New accreditation standards require better hospital preparation to handle maternal bleeding around childbirth

Hospital accrediting agency The Joint Commission has implemented new requirements for accredited hospitals to address maternal patient safety. This action is response to a disturbing trend in the United States reflecting an increase in deaths of mothers in or around childbirth.

While the national goal has been around 11 maternal deaths per 100,000 babies born, the most recent data reflect figures of 17.3 mothers dying per 100,000 live births. To put it in perspective, the maternal death rate in American has over doubled in the last 30 years.

With all of the advances in medicine and modern healthcare, this is really hard to accept or understand. There’s no doubt that hospitals, obstetrician/gynecologist physicians (OB/GYNs), and labor and delivery nurses want what’s best for their patients. Yet the U.S. Centers for Disease Control and Prevention (CDC) chalk up around 60% of maternal deaths as being preventable if the mothers received proper care around delivery.

Needless to say, a lot of medical professionals and researchers have been trying to figure out why this trend is moving in the wrong direction. Many experts believe that it may be because mothers are generally less healthy now than in previous years. They cite serious medical conditions including diabetes, being overweight or obese, high blood pressure (hypertension), and heart conditions.

While that may be true, the standard of care requires hospitals, doctors, and nurses to treat patients as they come in the door, including being prepared to handle other conditions or comorbidities that increase a patient’s risks.

Maternal hemorrhaging

One of the most common causes of maternal death around delivery is hemorrhaging. Here at Painter Law Firm, we’ve handled several cases where moms experienced massive amounts of hemorrhaging.

We’ve represented wrongful death clients in medical malpractice lawsuits involving uterine rupture where the mom’s bleeding was not promptly controlled, resulting in the mother’s death on the operating room table.

In another case, the mother got through delivery of her child just fine, but over the next day or so had an extreme amount of bleeding that wasn’t corrected appropriately by restoring her blood volume via transfusion. As a result, she was left with brain damage to her pituitary gland in a medical condition called Sheehan’s Syndrome.

To address this known serious problem, The Joint Commission added seven elements of performance that hospitals must demonstrate to keep their accreditation:

• The labor and delivery team must document a hemorrhage risk assessment in the patient’s medical record. This needs to be repeated after delivery when the mom is admitted for postpartum care.

• Accredited hospitals must have written policies and procedures to guide the management of maternal hemorrhaging. The Joint Commission wants hospitals to standardize the approach that nurses and staff are expected to undertake during maternal hemorrhaging.

• Hospitals will be expected to have a crash cart available that’s dedicated to responding to maternal hemorrhaging emergencies. This will be a separate cart from the regular emergency crash cart. The accrediting standard requires hospitals to have at least one maternal hemorrhaging crash cart on each floor where labor and delivery patients or postpartum patients are hospitalized.

• Hospitals must develop and offer education for nurses, staff, and physicians that focus on the roles of each provider in responding to maternal hemorrhaging. Hospitals will be expected to educate new hires about this life-saving healthcare, and repeat it any time there is a change in procedure or, at a minimum, every two years.

• To put the training into action, hospitals will now be required to conduct maternal hemorrhaging drills. As a former U.S. Army officer, I think this is an excellent idea because training and practice help reduce stress when the real event occurs.

• Hospitals will have to review cases of maternal hemorrhaging. I expect that this will be done at a committee level. Typically, mandatory reviews include a root cause analysis to explore why an adverse event occurred and lessons learned that can prevent it from happening in the future to other patients.

• Hospitals will have to provide patient and family education that include how to recognize the signs and symptoms of postpartum hemorrhaging and what to do in the hospital or when the patient is discharged home.

These accreditation changes will go a long way toward correcting a serious life-and-death problem that has really gotten out of control in many hospital labor and delivery units.

Based on my experience as a former hospital administrator (and Joint Commission compliance officer for our hospital’s accreditation surveys), I’m a strong believer that if something isn’t measured it isn’t done. Everyone will give lip service to wanting to improve patient care, but accreditation standards get the attention of hospital leaders from the board room through the administrative ranks all the way to every provider on the nursing, technical, or medical staffs.

By raising the bar and requiring hospitals to demonstrate improvement in their performance and patient safety, accrediting agencies like The Joint Commission are significant agents for positive change.

If you or someone you care for has been seriously injured because of poor hospital, physician, nursing, or labor and delivery care, then contact a skilled Houston, Texas medical malpractice lawyer for help in evaluating your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.