Australian Private Midwives Association: Midwives and prescribing

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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WHO ARE WE?

The Australian Private Midwives Association represents midwives in private practice. The association is focused on the safety of women, the ability of women to access quality midwifery care across Australia and the partnerships between women and midwives. APMA supports women’s choice in maternity options within a framework of quality and safety and believes in women being able to access midwives in all settings. APMA unites all midwives seeking to provide continuity of care for women.

APMA strives to provide midwives in private practice with information relevant to their practice and advocacy in the political process.

Enquiries:
Joy Johnston joy@aitex.com.au
Marie Heath NSW and National 0407 266004
Clare Lane (Vic) 0416 130219

APMA POSITION STATEMENT on PLANNED HOME BIRTHS WITH A MIDWIFE

1. We support home birth with a midwife in attendance for women who have uncomplicated labours. 2. We support and adopt the International Confederation of Midwives’ (ICM) Definition of the Midwife (2011), which is foundational to all midwifery practice, including homebirth. 3. We support the right of every woman to access a midwife as the primary maternity caregiver who works in partnership with the woman throughout the episode of care, who is able to be the responsible professional in attendance at the birth either at home or hospital, and who is able to make appropriate referral and transfer of care when required. 4. We support the right of a midwife to practise privately in a fee-for-service or funded relationship with the client, or to take up employment. 5. We support only those regulatory restrictions that are able to pass the ‘public interest’ test: “How does this promote health and wellbeing in the mother and baby?” 6. We support an expectation of equity, including equal pay for equal work throughout a midwife’s scope of practice. Midwives who provide primary maternity care are entitled to the same public funding, the same opportunity to charge a fee-for-service, the same access to hospital referral, and publicly supported indemnity insurance, as medical practitioners providing the same maternity services. 7. We support processes by which midwives are able to gain experience and mentoring in order to commence and demonstrate competence in homebirth practice. 8. We support seamless and reliable processes by which midwives are able to make hospital bookings for women planning homebirth, and arrange transfer to the hospital in a timely way when needed.