Please note:
If you are a midwife prescriber in Australia, you are invited to contribute to this survey.
There is a high degree of enthusiasm amongst midwives who have achieved endorsement as prescribers.
The Midwife prescriber facebook group facilitates discussion about prescribing issues. The group welcomes members who have the eligible midwife prescriber endorsement, and those who are working toward it, and others who have a strong interest in the subject. At the time of writing there are 130 members.
Showing posts with label scheduled medicines. Show all posts
Showing posts with label scheduled medicines. Show all posts
Saturday, February 8, 2014
Friday, October 25, 2013
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.
Sunday, October 20, 2013
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:
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.
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.
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 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.
Sunday, September 15, 2013
midwives and medicines
The Nursing and Midwifery Board of Australia (National Board) is consulting publicly on the draft Registration standard for endorsement of registered nurses and/or registered midwives to supply and administer scheduled medicines under protocol and invites comments and feedback from interested parties. The proposal is that provisions which are already in place for midwives (and nurses) in rural and remote settings be extended across the professions.
For more information, and to access the consultation discussion paper and draft Registration standard, click here.
The National Board is inviting submissions from the public, as well as professional groups and individuals.
Please note that this consultation does not relate to midwife prescribers: eligible midwives who have completed a course of study approved by the National Board, and been endorsed to prescribe scheduled medicines.
Why is this an important issue?
A midwife who is currently recognised as being able to supply and administer scheduled medicines under protocol is usually a midwife employed by a health service or hospital. The employer has set down protocols under which a midwife is permitted to use a scheduled drug. This has been in effect, to a greater or lesser degree, for many years. Oxytocics for prevention or management of postpartum haemorrhage are an obvious category of drugs that every midwife is expected to be able to manage competently. A midwife may also supply and administer an anti-emetic in labour, antibiotics in labour as prophyllaxis for Group B Streptococcus, or Anti-D to prevent Rhesus immunisation. These are prescribed by a doctor, dispensed and sold by a pharmacist, and subsequently supplied and administered by a midwife to the woman in her care.
What is the relevance of this consultation for independent midwives?
Midwives who practise privately, being employed directly by the woman rather than by a health service or hospital, may also be affected by any Registration Standard that the National Board develops. Midwives attending homebirths have historically for many years carried oxytocics, and used them when required. The midwife may ask women to obtain a prescription for Syntocinon 10units and Syntometrine from their local doctor. The midwife usually makes decisions about administration on her own authority, with the wellbeing and safety of the mother, in relation to postpartum blood loss, being the primary concern. This process is not covered by any formal protocols or reporting mechanisms. The midwife does not usually consult about the need for the scheduled medicine with the doctor who signed the prescription - delay could lead to compromise.
The proposed Registration Standard
The education of all midwives is required to prepare midwives for basic midwifery practice, as stated in the ICM Definition (2011):
MIPP will be preparing a submission to this consultation.
Your comments are, of course, welcome.
For more information, and to access the consultation discussion paper and draft Registration standard, click here.
The National Board is inviting submissions from the public, as well as professional groups and individuals.
Please note that this consultation does not relate to midwife prescribers: eligible midwives who have completed a course of study approved by the National Board, and been endorsed to prescribe scheduled medicines.
Why is this an important issue?
A midwife who is currently recognised as being able to supply and administer scheduled medicines under protocol is usually a midwife employed by a health service or hospital. The employer has set down protocols under which a midwife is permitted to use a scheduled drug. This has been in effect, to a greater or lesser degree, for many years. Oxytocics for prevention or management of postpartum haemorrhage are an obvious category of drugs that every midwife is expected to be able to manage competently. A midwife may also supply and administer an anti-emetic in labour, antibiotics in labour as prophyllaxis for Group B Streptococcus, or Anti-D to prevent Rhesus immunisation. These are prescribed by a doctor, dispensed and sold by a pharmacist, and subsequently supplied and administered by a midwife to the woman in her care.
What is the relevance of this consultation for independent midwives?
Midwives who practise privately, being employed directly by the woman rather than by a health service or hospital, may also be affected by any Registration Standard that the National Board develops. Midwives attending homebirths have historically for many years carried oxytocics, and used them when required. The midwife may ask women to obtain a prescription for Syntocinon 10units and Syntometrine from their local doctor. The midwife usually makes decisions about administration on her own authority, with the wellbeing and safety of the mother, in relation to postpartum blood loss, being the primary concern. This process is not covered by any formal protocols or reporting mechanisms. The midwife does not usually consult about the need for the scheduled medicine with the doctor who signed the prescription - delay could lead to compromise.
The proposed Registration Standard
"... will ensure that registered nurses and midwives who work in situations where medical and nursing supervision is low and the clinical risk is relatively high are educationally prepared and competent to supply medicines to their patients/clients."Women planning homebirth in the care of an independent midwife are usually well, and in spontaneous labour. Homebirth is a situation where the midwife acts on her own authority. Whether a midwife is practising solo, or with another midwife, each midwife is responsible to act in a competent and professional manner. There is no clinical supervision of independent midwifery practice. Obviously, the 'clinical risk' is relatively high. This places private midwifery practice within the scope of the National Board's proposed Registration Standard.
The education of all midwives is required to prepare midwives for basic midwifery practice, as stated in the ICM Definition (2011):
... The midwife is recognised as a responsible and accountable professional who works in partnership with women to...
give the necessary support, care and advice during pregnancy, labour and the postpartum period, toThis care includes
conduct births on the midwife’s own responsibility and to
provide care for the newborn and the infant.
preventative measures,
the promotion of normal birth,
the detection of complications in mother and child,
the accessing of medical care or other appropriate assistance and
the carrying out of emergency measures.
MIPP will be preparing a submission to this consultation.
Your comments are, of course, welcome.
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