Midwife prescriber Part 2

A scheduled medicines’ endorsement identifies those midwives who are considered by the Board to be qualified to:
·        administer, obtain, possess, prescribe or supply specified schedule 2, 3, 4 and 8 medicines to the extent authorised under the relevant legislation that applies in the State or Territory in which they practise;
·        use those medicines appropriately for the management of women and infants during the pregnancy, birth and post natal periods; and
  apply to Medicare Australia for a Pharmaceutical Benefits Schedule prescriber number.  (NMBA 2011)

obtain ... possess ... prescribe ... supply ... administer 

Useful links are:
Medicare Australia's e-learning site: PBS for new Health Professionals
Pharmaceutical benefits scheme (PBS) for midwives
NMBA search for 'midwife prescriber formulary'
Victorian gazetted drugs - The list of Schedule 2, 3, 4 and 8 poisons approved by the Minister for Health for the purposes of Section 13(1)(bc) of the Act for registered midwives was published in Victoria Government Gazette No. S 410 Friday 30 November 2012.

It's easy to become confused or unsure when venturing into new territory, such as that of an endorsed 'midwife prescriber'.   Prescribing covers a cluster of activities, some of which every midwife is familiar with, and others which are new.  A restricted drug such as Syntocinon (synthetic oxytocin), and other oxytocics, have been used by midwives in home birth situations, for many years.  Although midwives have not had authority to prescribe, the usual process has been that a prescription has been written by a General Practitioner for a pregnant woman who is planning homebirth.  The midwife takes responsibility for decisions around the use of the medicine.

It seems that midwife prescribers are now able to tick all the boxes as far as the law is concerned.  This is good.  Noone wants to face a challenge when a medicine group as basic to midwifery, and as potentially life-saving for women, as oxytocics are concerned. The endorsed midwife prescribers are also able to manage other important drugs within our scope of practice: a significant extension of practice for most who have referred women to their GPs for anything from Maxolon for vomiting. to antibiotics for urinary tract infection, postnatal uterine infection, or mastitis.


                                

midwife prescriber

Midwives across this country are extending our practices as those who are classified as 'eligible' complete the requirements for endorsement to prescribe scheduled medicines.  For the details of notation and endorsement, go to the NMBA website.   The most recent statistics (June 2013) provided by NMBA tell us that 22 midwives had endorsement to prescribe medicines, of the 212 midwives who have the 'eligible' notation on their registration.

To access the NMBA Prescribing Formulary for Eligible Midwives with a Scheduled Medicines Endorsement, as a .pdf document, search formulary+midwives at that site (the hyperlink I tried was incomplete).  This document lists the medicines, route of administration, duration of use, and indications for use, and states that:

A scheduled medicines’ endorsement identifies those midwives who are considered by the Board to be qualified to:
• administer, obtain, possess, prescribe or supply specified schedule 2, 3, 4 and 8 medicines to the
extent authorised under the relevant legislation that applies in the State or Territory in which they practise;
• use those medicines appropriately for the management of women and infants during the
pregnancy, birth and post natal periods; and
• apply to Medicare Australia for a Pharmaceutical Benefits Schedule prescriber number.
The Board has approved the lists of schedule 4, schedule 8 and intravenous medicines (below) for prescribing by eligible midwives with a scheduled medicines endorsement. These lists are to be read in conjunction with the Board’s Guidelines and Assessment Framework for Registration Standard for Eligible Midwives and the Registration Standard for Endorsement for Scheduled Medicines for Eligible Midwives (July 2010).

Another fount of useful information about Medicare and Prescribing is the Medicare site for Nurse Practitioners and Midwives.

Making the transition from being an 'ordinary' midwife (with all the social and professional restrictions that we have become used to) to the new class of eligible midwife who has a Medicare number, a Prescriber Number, and a personalised script pad may at times call for support and discussion between peers.  With this in mind, a new group has been formed using a social media site.   It's a closed group, and those who send a request to join are asked to introduce themselves to the group.

Midwife Prescriber - Australia

This group is for discussion about prescribing issues, for eligible midwives who have the prescriber endorsement, and those who are working toward it.
There may be clinical questions, for which members are able to share insight and experience.
Members may have questions about processes.
Files and links to the medications lists in the various states and territories can be shared and stored at this site.

This new group grew to 50+ members in its first 24 hours of existence.  One member who joined by invitation is a supportive obstetrician.

A midwife who has worked independently for many years may be unsure of which antibiotic would be best for a postnatal uterine or wound infection.  In previous years that midwife would have referred a woman with suspected infection to a hospital or doctor for diagnosis and prescription.  Now that midwife can arrange to have a high vaginal swab taken for culture and sensitivity, and prescribe a suitable antibiotic treatment.

The Schedule 4 medicines listed on the NMBA formulary, and on the Pharmaceutical Benefits Scheme (PBS) Midwife Items, as being suitable for postnatal infection, include Amoxycillin, Amoxicillin with clavunic acid, Cephalosporin, Dicloxacillin, and Lincomycin, with several others that are not PBS items.

The complexities of knowing which drug is best, which dose is appropriate in the situation, how often it should be taken, and for how many days - this is the sort of knowledge that a midwife needs to have in order to act professionally in this situation.  Eligible midwives are required to have collaborative arrangements for each woman, and it is anticipated that a phone call will be made to the collaborating doctor or hospital, or a friendly supportive obstetrician, if the midwife is in any way uncertain of the best course of action.



ps. Note that some States have formularies that have been gazetted by that jurisdiction, while others have adopted the NMBA formulary.

Click here for a FAQ document from the Victorian Health Department.

Your comments are welcome.

Finding a midwife in Victoria

Today we have updated the 'Midwives' websites' list at the right on this blog.  These midwives are registered with AHPRA, and members of Midwives in Private Practice (MiPP).

Face to face meetings of MiPP are held at least bi-monthly, usually in the Melbourne metropolitan area.  Continuing professional education, such as newborn resuscitation workshops with NETS, is facilitated by members from time to time.


Each MiPP member is responsible for her/his own practice of midwifery, maintenance of professional standards, and appropriate record keeping.

The midwife joining or renewing full membership agrees to:

• Practice in a way that is consistent with the International Confederation of Midwives' Definition of the midwife 
• Attend MIPP meetings when able. If this is not possible at any time, the midwife sends an apology, and contributes to current discussion by other means. 
• Contribute to the activities and work of MIPP. 
• Participate in professional standards peer review within the collective. 
• Contribute to periodic reviews, providing quantitative and/or qualitative data as appropriate. 

Note: MIPP welcomes Associate members. A midwife who wishes to commence private practice, ie ‘fee for service’ outside the acute health sector/hospital, is encouraged to seek mentoring with experienced independent midwives.