This article excerpts a HealthStream article by Trisha Coady, BSN, RN, Senior Vice President and General Manager of HealthStream’s Clinical Solutions, about the new perinatal care standards that have been issued by the Joint Commission.
Multiple health conditions occur during pregnancy and after delivery that put the mother and child’s lives at risk. Three of the most significant are explicitly addressed in these new Joint Commission Guidelines. Understanding them, as well as understanding the standard treatments for avoiding or addressing them, can help a reader understand just how negligent some healthcare providers have been in their precautions.
According to the Children’s Hospital of Philadelphia, “Postpartum hemorrhage is excessive bleeding following the birth of a baby. About 1 to 5 percent of women have postpartum hemorrhage and it is more likely with a caesarean birth. Hemorrhage most commonly occurs after the placenta is delivered. The average amount of blood loss after the birth of a single baby in vaginal delivery is about 500 ml (or about a half of a quart). The average amount of blood loss for a cesarean birth is approximately 1,000 ml (or one quart). Most postpartum hemorrhage occurs right after delivery, but it can occur later as well” (CHOP.edu, n.d.). In addition to assessing mothers for hemorrhage risk, clinicians should monitor for cumulative blood loss during delivery and have a treatment cart with supplies nearby.
Maternal hypertension, also known as gestational hypertension, “is a form of high blood pressure in pregnancy. It occurs in about 6 percent of all pregnancies. Another type of high blood pressure is chronic hypertension--high blood pressure that is present before pregnancy begins” (CHOP.edu, n.d.). Treatment involves “measurement and assessment of BP and urine protein for all pregnant and postpartum women” (Council on Patient Safety in Women’s Health Care, 2015) and medication treatment and other escalation measures as needed.
The Mayo Clinic shares that “Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys. Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal” (Mayo Clinic Staff, n.d.). According to the Preeclampsia Foundation, prevention and timely treatment occurs when the healthcare provider watches “for signs of instability in the mother, including very high blood pressure that’s not responding to antihypertensive drugs, signs the kidneys and/or liver are failing, and a reduced number of red blood cells or platelets. Providers also watch closely for indications of an impending seizure or signs the brain is about to stroke and may treat the patient with magnesium sulfate (an anticonvulsant specifically used for preeclampsia). Antihypertensive drugs will be used if blood pressure rises to dangerously high levels, 160/110 or higher” (Preeclampsia.org, 2018). The Joint Commission Standards establish multiple requirements for improving maternal care and outcomes. For example, they call “for maternity units to keep life-saving medications immediately accessible. Hospitals also must plan for the rapid release of blood supplies for transfusions” (Stein, 2019). Because a rapid response is often essential when dealing with complications, the standards focus strongly on making equipment and medication available for when they are needed.
In addition, the article includes:
Download this article, “New Joint Commission Guidelines Target Poor Maternal Mortality Outcomes,” to learn about the new Joint Commission safety standards for the improvement of maternal and perinatal care, and why it has taken so long for the US to understand the need for them.
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