The Joint Commission announces new guidelines
Of every 100,000 births in the U.S., there are 17.4 maternal deaths—ranking the U.S. 65th among industrialized nations, according to the Centers for Disease Control and Prevention (CDC). To combat this problem, The Joint Commission has taken aim at two key factors influencing maternal mortality and morbidity—hemorrhage and severe hypertension/preeclampsia—in its latest guideline changes.
Taking effect in January 2021 (delayed from an original date of July 2020), the requirements apply 13 new elements of performance to Joint Commission-accredited hospitals. According to The Joint Commission, a comprehensive literature review “revealed that prevention, early recognition and timely treatment” for those two maternal conditions could produce the greatest impact in states working to reduce maternal complications.
“You’d think from all the technology and resources we have, the United States should have the lowest maternal mortality rate,” says HealthTrust Physician Advisor Frank Kolucki, M.D., FACOG, Chairman of the Department of Obstetrics at Moses Taylor Hospital in Scranton, Pennsylvania, and the Community Health Systems Obstetrics and Gynecology Advisor.
“One of the barriers has been a lack of evidence-based protocols for how to treat women who have significant complications,” he says. “The Joint Commission is promoting standardization and a heightened preparedness on behalf of hospitals.”
Key measures
The Joint Commission’s new guidelines are part of an ongoing effort to address and improve various aspects of perinatal care, Dr. Kolucki notes. Scenarios targeted in recent years include elective deliveries, primary cesarean sections, and neonatal mortality and morbidity.
As the first in the country to be accredited as a Perinatal Center of Excellence in 2015, Moses Taylor Hospital has been tapped by The Joint Commission to provide its protocols surrounding maternal care for the Commission’s library. There, other institutions aspiring to achieve this certification can access this information.
Dr. Kolucki points out that maternal hemorrhage and severe hypertension/preeclampsia are “two high-focus areas” when the goal is cutting complications and deaths in the perinatal setting. “These are two disease processes that can really move the needle when you’re hoping to decrease maternal morbidity and mortality,” he explains. “Studies have shown that up to 70% of deaths associated with hemorrhage are preventable, as are 50% of those associated with hypertensive emergencies.”
Several key measures outlined in The Joint Commission’s new guidelines include:
- Developing written evidence-based procedures for managing patients who are experiencing maternal hemorrhage or high blood pressure
- Creating standardized, dedicated hemorrhage supply kits
- Providing role-specific education to all staff members and providers regarding the hospital’s procedures during these patient scenarios
- Conducting drills at least once a year to determine opportunities for process improvements
- Providing education to patients and families about these conditions
Moving these standards forward will require a mindset change. “It’s not just about having a simple toolkit,” adds Dr. Kolucki. “This is a culture shift that will provide great dividends.”
HealthTrust’s Nursing Advisory Board and Perinatal Specialty Committee both played an integral role in providing feedback and reviewing equipment to meet the new Joint Commission guidelines, says Tara Coleman, MBA, BSN, RN, former Director of Nursing Services, Clinical Operations for HealthTrust. Coleman adds that for the HealthTrust category Blood/Fluid Warming Equipment and Supplies, the Advisory Boards reviewed equipment for rapid infusion of blood products and IV solutions to help prevent hypothermia, which often occur during maternal hemorrhage.
Creating a culture of safety
Dr. Kolucki explains that most highly reliable hospitals will have at least some of these performance elements already in place as part of their perinatal care. But for some, the new requirements will serve as a checklist—and perhaps an incentive—to fuel efforts to become a Perinatal Center of Excellence. “I support The Joint Commission’s efforts in requiring these standard processes for maternal care,” he says.
Healthcare facilities will face certain obstacles in implementing The Joint Commission requirements, Dr. Kolucki says. First and foremost is making sure they practice in a culture of safety and collaboration.
“Obstetrics, perhaps more than any other specialty, is a team sport,” notes. Dr. Kolucki. “It’s not just the birth attendant, physician or midwife taking care of the patient—it’s everyone who’s engaged in her care. Therefore, it’s imperative to foster a team-based culture of safety.”
COVID-19’s impact on obstetrics
The COVID-19 pandemic has spared no population—including pregnant women, new mothers and neonates. But while the data is changing rapidly, it appears these groups aren’t more vulnerable than others to either catch the virus or suffer worse outcomes, says Dr. Kolucki.
“Put it in juxtaposition to the flu: When pregnant women get the flu, they’re much more likely to have adverse outcomes compared to non-pregnant women,” he explains. “They don’t have the pulmonary reserve, so it’s harder to breathe, and they’re in a relatively immunocompromised state and more likely to get severely ill. Thankfully, this hasn’t been the case with COVID-19.”
Dr. Kolucki recommends other facilities consider a standardized approach to shaping perinatal care, including looking to evidence-based protocols issued by the Centers for Disease Control and Prevention (CDC), American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal-Fetal Medicine (SMFM).
“Regarding COVID-19, we’re learning as we go, using the evidence that is available. This situation is extremely fluid,” Dr. Kolucki notes. “Women are going to be having babies whether or not there’s COVID-19. What’s incumbent on clinicians is to stay up to date on the latest information as it evolves.”
Dr. Kolucki will offer two new programs on maternal morbidity and hypertension. Click here to sign up or listen to a recording. For more information on contracted products in related categories, contact AVP of Clinical Operations Jennel Lengle.
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