Let’s Talk: Q&A Highlights from OB Panel on New Maternal Safety Standards

Effective July 2020, new elements of performance will be applicable to hospitals that are Joint Commission accredited within the Provision of Care, Treatment, and Services standards for maternal safety. To prepare hospitals to meet these new standards, The Joint Commission has issued a new R3 Report that provides guidelines for the 13 new elements of performance (EPs) that fall under the standards. The report provides the requirement, rationale and reference for each EP.

A recent online panel discussion, “July 2020 New Joint Commission Maternal Safety Standards: How Prepared Are You?” was led by obstetrics experts on specific solutions, interventions, and recommendations on how to meet these new requirements.

View the webinar slides and recording.

Highlights from the Q&A session include:

Q: Is there data available demonstrating when postpartum hemorrhages (PPH) most frequently occur (e.g., labor and delivery, postpartum, home, and/or birthing centers)?

A: PPHs can be categorized into two groups—early postpartum hemorrhage and late postpartum hemorrhage. Early postpartum hemorrhages (occurring within 24 hours of delivery) represent the clear majority of obstetrical hemorrhages, with uterine atony accounting for 70% to 80% of all hemorrhages.

Late postpartum hemorrhages (occurring 24 hours to 6 weeks post-delivery) should also be addressed, especially with the growing rate of women delivering outside the hospital. This makes patient education for late postpartum hemorrhages especially important.

Q: How can hospitals access AWHONN’s POST-BIRTH program resources?

A: Recognizing that over half of maternal deaths occur within the first year after childbirth, AWHONN has developed the POST-BIRTH Warning Signs Education Program to help nurses and clinicians implement this life-saving program at their facility. The POST-BIRTH Warning Signs Education Program consists of multiple components:

• An online education course with CNE offering
• Implementation Toolkit
• The Post-Birth Warning Signs Magnet and Magnet templates
• Save Your Life handouts in English, Spanish, Arabic and Mandarin-Chinese translations

This page provides more information and instructions for obtaining the specific materials listed above.

Q: Which states are participating in the AIM initiative?

A: The Alliance for Innovation on Maternal Health (AIM) is a national data-driven maternal safety and quality improvement initiative based on proven implementation approaches to improving maternal safety and outcomes in the U.S. Participating states and systems can be found here.

Q: 2020 Standards say annual drills. Does this imply annually for each RN and provider? Or minimum of one multidisciplinary drill annually on the unit?

A: Effective July 1, 2020, 13 new elements of performance (EPs) will be applicable to Joint Commission-accredited hospitals. These new requirements are within the Provision of Care, Treatment, and Services (PC) chapter at PC.06.01.01 and PC.06.01.03 and are designed to improve the quality and safety of care provided to women during all stages of pregnancy and postpartum.

According to the PC.06.01.01 (reduce the likelihood of harm related to maternal hemorrhage) EP 5 calls for hospitals to “conduct drills at least annually to determine system issues as part of on-going quality improvement efforts. Drills include representation from each discipline identified in the organization’s hemorrhage response procedure and include a team debrief after the drill.”

Subject matter experts at Relias understand this to mean every nurse and provider from the labor and delivery team must complete at least one drill annually as part of a simulation team training event.

We have found that clients already simulating OBH and HDP drills require each active nurse and credentialed physician to participate in a simulation team training annually. This is accomplished with flexibility in participation per drill (e.g., one drill may include one provider and four nurses, and another might have two providers and one nurse).

The goal is to ensure every team member participates in one, if not more than one, simulation team training exercise. This is effective in learning and understanding roles, communication, action, documentation, location of drugs, supplies, blood, etc.  Each drill includes a debrief on what went well and identifying opportunities for improvement.

Q: How do we get doctors on board to comply?

A: Large-scale change requires commitment from all levels of a healthcare organization—often starting with physicians. While patient safety is the most critical and pressing issue, physicians are incredibly busy and still faced with a number of tasks and requirements on a regular basis (charting, billing, admin, re-credentialing, education, and so on).

As a nurse who’s led maternal safety improvement efforts at the nation’s largest nonprofit healthcare system, I understand firsthand the challenges that can come with gaining physician’s buy-in. As echoed by Dr. Cusick on the panel recording, the following five steps are a great start to approaching physician champions:

1. Outline the common purpose (e.g., decrease maternal harm, demonstrate multidisciplinary participation, have clinical leaders help gain buy-in from medical staff and nurses)
2. Provide the big picture (how this will affect the entire organization)
3. Be prepared with the facts (data, data, and more data)
4. Ask for their commitment to help find a champion
5. Deliver routine updates on progress or challenges

Q: How does Relias OB address the new maternal mortality standards?

A: Relias OB (formerly GNOSIS™) is an evidence-based, effective education solution, available for the full obstetrics team (both providers and nurses) in both obstetrical hemorrhage and hypertensive disorders of pregnancy.

Relias OB is truly unique in its multidisciplinary education approach, ensuring that the entire labor and delivery team are following the same evidence-based best practices, allowing them to provide care and communicate as a true team.

For more than 20 years, Relias has helped hospitals identify and reduce variation in care and improve patient safety with analytics, provider and nurse assessments, and evidence-based education tailored to the individual.

Relias OB offers a suite of AWHONN-validated and co-authored courses for providers and nurses on promoting vaginal birth, fetal assessment and monitoring, shoulder dystocia, obstetrical hemorrhage, and hypertensive disorders in pregnancy.