A link to the specifications for PC-08 can be found on the external Joint Commission website: Electronic Clinical Quality Measures (eCQMs) | Joint Commission

https://www.jointcommission.org/en-us/knowledge-library/support-center/measurement/electronic-clinical-quality-measures

Severe hypertension blood pressure is a systolic blood pressure of greater than or equal to 160 mm Hg OR a diastolic blood pressure greater than or equal to 110 mm Hg. Only one of the criteria needs to be met for the blood pressure to be considered in the severe range.

Maternal hypotension after guideline‑concordant antihypertensive treatment is uncommon and rarely leads to clinically significant fetal compromise. Timely treatment of severe hypertension is a critical patient safety intervention. Monitoring maternal hypotension and cesarean deliveries for fetal indications would support ongoing evaluation of treatment practices and help avoid overtreatment. Other perinatal care measures such as PC-02 Cesarean Birth and PC-06 Unexpected Complications in Term Newborns could also be monitored for unintended consequences.

An episode is considered persistent if a blood pressure recheck is not performed within 15 minutes of an initial severe-range reading. The measure uses this specification because failure to repeat in a timely manner after a severe finding is a quality gap. According to the Society for Maternal-Fetal Medicine (SMFM) “The burden of proof is on providers to document that the BP has declined to the non-severe range. Failure to recheck the BP promptly is a quality gap that should be tracked and acted on” (SMFM, 2022).

The metric starts with the first severe‑range blood pressure to prevent delays in reassessment and treatment. If timing began only after persistent severe hypertension was confirmed, delays in repeat measurements or interventions could occur without being captured. Measuring from the initial severe‑range value reinforces the urgency of a timely clinical response.

The measure logic identifies the first severe‑range blood pressure and evaluates the subsequent hour for additional severe readings. Expanding the logic to capture all severe blood pressures during an encounter would add complexity and may not accurately reflect the measure’s clinical intent.

The measure focuses on the first severe‑range hypertension episode; however, all severe‑range blood pressures throughout the encounter should be reviewed for quality improvement and patient safety opportunities.

While magnesium sulfate is recommended for seizure prophylaxis in patients with severe hypertension, it is not an antihypertensive medication and does not lower blood pressure to the non‑severe range. Therefore, it is not included in a measure focused on the timely treatment of severe‑range high blood pressure.

A severe range BP warrants the initiation of frequent BP measurements every 15 minutes for at least one hour. (Druzin et al., 2021) Severe HTN episode: One or more repeat severe HTN observation(s) are documented at 15-60 min after episode onset, even if interspersed with non-severe HTN BPs. The burden of proof is on providers to document that the BP has declined to the non-severe range. Failure to recheck the BP promptly is a quality gap that should be tracked and acted on (SMFM, 2022). Following SMFM guidance, if there is no documentation indicating that the severe HTN episode resolved within 15 minutes, the episode is considered persistent severe HTN. Likewise, if there is no documentation showing that the episode did not continue during the full hour, the episode is also treated as persistent severe HTN for purposes of this measure.

Accurate blood pressures are important, and best practices for taking blood pressures should be followed. To ensure accuracy of blood pressure, the blood pressure should be rechecked and monitored for the full hour.

The measure was developed to align with the evidence while providing clear definitions and timing to allow for standardization. See Table 1: Denominator definitions and aligned guidance below.

Table 1: Denominator Definitions and Aligned Guidance

Bernstein PS, Martin JN Jr, Barton JR, et al. National Partnership for Maternal Safety Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period. Obstet Gynecol 2017;130:347-57.  

Druzin M, Shields L, Peterson N, Sakowski C-ONQS, Cape V, Morton C. Improving Health Care Response to Hypertensive Disorders of Pregnancy, a California Maternal Quality Care Collaborative Quality Improvement Toolkit, 2021. 

Society for Maternal-Fetal Medicine (SMFM), Combs, C. A., Allbert, J. R., Hameed, A. B., Main, E. K., Taylor, I., Allen, C., & SMFM Patient Safety and Quality Committee. Electronic address: smfm@smfm.org (2022). Society for Maternal-Fetal Medicine Special Statement: A quality metric for evaluating timely treatment of severe hypertension. American Journal of Obstetrics and Gynecology, 226(2), B2–B9. Society for Maternal-Fetal Medicine Special Statement: A quality metric for evaluating timely treatment of severe hypertension

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