New 2020 Maternal Mortality Framework & Standards

While the issue of maternal safety in the U.S. has been at the forefront of the healthcare landscape for the past several years, little progress has been made to improve quality and safety for mothers and babies.

Maternal & Neonatal Care Standards – 30 Years Later

Perhaps it’s the nature of “news fatigue,” that providers are routinely reminded of the national crisis, why the severity of the problem has lost its sense of urgency. It’s important to remember that for nearly 30 years, the maternal mortality rate in the U.S. is rising, while stable or falling everywhere else, as noted in USA Today’s Deadly Deliveries.

The full article title, “Deadly deliveries: How hospitals are failing new moms” presents a harsh reality. Hospitals and health systems have had ample time (nearly three decades) and opportunity to improve care for mothers and babies, yet maternal quality and safety have only decreased.

A New National Call to Maternal Quality of Care Action

Due to the lack of progress from our nation’s hospitals and health systems, many quality organizations have intervened to set standards and requirements in place that will ensure hospitals and health systems follow best practices to rapidly and drastically affect mothers’ and babies’ care.

One of the latest set of requirements comes from The Joint Commission, an independent not-for-profit organization that accredits and certifies over 22,000 healthcare organizations and programs in the U.S. Their mission is to “continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value” with a vision to ensure that “all people always experience the safest, highest quality, best-value health care across all settings.”

What does this mean for hospitals with Joint Commission accreditation?

Effective July 2020, hospitals that are Joint Commission accredited will be held accountable to demonstrate adherence to new requirements focused on improving the quality and safe care provided to women during all stages of pregnancy and postpartum—particularly in the areas of obstetrical hemorrhage and severe hypertensive/preeclampsia.

The rationale for this new neonatal quality of care framework:

1. The U.S. ranks 65^th compared to other industrialized nations in maternal death.
2. The Joint Commission identified that the highest impact/improvement for maternal complications is in hemorrhage and severe hypertensive/preeclampsia.
3. And that prevention, early recognition, and timely treatment is what is leading to improvement in maternal complications.

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.

The standards were developed based on recommendations from The Alliance for Innovation on Maternal Health (AIM) program’s maternal safety bundles that provide best practices for maternity care, and with advice from the American College of Obstetricians and Gynecologists (ACOG), California Maternal Quality Care Collaborative (CMQCC) and other national experts.

In addition to compiling data from an extensive literature review and public field review, The Joint Commission consulted with a Technical Advisory Panel (TAP) of subject matter experts in maternal health and a Standards Review Panel (SRP) of clinicians and administrators to provide an insider’s perspective.

The prepublication version of the maternal safety standards is available online until June 30, 2020. After July 1, 2020, the new requirements may be accessed in the E-dition or standards manual.

Expert Advice

Relias’ recent online panel discussion, “July 2020 New Joint Commission Maternal Safety Standards: How Prepared Are You?” was attended by more than 800 nurses and providers across the nation (with over 2,800 registrants).

The panel discussion featured obstetrics experts on specific solutions, interventions, and recommendations on how to meet these new requirements.

Significant webinar insights included:

• A close look at the 13 new elements of performance within the Provision of Care, Treatment, and Services standards for maternal safety
• Nurses’ and providers’ roles in meeting the new standards (per AWHONN, ACOG, SMFM, etc.)
• Specific solutions, interventions, and recommendations on how organizations will meet the new requirements
• Results from gap analyses from leading organizations

View the webinar slides and recording.

The Current State

Based on live polling during the webinar, results indicate:

• Overwhelming support (88% of attendees) for national maternal safety standards having a positive effect on maternal outcomes.
• However, less than half of the attendees (44%) reported having performed a gap analysis for maternal safety outcome improvement.
• Almost 50% noted “physician participation” as the leading area of concern.

Maternal Safety Standards Webinar Poll Results

1. Do you believe these measures will be helpful to improve maternal outcomes?
   1. Yes: 87.6%
   2. No: 0.5%
   3. I’m not sure: 11.9%
2. Have you performed your gap analysis yet?
   1. Yes: 43.9%
   2. No: 32.4%
   3. I’m not sure: 23.7%
3. If you have performed a gap analysis, what is your number one area of concern?
   1. Physician participation: 46%
   2. Simulation and team training: 20.5%
   3. Documenting proof of meeting the Eps: 23.8%
   4. Other: 9.7%

Relias – A National Leader in Maternal Safety

What sets us apart? At Relias, we have the most effective education solution, available for the full obstetrics team (both providers and nurses) in both obstetrical hemorrhage and hypertensive disorders of pregnancy.

Relias OB (formerly GNOSIS™) 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.

Benefits of Working With Relias

Clients that are using Relias OB are able to demonstrate improvement in maternal safety by leveraging the solution’s benefits, including:

1. Easily accessible and consistent evidence-based education delivered for the multidisciplinary team, including: physicians, nurses, midwives, and residents.
   • Education includes: risk assessment, anatomy and physiology, diagnosis and treatment, real simulated cases with multimedia, downloadable tools, medications and indications, surgical interventions, team roles and responsibilities, skills demonstration.
   • Examples include blood quantification and blood pressure measurement techniques, examples from other health systems on protocols, and so much more.
2. Assessment-based, personalized learning that provides individual and team variation/analytics to inform leaders on where performance is strong and where improvement needs to occur.
3. Benchmark comparison analytics to inform how teams are performing compared to others across the nation in terms of following national evidence-based guidelines for maternal hemorrhage and severe hypertension/preeclampsia. This also includes the utilization and completion reports for all users.
4. Guidance on how to develop, run, and manage high and low fidelity simulation and team training programs and simulations embedded within the education solution’s content.

Clients that are currently using Relias OB have demonstrated nothing short of remarkable results in improving quality and safety for mothers and babies, including:

• 50% improvement in massive transfusion protocols (codes for obstetrical hemorrhage)
• 50% reduction in blood and blood products utilization
• Zero maternal deaths associated with an obstetric hemorrhage since using Relias OB
• 46% reduction in coded eclampsia cases following the use of our solution across their system (demonstrated by one of the largest health systems in the U.S.)

Additionally:

• 8 of 10 of the top hospital systems and over 800 facilities across the U.S. use Relias OB
• Over 20% of obstetricians are covered by Relias OB nationally
• Over 25% of labor & delivery nurses in the U.S. have completed a course within Relias OB

How Relias Can Help

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.