Despite organizational guidelines, federal reports, and equipment redesign, tubing misconnections continue to occur. This review updates the 2011 article, Tubing misconnections: normalization of deviance, with a further 96 case reports of errors resulting from tubing misconnections. Harm was reported in 69% of cases and death was reported in 4% of cases. The authors urge all healthcare organizations to transition from universal connectors to syringes and tubing designed to be compatible only with themselves (for example, use of enteral tube with a unique connector that cannot be connected to an intravenous syringe).