Sentinel alert: ISO tubing connector standards

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The Joint Commission has released Issue 53 of its Sentinel Event Alerts on following the International Organization for Standardization's tubing connector standards.

The first standard has been introduced, and others are expected to be rolled out and implemented through 2014 and 2015. The standards were developed by the ISO in collaboration with the Association for the Advancement of Medical Instrumentation as well as clinicians, manufacturers and the Food and Drug Administration.

While misconnection does not occur often, it can be a fatal error. It can be caused by unrelated connectors fitting together well, provider inattention, poor lighting and other environmental factors, putting too many unrelated tubes in close proximity and not double-checking patients' tubes, according to The Joint Commission. The new standards are intended to reduce the incidences of misconnection due to these factors.

To prepare for the new standards, The Joint Commission suggests assessing current risks of injury due to misconnection, learning about the upcoming standards, modifying existing processes to prepare for the standards and being aware of the transition period in which new connectors will be available.

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