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Wednesday, November 30, 2011

Midwives and prescribing

Midwives who have achieved eligibility for Medicare (MBS) are required to sign an undertaking:
• That I will undertake, and successfully complete, within 18 months of recognition as an eligible midwife:-

(i) an accredited and approved program of study determined by the Board to develop midwives’ knowledge and skills in prescribing; or

(ii) a program that is substantially equivalent to such an approved program of study, as determined by the Board.

I understand that until I meet the above requirement I will not be able to seek endorsement for scheduled medicines and will therefore not be prescribing medicines.

As there is at present no option (i) 'accredited and approved program of study', option (ii) is being used, and midwives who have completed a course of study in pharmacological management for Nurse Practitioners are required to undertake an exercise in *mapping* their course against the AHPRA guideline and accreditation standard. For more information regarding each section and for greater context please refer to the “Guidelines for Education Requirements for Recognition as Eligible Midwives and Accreditation Standards for programs of study leading to endorsement for scheduled medicines for Eligible Midwives”


A template has been provided for this mapping exercise.

Mapping of XXXX University’s Therapeutic Medication Management Course against Accreditation Standards Essential Course Requirements for programs of study leading to endorsement for scheduled medicines for Eligible Midwives  

ESSENTIAL COURSE REQUIREMENTS Prescribing medicines requires a robust knowledge base. The content of the program must reflect the fact that prescribing is a competence-based professional act, and will aim to enable midwives to develop their knowledge and skills in prescribing, and will include the critical elements relating to clinical assessment, judgement and evaluation. The educational organisation designing a program or units of study designed to develop the competence of midwives in this area must demonstrate the four components of prescribing as outlined below to obtain the approval of the NMBA.  

INFORMATION GATHERING
• Medication history, adverse drug reactions, medicine taking behaviour, adherence
• Presenting health, relevant health and maternity history
• Current problems
• Relevant signs symptoms
• Pathology results
• Guidelines, protocols, pathways  

CLINICAL DECISION MAKING
• Clinical assessment
• Consider ideal therapy
• Balance risks/benefits of drug-drug, drug recipient, drug-disease/condition problems
• Consider beliefs and needs re medication of woman and her infant
• Consider economical/availability of therapeutic options
• Select drug, form, route, dose, frequency, duration  

MONITOR and REVIEW
• Review control of signs and symptoms
• Review adherence
• Review woman or her infant’s outcomes
• Consider need for therapy to be tailored to person, continued or ceased
• Reflection by prescriber, peer feedback and review  

COMMUNICATE DECISION AS AN INSTRUCTION TO (GENERATE ORDER)
• Other health professionals/prescribers to continue and monitor (including discharge)
• Midwife to administer or supply
• Pharmacy staff to review and dispense or arrange supply
• Woman, her nominated partner, family or friend to administer

Each of the essential components of prescribing required in approved courses demonstrating midwife competence is listed and the applicant notes components of study within the course demonstrating the required essential requirements.

The second part of this exercise is to map
Pharmacology Knowledge and Skills required for prescribing and appropriate qualifications for programs of study leading to endorsement for scheduled medicines for Eligible Midwives 

In addition, any course accredited for the purpose of ensuring midwives have the pharmacology knowledge and skills required for prescribing and appropriate qualification, the following elements will be incorporated:

  • Legislation, regulations and policies relevant to the prescribing of medicines 
  • Prescription writing and documentation 
  • Professional accountability and responsibility 
  • Professional relationships and referral 
  • Anatomy, physiology and pathophysiology 
  • Pharmacology and pharmacokinetics 
  • Assessment, history, diagnostics investigations and data for prescribing 
  • Common medicine prescribed across the continuum of midwifery care 
  • Safety of medicines (quality use of medicine principles) 
  • Safety and quality – risk management and error prevention in medication management, contraindications and the use and safety of medicines during pregnancy, including teratogenesis
  • Psychology of prescribing 
  • Critical appraisal, integration of research relevant to prescribing of medicines 
  • Information sources regarding medicines 
  • Over-the-counter medicines and polypharmacy 
  • Combinations with complimentary therapies, and the contraindications during pregnancy and breastfeeding 
  • Considerations when working with women with drug addiction and substance use problems (and the need for consultation and referral in these situations) 
  • Behavioural aspects in relation to medication ‘compliance’ 
  • The role and function of therapeutics agencies and the regulation of medicine (including the role of the Therapeutic Goods Administration). 

Further information or comment is welcome.  Midwives who have undertaken the units of study necessary for notation as PBS eligible may have some advice that you would like to share with others.

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