Starting next July, the Joint Commission will require accredited hospitals to have 13 policies in place to help prevent the likelihood of hemorrhage and severe hypertension for pregnant patients.
The new standards, which will go into effect July 1, 2020, are in response to many hospitals adopting evidence-based practices to prevent maternal mortality due to hemorrhage and hypertension, two of the most common reasons for death in pregnant women.
"There has been a lot learned about what needs to be done to reduce maternal mortality rates," said Dr. David Baker, executive vice president for healthcare quality evaluation at the Joint Commission. "We thought it was time to take those (best practices) and turn them into requirements to ensure that all hospitals try to follow them."
The U.S. has a higher maternal mortality rate than other developed countries, with about 700 pregnancy-related deaths occurring each year, and 60% of those are preventable.
Hospitals' compliance with the standards will be evaluated during Joint Commission accreditation surveys, which occur every three years.
The requirements were selected based on input from the Alliance for Innovation on Maternal Health and the California Maternal Quality Care Collaborative, which has been successful in reducing maternal mortality rates through evidence-based practices in the state.
Prior to finalizing the standards, the Joint Commission also visited hospitals throughout the U.S. to get their feedback. Baker said hospitals were overwhelmingly positive.
The American Hospital Association is also supportive of the new requirements.
"These standards play a vital role for pregnant and postpartum women, as well as their families," Thomas Nickels, executive vice president of the AHA, wrote in a letter to the Joint Commission. "Maternal hemorrhage risk and severe hypertension/preeclampsia are two of the most common complications that occur in pregnant and postpartum women. Ensuring that hospitals and providers are trained and prepared to diagnose, manage and effectively treat such complications is critical."
Some of the standards are providing education to all staff who treat pregnant and postpartum patients about the organization's hemorrhage and hypertension procedures; conducting drills at least once per year to determine issues with ongoing quality improvement work and offering education to patients and their families about symptoms of postpartum hemorrhage and severe hypertension.
Baker said the Joint Commission attempted to select standards that all hospitals, no matter their resources, could comply with. For instance, the Joint Commission opted not to include a component of the safety bundles developed by the Alliance for Innovation on Maternal Health related to counting blood loss. Baker said there was concern that it would be too difficult for small hospitals to comply with.
"We see this as an ongoing process," he said. "We want to make sure that all hospitals can meet these new requirements, but we will continue to look at what we can do as hospitals get more experience with these things. They might be able to do additional things in the future."
In the coming months, the Joint Commission plans to host webinars with its accredited hospitals to explain the changes in more depth. Additionally, the Joint Commission is offering the Alliance for Innovation on Maternal Health and the California Maternal Quality Care Collaborative as resources for hospitals to successfully comply with the standards.
