Drug Therapy Protocol: Midwifery

2011 Review and Changes

Dr Belinda MaierMidwifery Advisor

Health Management Protocolsfor the Drug Therapy Protocol: Midwifery

Dr Belinda Maier

Midwifery AdvisorOffice of the Chief Nursing OfficerMidwifery Practice and Profession

Key Projects for 2011

• Policy - Breastfeeding

• Policy - Transfer of a woman and or infant from a planned home birth to a Qld Health Service

• Drug Therapy Protocol- Midwifery

• Rural Maternity Initiative Management

• Clinical Governance for Midwifery Models of Care

• Review - Midwifery Models of Care Implementation Guide

• Collaborative Arrangements for Private Practice Midwives

Background Summary1998 NHMRC Review of Services Offered by Midwives2005 Re-Birthing: Report of the Review of Maternity Services2005 QLD Health Minister endorsed a review of Health Drugs & Poisons regulation 1996.2006 QH Midwifery DTP working Party2007 Health Legislation Amendment passed to Health Drugs and Poisons Regulation 19962008 DG approved DTP: Midwifery and Senior Director population Health signed off Appendix 1- the list of drugs a midwife can give2008 Statewide Health Management Protocols and education package developed for use in Districts2010-11 DTP , HMP and education package review and update

Legislation

In 2007 the Health (Drugs and Poisons) Regulation 1996 was amended to authorise Midwives to:

“the extent necessary to practice midwifery: to obtain, possess, administer or supply a controlled or restricted drug, under a drug therapy protocol”

DTP: Midwifery is different to PBS for Eligible Midwives

DTP Midwifery is a resource for Registered Midwives employed within Queensland Health.

PBS is different to a DTP and is for Eligible Midwives.

• District Endorsed• Any registered midwife, who has met the local

requirements, can administer and supply medications under the Drug Therapy Protocol

• Midwives administer and supply medications• Once off administration and supply of

medications under specific circumstances• Specific medications only • Midwife to complete local education package

Drug Therapy Protocol: Midwifery

PBS for Eligible Midwives• Commonwealth legislation• Only midwives who hold eligibility registration with NMBA

can prescribe, administer and supply medications under PBS

• Midwives prescribe, administer and supply medications

• Ongoing prescription, administration and supply of medications

• Midwives can prescribe medications identified in the PBS as being authorised for midwives to prescribe (identified as a midwife item in the PBS schedule)

• Midwife required to have completed a prescribing program of study that is accredited and approved by NMBA

Drug Therapy Protocol: Midwifery

The objective of Drug Therapy Protocols are to recognise the existence of extended practices by health practitioners by creating a mechanism which enables suitably endorsed health professionals to administer and supply scheduled drugs and poisons under specific circumstances.

Appendix 1 list the allowed drugs under the DTP.

Drug Therapy Protocol: MidwiferyAppendix 1

• Restricted Substances (S4)Antibiotics

– Benzylpenicillin– Amoxycillin– Cephalexin– Nitrofurantoin– Flucloxicillin

• Controlled Substances (S8)– Morphine Sulphate– Pethidine

Drug Therapy Protocol: MidwiferyAppendix 1

• Antidotes– Naloxone (Neonates only)

• Anti-emetic– Metoclopramide

• Local Anesthetic– Lignocaine

• Labour Supression– Nifedipine

• Anti Hypertensives– Nifedipine

Drug Therapy Protocol: MidwiferyAppendix 1

• Corticosteroid– Betamethosone

• Inhalation Analgesia– Nitrous Oxide and Oxygen

• Agents Acting on the Uterus– Oxytocin– Oxytocin/Ergometrine maleate– Ergometrine maleate

Drug Therapy Protocol: MidwiferyAppendix 1

• Oral Contraceptive– Levongesterel (including

emergency contraception)• Specific Vaccines

– Anti D (Rh) immunoglobulin– MMR– Hepatitis B Immunoglobulin – VF– Hepatitis B– BCG

Health Management Protocol

• For the implementation of the DTP the Health (Drugs and Poisons) Regulation 1996 requires the development of a Health Management Protocol (HMP)

• This includes either adoption of the Queensland Health Statewide HMP or development of a local document.

• Minimum requirements of the HMP are identified in the DTP

Health Management Protocol

The HMP Midwifery is a set of clinical guidelines that outline the situations and conditions under which an registered midwife can administer and supply medications listed in Appendix One of the DTP.

