Recently created Joint Commission standards aim to reduce maternal morbidity, which as the CDC reports, rose by nearly 200% between 1993 and 2014.1 The new standards require standardized care and protocol adherence, and they require the use of technology to support decision-making.
In 2019, the Joint Commission released its R3 Report: Requirement, Rationale, Reference for the "Provision of Care, Treatment, and Service standards for maternal safety."2 This report outlines new "elements of performance" for accredited hospitals. As the report's title would suggest, each requirement is followed by a rationale and a reference to the scientific study or report on which it is based. The report lays out requirements for two of the most pressing problems in maternal care: hemorrhage and severe hypertension/preeclampsia.
The requirements encompass many aspects of patient care, centering around education for both care teams and the patients' families, as well as requirements for supplies and medications that must be on hand. Importantly, the new accreditation standards also address the need for evidence-based tools for determining risk, standardized protocols of care, and reviews of events involving hemorrhage or severe hypertension/preeclampsia. This article examines technical solutions that identify and address risk from multiple points, enhancing the care team's ability to provide care that's timely, protocol-based, and preventative rather than reactive.
Technical Solutions Monitor and Provide Alerts
Maternal care teams have traditionally relied on post-discharge data to parse out what went wrong and apply these lessons to patients in the future. Even with external fetal monitors, blood pressure checks, and manual charting, noticing trends in patient status required a person to pour through records to see what changes had already taken place. Clinical decision support systems, which integrate hospitals' care protocols and pull information from the electronic medical record (EMR) and other medical devices, are embedded within algorithms designed to identify a patient's evolving risks. These systems actively monitor trends in a patient's health, alerting the teams ahead of a possible event, providing the chance to intervene before clinical deterioration happens.
Clinical decision support systems like GE Healthcare’s Mural Solution for Labor and Delivery allow care teams to see all patients on one dashboard, by hospital defined risk and status. Personnel also see color-coded prompts when labs or medications are needed to avoid missing the window of time-prescribed protocol steps.* The care team can define protocols they feel are important to track and be notified at critical points with defined protocol steps that should be taken at that time, intervening before the patient deteriorates.
Real-Time Tracking of Care Delivery and Patient Status
The Joint Commission elements of performance on maternal safety were developed based on the understanding that "prevention, early recognition, and timely treatment for maternal hemorrhage and severe hypertension/preeclampsia had the highest impact" toward decreasing maternal morbidity events.3
Real-time tracking of steps in care delivery and availability of patient status offer an important solution to reducing risks to both the patient and the organization.
Digitized Protocols and Workflows to Reduce Errors
Digitizing protocols and workflow within a system that can read data from virtually any device from any vendor and prompt the care team on the hospital's best practices can help to reduce error, increase the likelihood that protocol-defined care will be given as scheduled, and bring potential events to the team's attention before they happen. During handoffs, clinical surveillance systems ensure that all information on the patient is available to the entire team. They can see what care tasks have been completed, whether any steps have been missed, and what the next steps are.
Harnessing Data to Meet Maternal Care Standards
Clinical decision support tools that visualize data from multiple systems and devices and prompt clinical teams on necessary steps for compliant care can help hospitals meet the standards of care required for Joint Commission accreditation. These tools could make it easier for teams to assess the patient status including whether time-defined protocol elements have been performed and whether the facility's care standards are being followed. Clinical decision support solutions that also provide the ability to review and report on this data can enable hospitals to identify trends in care, such as if there was a recurring time when events were more likely to occur—during shift changes, for example.
The Joint Commission maternal care standards have one goal in mind: reducing maternal morbidity and mortality by promoting efficiency, transparency, and reducing variations in care. A clinical decision support system can help hospitals of any size meet these accreditation standards while improving care for each patient receiving maternity services.
REFERENCES
- Severe Maternal Morbidity in the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html#anchor_how
- R3 Report: Requirement, Rationale, Reference. The Joint Commission. https://www.jointcommission.org/standards/r3-report/r3-report-issue-24-pc-standards-for-maternal-safety/
- R3 Report. The Joint Commission.
- ICU Attending Handoff Practices: Results From a National Survey of Academic Intensivists. Critical Care Medicine. https://pubmed.ncbi.nlm.nih.gov/26588827/
- Sentinel Event Alert. The Joint Commission. https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/sentinel-event/sea_58_hand_off_comms_9_6_17_final_%281%29.pdf?db=web&hash=5642D63C1A5017BD214701514DA00139&hash=5642D63C1A5017BD214701514DA00139
*Enabled by Decisio - Class II 510(k) Cleared device
