Hospital Case Management asked Jennifer Hurlburt, MSN, RN, APN/CNS, associate director of The Joint Commission’s (TJC) department of standards and survey methods, to answer a few questions about TJC’s Proposed Standards for Perinatal Safety, published April 17, 2019. (The standards are available online at:

HCM: The element related to developing evidence-based procedures for identifying and treating maternal hemorrhage includes items related to creating a blood bank plan and using emergency response medications. Are these procedures that The Joint Commission has found to be lacking in some hospitals? And why is it important that hospitals have written plans for such procedures?

Hurlburt: Having written response plans ensures that all team members are educated about the organization’s response, which increases the team’s readiness to respond. Ensuring that key elements, such as emergency response medications and blood bank procedures, are in place decreases the time it takes for the team to respond to an emergency. This level of preparedness may increase the patient’s chance of survival because interventions are able to occur much sooner.

HCM: How new is the idea of having a dedicated hemorrhage supply kit in the maternity area?

Hurlburt: Having a dedicated supply kit for hemorrhage has been around since the AIM [Alliance for Innovation on Maternal Health] bundles were created in 2014.

HCM: Hospitals often create other types of drills, such as disaster drills. Why is it a good idea also to have a drill related to maternal hemorrhage and pre-eclampsia emergencies?

Hurlburt: Drills allow the team to practice their skills and identify system issues. When these issues are discovered during a drill, this allows the organization to make improvements before an emergency actually happens. It is also an opportunity to determine what the team does well, and highlight successes, too.

HCM: How might hospitals employ case management procedures to improve management of high-risk pregnant women on the obstetrics floor? How helpful might it be to have RN case managers involved in the guidance or team decision-making process and in educating staff, providers, and patients?

Hurlburt: Each organization may determine whether an RN case manager’s role is employed in the management of high-risk pregnant women.