Processes• OCNO developed statewide DTP: Midwifery• DTP: Midwifery requires endorsement by the

Chief Executive Officer of the Health Service District

• If services choose to adopt the statewide HMP it also requires sign off by CEO of the HSD.

• The statewide HMP cannot be changed at a district level

• Midwifery HMP complementary to PCCM for RIPERN midwives

• The DTP and HMP must be reviewed every two years

Endorsement signed by District Chief Executive Officer

• The Health Management Protocol for the Drug Therapy Protocol – Midwives

• in …………………………………………… district has been endorsed by:

• District Chief Executive Officer …………………………………..

• Signature: ……………………………………………. Date: / /

• Name…………………………………………………………………………

Implementation Drug Therapy Protocol Health Management Protocol for Midwives

Flowchart• Drug Therapy Protocol: Midwifery approved by the Chief Health Officer 2011

↓• District Director of Nursing / Director of Nursing will identify plan for implementation and

evaluation of progress and midwifery role expansion regarding DTP↓

• District Director of Nursing to ensure Chief Executive Officer has endorsed DTP/HMP↓

• District Director of Nursing to notify Directors of Nursing and Nurse/Midwifery Unit Managers of endorsement, implementation and evaluation plans

↓• District Director of Nursing to notify the Midwifery Advisor in the Officer of the Chief

Nursing Officer of endorsement↓

• Nurse/Midwifery Unit Manager/Nurse/Midwifery Educator• Implement DTP/HMP

↓• Nurse/Midwifery Unit Manager/Nurse/Midwifery Educator

• Report progress evaluation back up management lines↓

• Feedback, reporting to Belinda Maier, Midwifery Advisor, Officer of the Chief Nursing Officer

Belinda_Maier@health.qld.gov.au 073234 1441

OCNO review 2011

• Feedback requested from all HSD’s regarding implementation and usefulness in practice

• DTP, HMP and education package all reviewed with feedback from services included

2011 Review

Addition• Morphine Sulphate: Pain Relief in Labour

– Morphine has a shorter half life than Pethidine.

– Important for breastfeeding initiation and maintenance, for both mother and infant

2011 ReviewRemoved

• Indomethacin as not recommended in the SMNCN Guideline : Assessment and management of preterm labour.

• Clindamycin as unable to be supplied under the Queensland Health List of Approved Medicines (LAM)

• Levongestrel/Ethinyloestradiol as unable to be supplied under the Queensland Health List of Approved Medicines (LAM)

2011 ReviewRevised dosages• Nifedipine: Hypertension disorders in

pregnancy– Dosage changed to 10 – 20mg– Inline with SMNCN guideline: Hypertensive

disorders in pregnancy• Nifedipine: Suppression of preterm labour

– Dosage changed to 20mg– Inline with SMNCN guideline: Assessment

and management of preterm labour

2011 ReviewRevised dosages• Ergometrine: Postpartum haemorrhage

– IV dosage added– Inline with SMNCN guideline: Primary

postpartum haemorrhage• Levonorgestrel: Emergency contraception

– Dosage changed to one 1.5mg tablets stat– Inline with Primary Clinical Care Manual 6th

Edition and Therapeutic Guidelines

2011 ReviewRevised dosages• Pethidine: pain relief

– Dosage increased to up to 150mg– Inline with Primary Clinical Care Manual

6th Edition

• Antibiotic dosage changed from 10 days to 5 days in line with Therapeutic Guidelines

Endorsement process

• If already using DTP: Midwifery, the district may continue using until review date

• The Chief Executive Officer of the Health Service District needs to re-endorse the revised DTP and HMP

• Initial endorsement: The DTP and HMP must be endorsed by the Chief Executive Officer of the Health Service District

Endorsement Process of HMP

• Developed as per DTP requirements– Steering group with representation from:

• Medical Practitioner• Registered Midwife• Immunisation Program Nurse• Pharmacist

Implementation in Service

• Endorsement of DTP and HMP by CEO utilising template provided on OCNO website

• Education package available on OCNO website and has been reviewed to reflect changes to the DTP and HMP

Local Implementation• Some medications will require local

processes for packaging for supply by Registered Midwives under the DTP

• The Midwifery Advisor OCNO welcomes feedback from services to contribute to future reviews of the DTP: Midwifery

For More Information

Visit the Office of the Chief Nursing Officer website

Internalhttp://qheps.health.qld.gov.au/ocno/content/midwifery.htm

Externalhttp://www.health.qld.gov.au/ocno/midwifery.asp