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 OB Readiness Toolkits

CMS Rules

1. List of rules by implementation date
a. Effective 7/1/2025:
i. Emergency services readiness
ii. Transfer protocols

b. Effective 1/1/2026:
i. Baseline Standards
ii. Organization
iii. Staffing
iv. Delivery of Care

c. Effective 1/1/2027:
i. Maternal Quality Assessment and Performance Improvement (QAPI)
ii. Staff Training

1. Indian Health Services
a. Obstetric Emergency Readiness
b. Obstetric Emergency Cart
c. Neonatal Emergency Readiness
d. Neonatal Emergency Cart

2. Alliance for Innovation on Maternal Health (AIM)
a. Medications
b. Equipment
c. Vascular Access
d. Hemorrhage
e. Hypertensive Disorders of Pregnancy
f. Cardiac Disorders
g. Sepsis

3. Emergency Department Readiness
a. IHS OB Emergency Readiness

1. Transfer

2. AHRQ Rapid Response Team

3. Massive Transfusion Protocol

4. Blood Products and Blood Product Alternatives

5. University of Toledo Childbirth and Maternal Care in the Emergency Department

6. CMQCC Sample Nursing Management Policy and Procedure Hypertensive Disorders

7. AHRQ Safe Medication Administration: Magnesium Sulfate

8. CMQCC Cardiovascular Disease Assessment

9. Intermountain Healthcare Suicide Risk Assessment Tool

10. Massachusetts Child Psychiatry Access Program Assessment and Management of Perinatal Mood and Anxiety Disorders

1. Preparing for OB Emergencies
a. AGOG

2. Hemorrhage
a. CMQCC Obstetric Hemorrhage Orderset

3. Hypertension
a. ACOG Hypertension Algorithm
b. ACOG Eclampsia Algorithm

4. Substance Use Disorder
a. Northern New England PQC

5. Cardiovascular Disease
a. ACOG
b. Algorithm
c. CMQCC Assessment

6. Sepsis
a. CMQCC flow chart
b. CMQCC order set
c. CMS Sepsis 1 Accommodations

7. EMS
a. ACOG Info Sheet

8. Education/Training
a. Evidence-Based Education Programs
b. AIM InSitu Drills
c. IHS OB Readiness Simulation Education
d. Sepsis
i. CMQCC
ii. UC Davis
e. Perimortem C-Section

CMS Rules

1. List of rules by implementation date
a. Effective 7/1/2025:
i. Emergency services readiness
1. Maintain protocols consistent with Complexity and Scope of services offered and aligned with
Nationally recognized evidence-based guidelines for care of patients with emergency conditions.
(New Language for CAHs CoPs 42 CFR 485.618(e))
a. Including, but not limited to, OB emergencies, complications, and immediate post-delivery
care
b. Facility must be able to articulate their standards and sources and to demonstrate that
their standards are based on evidence and nationally recognized sources
i. Review Emergency Department data
1. Number of deliveries/ year
2. Maternal and Newborn complications
ii. Prioritize development/review of protocols/policies/procedures based on internal or
external data and document prioritization

2. Identify a Rapid Response Team for obstetric emergencies

3. Identify protocols and procedures for activating the Rapid Response Team

4. Ensure a safe and adequately equipped space is available to care for routine births

1. Indian Health Services
a. Obstetric Emergency Readiness
b. Obstetric Emergency Cart
c. Neonatal Emergency Readiness
d. Neonatal Emergency Cart

2. Alliance for Innovation on Maternal Health (AIM)
a. Medications
b. Equipment
c. Vascular Access
d. Hemorrhage
e. Hypertensive Disorders of Pregnancy
f. Cardiac Disorders
g. Sepsis

3. Emergency Department Readiness
a. IHS OB Emergency Readiness

1. Transfer

2. Rapid Obstetrical Response: Facilities without OB Services

3. AHRQ Rapid Response Team

4. Massive Transfusion Protocol

5. Blood Products and Blood Product Alternatives

6. University of Toledo Childbirth and Maternal Care in the Emergency Department

7. CMQCC Sample Nursing Management Policy and Procedure Hypertensive Disorders

8. AHRQ Safe Medication Administration: Magnesium Sulfate

9. Intermountain Healthcare Suicide Risk Assessment Tool

10. Massachusetts Child Psychiatry Access Program Assessment and Management of Perinatal Mood and Anxiety Disorders

1. Preparing for OB Emergencies
a. AGOG
b. IHS Precipitous Delivery
i. Vaginal
ii. Shoulder Dystocia
iii. Breech
c. Maternal Cardiac Arrest/Perimortem C-Section
d. Postpartum Hemorrhage
e. ACOG Acute Hypertension in Pregnancy & Postpartum Algorithm
f. ACOG Eclampsia Algorithm
g. IHS Hypertension Algorithm
h. CMQCC Maternal Sepsis Flow Chart
i. IHS Maternal Sepsis Algorithm
j. ACOG Cardiovascular Disease in Pregnancy/Postpartum Algorithm
k. CMQCC CVD Assessment Algorithm
l. AIM Signs and Symptoms of Underlying Cardiac Disease
m. Obstetric onset of withdrawal from substances on ED presentation

2. EMS
a. ACOG Info Sheet

3. Education/Training
a. Evidence-Based Education Programs
b. AIM InSitu Drills
c. IHS OB Readiness Simulation Education
d. Sepsis
i. CMQCC
ii. UC Davis
e. Perimortem C-Section