BD NRFit roundtable booklet | Page 5

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We cannot stop the train – more or less every clinic in Europe and around the world has to adopt the new system Paul Kessler
More cases
Wrong-route errors IV to : a
Epidural b
Intrathecal c
Intraventricular / extraventricular Epidural to IV
Fewer cases
‘ We cannot stop the train ’
Prioritise patient safety as a benefit of NRFit™
Call for EU Registry of misconnections toward the ISO standard among anaesthetists is mixed , and that it is trying to solve problems they do not have , ie . they do not make mistakes , and that they prefer to use those systems on which they have been trained . They require easy identification of the differences between neuraxial connection types and should be able to identify a device specific to neuraxial applications .
There was unanimous support among the Faculty for the rigorous testing to which BD has subjected NRFit™ regarding torque and force required for proper placing of needles , stressing the importance of using the minimal amount of force to get a proper connection . There was agreement among the Faculty that implementation of the standard within one institution at a time should be the first goal , and that wider implementation , say within and across countries , will take time .
The Faculty shared their insight into the impact that NRFit™ might have on their patients and their practice . There was agreement that implementation would confer a potentially significant safety implication , but that the transition might be complicated and protracted . Controversies regarding winning over anaesthetists notwithstanding , there was the view that ‘ we cannot stop the train ’ in view of the fact that so many organisations and societies are pushing for something to be done regarding the safety of current connectors : Europe has to change and adopt the new system .
Regarding anaesthetist preferences , it was agreed among the Faculty that Luer Lock connection requires too much manipulation , and that they would be amenable to transitioning to Luer Slip connection for single shot and catheter , while perhaps retaining the Luer Lock for continuous applications , because it ’ s safer regarding disconnection .
Current status of NRFit™ guidance In response to a pre-Board Faculty questionnaire , it was learned that NRFit™ is currently being used by only one member from the UK , and its use is not yet widespread in the UK . It is being used mainly for spinals and some for PNBs , but the adoption is still very much in transition phase . Based on the experience from the UK delegate , clinicians are coming to terms with changing the way they work , and it is important that they be absolutely comfortable with the new systems . Nobody likes changes being made without their having been consulted , and the transition does cause some anxiety . In addition to the logistical and changeover problems , there were effectiveness

reduce information complication safety

patient safety cost
Potential impact of NRFit TM on patient care and practice
some instances of staff members finding workarounds . These and other transition issues are captured by a governance team , and addressed in route cause analysis , and learnings are cascaded back to all teams .
Also part of the pre-work was the question whether misconnections are monitored . It was ascertained that there is some monitoring , but it is neither routine nor mandatory . The consensus was that it would be good idea to have a European registry of misconnections , despite the fact that it is likely to run into problems of inconsistent methods and underreporting . Such a registry would best be done in association with ESRA through National Societies , so as to eliminate perception of industry bias .
Raising awareness of NRFit™ The raising awareness session was approached in three sections : ( 1 ) how to enable drivers to overcome barriers to the uptake of NRFit™ , ( 2 ) how to summarise the need for NRFit™ , and ( 3 ) what would comprise a strategy for raising awareness .
Patient safety was the overwhelming key driver to impact the conversion to NRFit™ , followed by training and product information . Other drivers included evidence of a reduction in complications , ease of introduction and cost-effectiveness .
Rating the impact that a range of drivers would have on conversion , manufacturer readiness and European Directives were rated most highly , followed by clinical standards and recommendations , and clinical evidence .

There was divided opinion among Faculty Members on the need for further clinical evidence ; some believed that the clinical evidence was clear , and that a transition to NRFit™ can reduce the number of wrong infusions . In 2017 the German Society of Anaesthesiology recommended the change to NRFit™ , but at that time the products were not available and there was little pressure to do so . Even as companies can assure product supply , because a recommendation is not mandatory , uptake has been slow . It might help if a recommendation could come training ease of introduction from ESRA or individual European Societies . In the case of Nottingham Hospital , which has trialled NRFit™ , the key driver is patient safety to avoid near misses , clinical incidences and never events . But nobody really likes to change and the real , enduring motivational driver will be those people who believe in it . Switching to identification of key costs barriers to conversion , availability of product and evidence resonated with everyone . >