Health (Drugs and Poisons) Regulation Drug Therapy Protocol Midwives

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1 Health (Drugs and Poisons) Regulation 1996 Drug Therapy Protocol Midwives Health Protection Unit Medicines Regulation and Quality PO Box 21 Fortitude Valley BC QLD 4006 Telephone (07) Facsimile (07) Disclaimer: Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to for updates

2 Health (Drugs and Poisons) Regulation 1996 Drug Therapy Protocol Midwives This drug therapy protocol, made under sections 62(d)(ii) and 167(1)(ii) of the Health (Drugs and Poisons) Regulation 1996 states the circumstances and conditions under which a midwife is authorised to administer or supply Scheduled drugs listed in Appendix 1 to the extent necessary to practice midwifery. Conditions and circumstances of this drug therapy protocol 1. A midwife may only administer or supply those scheduled drugs listed in Appendix The actions of the midwife must at all times be in accordance with the Drug Therapy Protocol and in line with clinical guidelines that are relevant to the conditions treated as part of the practice of midwifery, where guidelines are developed with appropriate multidisciplinary editorial and clinical governance (relevant clinical guidelines). 3. The midwife must have access to current versions of the following literature: 3.1. A copy of this Drug Therapy Protocol; and 3.2. Relevant clinical guidelines including a current edition of the NHMRC Australian Immunisation Handbook; and 3.3. A current MIMS Annual and Australian Medicines Handbook; and 3.4. A copy of the Health (Drugs and Poisons) Regulation 1996; and 4. The midwife must be aware that practising within the Drug Therapy Protocol does not relieve that person of their legal responsibility or accountability for that person s actions and may not provide immunity in case of negligence. 5. Prior to the or supply of the scheduled drug, the midwife must familiarise themselves with the contra-indication(s) and known side effects of the scheduled drug, and advise the patient accordingly. 6. When Consumer Medicine Information is available for a particular scheduled drug, the midwife should offer this information to each person when administering or supplying medication. 7. An endorsed eligible midwife may prescribe restricted medicines, relevant to their scope of practice, under section 167A in the Health (Drugs and Poisons) Regulation Were relevant to their scope of practice and in line with relevant clinical guidelines, a midwife may obtain sufficient stock of the scheduled medicines from a pharmacy by placing a purchase order as described under Chapter 2, Part 5 and Chapter 3, Part 5 of the Health (Drugs and Poisons) Regulation Where a scheduled drug is supplied to a person by a midwife, the primary medicine container must be labelled to the same standards as required under section 85 and for dispensed medicines under section 198 in the Health (Drugs and Poisons) Regulation Where a Controlled Drug is obtained, administered or supplied by a midwife, the midwife must keep appropriate records as required under section 112 of the Health (Drugs and Poisons) Regulation 1996 to enable reconciliation of stock obtained, used and stock on hand. Where a Restricted Drug is supplied by a midwife, the midwife must keep records to the same standards as described under section 207 (2-5) of the Health (Drugs and Poisons) Regulation Drug Therapy Protocol: Midwife September

3 11. When a midwife obtains and possesses scheduled drugs, the drugs must be stored appropriately to the same standards as required under section 119 (4-5) and as required under section 211 of the Health (Drugs and Poisons) Regulation Certification Certified at Brisbane on this 16th day of September Dr Jeanette Young Chief Health Officer Department of Health Drug Therapy Protocol: Midwife September

4 Appendix 1 Controlled Drugs (S8) Opioid Analgesics for Obstetric Use Morphine sulfate Subcutaneous Single dose only up to a maximum of 10mg intrapartum. Pethidine Single dose only up to a maximum of 150mg intrapartum. Restricted Drugs (S4) Antibiotics and other Anti-infective agents Benzylpenicillin Lincomycin Group B Streptococcus prophylaxis intrapartum. Administer one dose. For unplanned births in rural and isolated practice settings, additional maintenance doses can be administered until evacuation to an obstetric facility. Group B Streptococcus prophylaxis intrapartum. For women who are allergic to penicillins. Administer one dose. For unplanned births in rural and isolated practice settings, additional maintenance doses can be administered until evacuation to an obstetric facility. Amoxycillin Amoxycillin / Clavulanic Acid Administer one dose and supply one Cephalexin full course. Flucloxacillin Nitrofurantoin Administer one dose and supply one full course. Do not use in women at or near term or delivery. Not to be used in renal impairment. Antidotes (Agents to treat adverse events) Naloxone Neonates only. Maximum 0.4mg. Antiemetic Scheduled substance Metoclopramide Approved route of Adult only. Single dose only. Maximum 10mg. Drug Therapy Protocol: Midwife September

5 Local anaesthetic Lignocaine 1% Local infiltration Total maximum infiltration 200 mg. Labour suppression Nifedipine Two doses can be administered if required. Maximum dose 160mg per day. If a third dose is required, contact Medical Officer for an order. Antihypertensives Nifedipine Initial dose which can be repeated once if required. Corticosteroid Betamethasone Administer one dose only. Consult Medical Officer for order of a second dose. Inhalational analgesia Nitrous Oxide and Oxygen Inhalation Up to 70% nitrous oxide with 30% oxygen Agents acting on the uterus Oxytocin 10 units per dose up to a maximum of 20 units Oxytocin / Ergometrine Single dose only Ergometrine Single dose only contraceptives Levonorgestrel Administer stat dose for emergency contraception Supply up to 8 weeks supply for contraception Drug Therapy Protocol: Midwife September

6 Vaccines and immunoglobulins Anti D (Rh) immunoglobulin Antenatal prophylaxis at 28 and 34 weeks gestation. Sensitising events during pregnancy. Postpartum to avoid Rhesus isoimmunisation. MMR Measles, mumps and rubella live attenuated Subcutaneous Postpartum women found to be seronegative for rubella vaccine Hepatitis B Immunoglobulin- VF For babies of HBsAG positive mothers only Hepatitis B vaccine Single dose. Give to baby immediately after birth (preferably within 24 hours) BCG Vaccine Intradermal Only if midwife is certified by the Centre for Healthcare Related Infection Surveillance and Prevention and Tuberculosis Control and only under the Queensland Department of Health Tuberculosis Control Program Drug Therapy Protocol: Midwife September

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