Transition to NRFit™ Connectors for Intrathecal and Epidural Procedures, and Delivery of Regional Blocks

This is an alert update, issued by the NHS England National Patient Safety Team and co-badged by the Association of Anaesthetists, Royal College of Anaesthetists, and the Safe Anaesthesia Liaison Group. It instructs all relevant NHS-funded providers to transition to NRFit™ connectors for all intrathecal and epidural procedures, and the delivery of regional blocks. The original alert was published here on 30 January 2024.

Transition should be completed by 31 January 2025.

This National Patient Safety Alert was issued to ensure that the risk of misconnection and wrong route error is reduced by implementing the design solution as per ISO 80369-6.

Issuing the alert has driven significant change in product availability and consequently safer NHS care.

Suppliers to the NHS (including NHS Supply Chain) can provide support in sourcing NRFit™ devices and the Safe Anaesthetic Liaison Group (SALG) has produced an FAQ page to provide professional support in relation to which procedures fall within the remit of the alert and to support clinical queries.

In addition, organisations may wish to share insight into how they have implemented the alert and what products they have sourced with other organisations via their clinical procurement specialist (CPS) and medical device safety officer (MDSO) to ensure the sharing of good practice.

See our Useful Links section for the full alert on NHS England’s website.

This alert has been issued as a National Patient Safety Alert.

The NHS England National Patient Safety Team was the first national body to have been accredited to issue National Patient Safety Alerts by the National Patient Safety Alerting Committee (NaPSAC). All National Patient Safety Alerts are required to meet NaPSAC’s thresholds and standards.

These thresholds and standards include working with patients, frontline staff and experts to ensure alerts provide clear, effective actions for safety-critical issues.

NaPSAC requires providers to introduce new systems for planning and coordinating the actions required by any National Patient Safety Alert across their organisation, with executive oversight.

Failure to take the actions required under any National Patient Safety Alert may lead to CQC taking regulatory action.

Patient safety alerts are shared rapidly with healthcare providers via the Central Alerting System (CAS).

See our Useful Links section to read more about CAS.