Prescribing Rights and Diagnostic Tests
June 2006
The Australian College of Midwives supports the NHMRC (1998) guidelines for
midwives to order and interpret a limited range of test and to prescribe
specified drugs, as part of the care of healthy women and their babies during
uncomplicated pregnancy, childbirth and the early postnatal period. Current
diversity of legislation in Australian states and territories act as barriers to
enact these guidelines. The ACM calls on each state and territory government to
make the necessary changes to legislation and recognise midwives as the health
professionals they are, to make full use of the midwifery workforce in providing
world best practice care to women and their families.
Prescribing means
the initiation and supply of drugs by practitioners acting entirely in their own
right as professionals, i.e. not acting under any protocols or orders.
In
general, legislation covering the prescribing, administration and supply of
drugs only allows these activities to be carried out by medical practitioners,
dentists and veterinary surgeons (and pharmacists for dispensing).
In
some States and Territories amendments have been made to broaden the scope of
such legislation to allow midwives to initiate (but not ‘prescribe’ in the full
sense given above) the use of medications in some circumstances.
In
Australia it is common and accepted midwifery practice in many settings for
midwives, who are duly registered or endorsed to practice midwifery, to order
and interpret a specific range of tests and initiate specific and relevant
medications. Standing orders often exist for midwives to initiate these
medications. This system demonstrates midwives are competent to judge when these
drugs are required, and to safely administer them.
In most other OECD
countries midwives are autonomous health professionals with prescribing rights
with full government support and funding.
Guidelines:
- The
College expects midwives to initiate within their scope of practice and
regulatory framework and to be competent to initiate substances for conditions
commonly associated with uncomplicated pregnancy, labour, birth and postnatal
care.
- Midwives are not expected to initiate medications for all
antenatal, labour, birth and postnatal situations The Australian College of
Midwives Guidelines for Consultation and referral should form the basis for
practice.
- The College expects midwives to have knowledge regarding the
effects, side effects, interactions and contraindications of drugs
initiated.
- It is appropriate for a midwife to prescribe relevant
substances such as vitamins and minerals (including vitamin K and iron), local
anaesthetics (eg1% lignocaine), antibiotics(in line with pathology results and
relevant allergies, to treat a UTI or vaginitis or as prophylactic cover for
GBS), antifungal agents(to treat thrush), antiemetics (eg metoclopramide),
antacids (eg Zantac, Mylanta), nitrous oxide, pethidine and its antagonist, IV
fluids (eg normal saline/Hartman’s solution for hydration or emergency
resuscitation), Oxytocics (for actively managed third stage and/or the
management and control of PPH) vaccinations and immunoglobulin (eg Hepatitis B,
anti D and Rubella).
- It is appropriate for a midwife to order and
interpret relevant tests such as routine antenatal blood tests (FBC, Hb, group,
glucose load, antibodies, rubella titre, chlamydia, syphilis, Hep B/C., HIV),
fetal morphology ultrasound scans, mid stream urine, cervical Pap tests, cord
blood tests and newborn screen test (NST) as part of routine care for a woman
and her baby.
- As midwifery care is based on individual assessment of a
woman’s health needs, this list is not exhaustive and is primarily to be used as
a guideline.
- Midwives are expected to recognise and correct any
knowledge deficit they may have through recognised continuing
education.
- Midwives are expected to know when and how to initiate
maternity emergency care and drugs until help
arrives.
References:
Hancock, H. Department of Health and Community
Services Protocol for Home Birth Midwives to refer, request, interpret and
respond to pathology tests NT Government Department of Health and Community
Services, January 2006.
NHMRC National Health & Medical Research Council.
Review of Services Offered by Midwives Australian government Printing Service,
Canberra 1998 (Note this document was assessed for currency in 2004 and has been
reissued until 31 December 2007)
NZCOM Consensus statement. Prescribing
Guidelines 1995
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