On January 26, 2010, The Joint Commission (TJC) issued a Sentinel Event Alert concerning maternal death. Since 1996, a total of 84 cases of maternal death, defined as a death occurring within 42 days of birth or termination of pregnancy, have been reported to TJC's sentinel event database. While still rare, the rate of maternal mortality was 13.3 deaths per 100,000 live births in 2006, significantly greater than the U.S. government's Health People 2010 goal of 3.3 deaths per 100,000 live births. Rather than decreasing, there is evidence that the maternal mortality rate actually may be increasing.
In response to this surprising trend, TJC issued this Sentinel Alert both to remind hospitals of the existing standards applicable to maternal health and provide suggested actions aimed at improving hospitals' training and protocols. Beginning in 2010, TJC Standards for Hospitals require each hospital to (1) have a process for recognizing and responding as soon as a patient's condition appears to be worsening; (2) develop written criteria describing early warning signs of a change or deterioration in a patient's condition and when to seek further assistance; (3) based on the hospital's early warning criteria, have staff seek additional assistance when they have concerns about a patient's condition; and (3) inform the patient and family how to seek assistance when they have concerns about the patient's condition. In addition to these basic requirements, TJC suggests hospitals take the following steps to help prevent maternal death:
- Educate physicians and other clinicians who care for women with underlying medical conditions about the additional risks that could be imposed if pregnancy were added.
- Identify specific triggers for responding to changes in the mother's vital signs and clinical condition and develop and use protocols and drills for responding to changes.
- Educate emergency room personnel about the possibility that a woman, whatever her presenting symptoms, may be pregnant or recently may have been pregnant.
When presented with a patient identified as high-risk, TJC suggests that hospitals also:
- Refer high-risk patients to the care of experienced prenatal care providers with access to a broad range of specialized services.
- Make pneumatic compression devices available for patients undergoing cesarean section who are at high risk for pulmonary embolism.
- Evaluate patients who are at high risk for thromboembolism for low molecular weight heparin for postpartum care.
While studies disagree regarding the percentage of maternal deaths that actually may be preventable, TJC has crafted these standards and suggestions in an attempt both to reduce the maternal mortality rate and avoid serious maternal complications.