Webinar | Call to Action: Experience in Adopting the ENFit System to Guard Against Accidental Tubing Misconnections

February 24, 2021 | 1:00 p.m. ET


Catheter misconnections involving enteral-to-IV tubing often lead to severe consequences for patients and families. Despite the recent adoption of connector design standards for enteral devices (ENFit™), the creation of a Joint Commission Sentinel event advisory in 2014, and the formation of a manufacturers consortium to support compliance and rapid development of ENFit devices in hospitals and health systems, the US response has been underwhelming at best. Even with improvements of a new low-dose tip ENFit syringe, a large number of organizations have yet to be fully compliant with this transition due to the complexity of the change that is required —leaving patients in a vulnerable position.

Join experts from the Institute for Safe Medication Practices, ECRI, and some of the nation’s leading health systems as they dissect the many challenges associated with wrong route errors, and discuss the product design concerns that led to the re-engineering of the new ISO standard and the low-dose tip syringe. Most importantly, the panel will highlight the patient safety benefits to an ENFit transition. One expert will share how their organization successfully made the ENFit transition, the practice implications, and the lessons learned in the implementation of ENFit-compliant devices.

Learning objectives

At the end of this webinar, attendees will be able to:

  • Describe the safety challenges associated with wrong route enteral-IV medication errors.
  • Reflect on the hierarchy of strategies used to support safe enteral administration of medications.
  • Identify continued opportunities for national improvement towards the prevention of wrong route errors.
  • Share in first-hand implementation experiences from a healthcare organization's adoption of ENFit-compliant devices.

Agenda & Speakers

Michael R. Cohen, RPh, MS, ScD (hon.), DPS (hon.), FASHP

President, ISMP

Dr. Cohen’s passion for medication safety began in 1974 when he was involved in a serious adverse event with insulin in the hospital where he was employed. He immediately saw the value in sharing his story with other hospital pharmacists to prevent the same error from occurring. Dr. Cohen founded ISMP in 1994 and launched the first of five ISMP Medication Safety Alert! publications in 1997. The Newsletters along with Safety Alerts now reach over a million health professionals in the US as well as regulatory authorities and others in over 30 foreign countries.

Juuso Leinonen

Senior Project Officer-Health Devices, ECRI

In his role at ECRI, Juuso Leinonen performs comparative hands-on medical device evaluations and investigates medical device related problems. Juuso is currently ECRI's lead subject matter expert on medication delivery and pharmacy technologies. He has tested and evaluated most of the currently marketed infusion devices in the US and assisted a number of healthcare facilities with technology selection/procurement projects.

Felix Lam, PharmD, MBA, BCPS

Pediatric Operations Manager, Pharmacy, University of Iowa Health Care

Felix Lam earned his Doctor of Pharmacy from the University Of North Carolina Eshelman School Of Pharmacy and his MBA with an emphasis on healthcare management from the Johns Hopkins Carey Business School while completing a combined PGY1/PGY2 in health-system pharmacy administration at The Johns Hopkins Hospital.

Emily Spellman, MSN, RNC-NIC

Nurse, University of Iowa Stead Family Children's Hospital

Emily Spellman has been a neonatal nurse for 23 years at University of Iowa Stead Family Children’s Hospital in Iowa City, IA. She has had various roles, including fifteen years at the bedside on the night shift, Assistant Nurse Manager, Interim Nurse Manager, Nursing Practice Leader and currently Associate Director for Neonatal Services, Co-Associate Director for the Neonatal/Pediatric Transport team, and Co-Director of the Neonatal Simulation Program.


Visit the Institute for Safe Medication Practices website to learn more about this webinar and to register.