The Joint Commission Response to the Rising Maternal Mortality Rate

That number equates to 810 women dying every day from preventable causes, leaving their newborns without a mother.¹ While the majority of the countries affected by increasing maternal mortality are considered low and middle income, there has been an alarming increase in maternal mortality in the United States, with numbers now ranking “65^th among industrialized nations in terms of maternal death.”² The CDC released the following graph showing the increase in pregnancy-related mortality in the United States between 1987 – 2016:³  

The CDC surveillance system tracked the causes of pregnancy-related deaths in the United States between 2011-2016 (in percentages):³

Additional information supplied by the CDC shows the existence of racial/ethnic disparities in pregnancy-related mortality, with black women being most at risk in the United States:³

In response to the increasing danger to women and ultimately their families, the Joint Commission assembled a technical advisory panel to review the existing expert literature and set an action plan that would guide its accredited hospitals in ways to help increase safety, thereby reducing maternal morbidity and mortality. The research showed two definite strategies that would have the greatest impact on the overall problem: “Prevention, early recognition, and timely treatment for maternal hemorrhage and severe hypertension/preeclampsia.”²

The new standards released by the Joint Commission address the most common findings that lead to poor outcomes for women. In the case of PPH, accredited facilities will have to show proof of the following:

• Clearly defined procedures for stage-based management of maternal hemorrhage
• Critical medications must be immediately available on the obstetric unit
• The ability to activate the emergency response team when needed
• A massive transfusion procedure or other blood bank plan for emergency release of blood products
• Annual drills including all members of the obstetric team as part of an ongoing quality improvement plan
• Review all cases to determine where improvements are needed²

In cases of severe hypertension / pre-eclampsia, accredited facilities will have to show proof of the following:

• Clearly defined procedures for blood pressure measurement
• Critical medications must be immediately available on the obstetric unit for decreasing blood pressure and seizure prophylaxis
• Correct use of fetal monitoring for all patients with elevated blood pressure
• Drills including all members of the obstetric team conducted at least annually, as part of an ongoing quality improvement plan
• Review all cases to determine where improvements are needed²

In order to enable multidisciplinary teams to meet the new JCAHO requirements, Limbs & Things have developed a series of training products that allow practicing for many high-risk, low-volume scenarios that affect families during pregnancy and childbirth. PROMPT Flex Maternal Hemorrhage Kit part of PROMPT Flex Range has been created for effective identification and management of PPH with an atonic and contracting uterus. Additionally, the new dark-skin range allows for the addition of drills that can improve the outcomes for all races and ethnicities. 

<sup>References:
1. WHO Maternal Mortality Fact Sheet
2. The Joint Commission Standards for Maternal Safety
3. CDC Pregnancy Mortality Surveillance System</sup>