Midwives exemptions frequently asked questions
Are the medicines listed on the circular the only ones that midwives can give?
No, we have included only the Prescription Only Medicines (POMs) on this list as the amended legislation considered only these. In the course of their professional practice, midwives can also administer:
-all medicinal products on a General Sale List (GSL), for example paracetamol, and
-all Pharmacy (P) medicines, for example ranitidine.
Why is it that the GSL, P and POMs conditions apply to ‘sale and supply’, and the parenteral drugs conditions are ‘administration’?
Medicines legislation focuses on setting conditions around sale and supply. It does not address administration unless the medicine involved is a parenteral. This means there is nothing to prevent the midwife administering non-parenterals, but to sell or supply them without the need for a pharmacist or registered pharmacy premises requires a specific provision. Parenteral medicines normally have to be administered by or in line with the directions of an independent prescriber so a specific provision is also required so a midwife can administer on her own initiative.
Our hospital has placed medicines on the exemptions list on a Patient Group Direction (PGD), is this ok?
A PGD is not necessary for midwives to be able to supply and/or administer any of those substances that are specified in medicines legislation under the ‘midwives exemptions’.
Why should we not use the term ‘standing orders’?
The term ‘standing orders’ is no longer used as there is no legal definition for this under medicines legislation. (NMC 2007) Standards for medicines management.
Where should midwives document administration of medicines under midwives exemptions?
The standards for medicines management (NMC 2007) standard 8 No 2.10 informs nurses and midwives of their responsibility in documenting administration of medicines.Currently this should be documented in the woman’s hand-held notes. Exemptions are distinct from prescribing as this requires the involvement of a pharmacist in the sale or supply of the medicine.
Can students administer medicines listed on midwives exemptions?
The amendment to midwives exemptions in July 2011 enables students to administer medicines listed on midwives exemptions, excluding controlled drugs, under direct supervision of a midwife. Students cannot administer controlled drugs as their administration comes under the Misuse of Drugs Act Students can participate in the checking and signing for of controlled drugs.
Students cannot administer controlled drugs as their administration comes under the Misuse of Drugs Act.
Can we give women a box of tablets (for example, pregaday antenatally or ferrous sulphate postnatally)? If so, where would they obtain them from? Yes. This would need to be arranged at local level. A midwife must issue the medicine in a labelled, pre-packed form suitable for the woman to take away.
The Medicines and Healthcare Products Regulatory Authority made this a condition of agreeing that midwives may enable students to administer medications listed under midwives exemptions.
Can we give women a box of tablets for example pregaday antenatally or ferrous sulphate postnatally, and if so where would they obtain them from?
Yes. This would need to be arranged at local level. A midwife must issue the medicine in a labelled, pre-packed form suitable for the woman to take away.
You have not included all the drugs we use (for example, meptid), why not?
The exemptions list has not been reviewed for some time. We will now review it every three years.
Diclofenac is now on the GSL, why have you included it?
It has been included on the exemptions list because this enables administration of a higher dose than the GSL. After 48 hours of use, diclofenac will need to be prescribed.
Why has entonox not been included in the exemptions list?
The updated list refers to POMs only. Nitrous oxide up to 50 percent in oxygen is a P medicine. Registered midwives may supply and/or administer P medicines in the course of their professional practice.
Why don’t you use the brand names on your table as we are all more familiar with these?
We do not use the brand names because we could be accused of advising midwives to use a particular brand. For example, there are some 20 different brands of diclofenac.
We do not use the brand names because we could be accused of advising midwives to use a partWhere do registered midwives stand in relation to the administration of diamorphine? They are able to administer diamorphine without prescription under the midwives exemption, but it is unlicensed for use in obstetric pain.cular brand. For example, there are some 20 different brands of diclofenac.
Not many drugs are licensed for obstetric use. Diamorphine can be given ‘off label’.
What does ‘off label’ mean?
Some medicinal products supplied and administered by midwives under midwives exemptions are used outside of their license. Using a medicine in this way is known as ‘off label’ use. Midwives may use ‘off label’ the medical products listed in the midwives exemptions list provided there is no appropriately licensed alternative and there is a sufficient evidence base and/or experience of using the medicine to demonstrate its safety and efficacy. Midwives should explain to women and their families, in broad terms, the reasons why the medicine is not licensed for the proposed use.
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