Midwives exemptions frequently asked questions

Are the medicines listed on the circular the only ones that midwives can give?

No, we have only included the Prescription Only Medicines (POM’s) on this list as the amended legislation only considered these. Midwives can also administer (provided it is in the course of their professional practice) 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 General Sales List (GSL), Pharmacy (P) and Perscription Only Medicine's (POM) 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 accordance with the directions of an independent prescriber so a specific provision is also required to enable a midwife to administer on her own initiative

Our Hospital has placed medicines on the exemptions list on PGD’s, is this ok?

A Patient Group Direction 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 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 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.

Why does the midwife supervising the administration of medicine by a student have to be a sign off mentor?

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 fro example Meptid, why not?

The exemptions list has not been reviewed for some time. We will now review it every three years, this will give us the opportunity to update.

Diclofenac is now GSL, why have you included this in midwives’ exemptions?

Because this enables us to administer a higher dose than the tablets on GSL. This should only be given for up to 48hrs, after this time it will need to be prescribed.

Why has Entonox not been included in the exemptions list?

The updated list is for POMs only. Nitrous oxide up to 50% in oxygen is a P medicine. Registered midwives may supply and or administer P medicines as long as it is 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 drug’s brand names in the table because we could be accused of advising midwives to preferentially use a particular brand, for example there are some 20 different brands of diclofenac.

Where do registered midwives stand in relation to the administration of diamorphine, which they are able to administer without prescription under the midwives exemption, but which is unlicensed for use in obstetric pain?
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 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.

Are midwives really covered to give babies drugs for Hepatitis B without prescription, what if the baby has a reaction?

Yes you are covered under the midwives exemptions. However, you should be aware that you should have the necessary training, outlined in page 35 of the Standards for medicines management.

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