to be connected to any other route, such as intravenous or endotracheal or any other route. And the purpose for that is to prevent enteral misconnection. There had been cases with fatalities with significant morbidity where mistakes have happened. Either a caregiver or a medical staff member accidentally administered intended formula or intended medicine through the IV route or another route other than enteral, and that’s led to significant morbidity and at times mortality. So, this new design is not going to be compatible with any other route. 

Dr. Smith:  So, it seems with the media attention more and more on hospital, medication errors, so it seems like Children’s Mercy here is being very proactive. When you mentioned that there have been some cases of harm done to patients where there’s been the wrong thing connected, what numbers are we looking at here? Was this really significant? Obviously, enough so. Once person’s harmed, that’s probably enough to make the change, right? But how often was this actually occurring?  

Dr. Abdelhadi:  So it is unfortunately under-reported, but there have been 116 published cases as of 2011. They were all accidental misconnection, and that is exactly what triggered the joint commission to bring this to the attention of the hospitals and the Global Enteral Device Association to make this change and to utilize the international standardization organization to make this change to be universal not only among European countries but now in the United States and Canada. So as of 2011, there are 116 published cases, but we believe that the real number’s higher than this. 

Dr. Smith:  Now, this is a change that is being made in many different hospitals. Is that true in the United States, this isn’t just Children’s Mercy making these changes? Is this something that’s being done throughout the country? 

Dr. Abdelhadi:  This is a national initiative. Universally, the hospitals are very interested in being part of this change. Children’s Mercy is among the pioneers in this field. We already have a very nice preparedness plan to make the change happen safely and effectively. It is for the benefit of the patient and patient’s safety. The change is going to be difficult, but it’s very much worth the while. We believe that with our continuous commitment to patient care and patient safety, we will get our patients and families and caregivers and home nurses and pharmacists, all of them ready and prepared to work with us through this change when it happens. 

Dr. Smith:  And what about parents and family members? Will they be notified of the change? Are they going to be involved in some of the education of the new connectors? How are they being included in all this? 

Dr. Abdelhadi:  Absolutely. Our families and caregivers at home, they are on the front line, they care for patients at home, and we absolutely need their help in patient safety. We do have fact sheets that are ready, and we have actually been giving them out at the G-tube enteral access clinic and in the hospital. When we do have patients who are enteral nutrition dependent, we have it in English and in Spanish. We also take the time to educate our families about the change that is going to happen at every clinical encounter, both in the hospital and in the clinic. So when the change happens, we feel that our patients and families will be ready for the change, and we will walk them through the new connection, and we will be sure that they have everything they need for the connection once they start receiving the new design in the mail from their home, from their home health or durable medical equipment company. 

Dr. Smith:  So, Dr. Abdelhadi, is there a specific date that this going to happen, or is this something that’s going to be introduced slowly over time starting at a certain point? 

Dr. Abdelhadi:  So the manufacturers are working on changing the design, and they have their molds in place. The date has been pushed back from the third or fourth quarter of 2015 to the first quarter of 2016 just for better readiness. We are expecting the change to occur to the syringes and nasogastric tubes, and then the actual G-tube, their G-J tube to follow. So, the change is going to happen gradually to affect everything single piece of the connection from the formula side or the medication side all the way to the route where the patient is receiving the enteral formula or medicine. And in the meantime, there are adapters that are also being manufactured to allow the patients to receive their feeding and medicine uninterrupted as the change affects every single piece of the way. 

Dr. Smith:  So you mentioned this is a national initiative. Is there a timeline for the completion of this project, where all the major hospitals, community hospitals, community centers are going to be using these new connectors? 

Dr. Abdelhadi:  So, Europe has been the pioneer in this change, and they already have their new unique ISO standard enteral connectors. For us, for the United States, Canada, and Puerto Rico, we are hoping to have everything complete in 2016. I cannot predict if there is going to be further delay, but actually the website, stayconnected2015.org, does describe a timeline. And when there is a change or a delay, stayconnected2015.org, they do update their timeline to cater for the delay when it happens. But as of now, the whole change is expected in 2016. 

Dr. Smith:  So the website stayconnected2015.org, if some of our listeners go to check that out, what can they expect to find on that website? Besides the timeline, is there other additional information about the initiative there? 

Dr. Abdelhadi:  Yes. They have a very nice video that describes the purpose of the initiative, very touching videos of families who have been negatively affected by enteral misconnection. It also describes the actual design. There are very nice pictures of the new design that is not going to be compatible with any other route. So I encourage everyone who’s interested in learning more to check out that website. 

Dr. Smith:  Well, thank you so much, Dr. Abdelhadi, for coming on, I appreciate the effort here. Sounds like a very important program, and I think it’s going to be very successful and very important to patients. You’re listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information you can go to childrensmercy.org. That’s childrensmercy.org. I’m Dr. Mike. Have a great day.