introducing the national midwifery formulary

Introducing the National Midwifery Formulary

A sample education resource 16 September 2011

File Name: 2011 10 10 MWF Sample education materials to introduce formulary v 4

Version: 2 Date: 10 Oct 2011

Produced by: Healthcare Improvement Scotland Page: 2 of 38

Contents of education resource

Introduction 3

Preparatory reading 8

Pre-Course worksheet 10

The workshop – Lesson plan 13

The slides used in the workshop – link 15

Final multiple choice questionnaire 26

Assessment of competence (sample) 30




Introduction

These resources were produced as part of the national midwifery formulary project.

For background to the national midwifery formulary project please see the documents

at

www.healthcareimprovementscotland.org (maternal and reproductive health

programme).

As the steering group oversaw the development of the national midwifery formulary, it

became apparent that local NHS boards in Scotland would wish to adopt only a

selection of the monographs on medicines in the national midwifery formulary

resource. Selection of these would be a local decision and it would be the

responsibility of the Head of Midwifery, to whom the monographs would be sent, to

ensure that these monographs would be taken through their local governance

processes and used either as hard copies or accessed via their local intranet.

The steering group agreed that the national midwifery formulary would have an

accompanying and supporting resource to prepare midwives to use it. This would be:

‘…a fit for purpose education resource for midwives to learn about their roles and

responsibilities in the use of drugs and to support them in learning how to use the

midwife formulary.’

To this end NHS Quality Improvement Scotland supported NHS Lothian to develop

and pilot materials to support their midwives in preparing for local change to

medicines practice in midwifery. (This included the introduction of a new version of a

local formulary and changes to medicines distribution in its hospitals.) This enabled

the materials to be tested by midwives and subsequently refined locally before being

available for national use.

It was agreed that the resource would be developed following the principles below:

The content would be fit for purpose and pitched at an appropriate level and with clear learning outcomes.

The design would be fit for purpose, containing elements which make the presentation of the work compatible with web use eg use of bullets and short segments of text, rather than paragraphs, use of tables, diagrams and visual material where possible, and giving opportunity for reflection, responses, and self assessment.

The resource would be easily accessed and implemented.

The question and answer framework overleaf identifies the thinking and key

parameters that informed the steering group in requesting an educational resource

be developed at the pilot site.

http://www.healthcareimprovementscotland.org/




Framework for the education support for the midwifery formulary

Question Answer

What problems does this resource

address?

Currently there is:

a) a lack of clarity around the midwife’s professional role

in relation to medicines

b) no clear source of where to find information about

midwife rights and obligations in relation to the use of

medicines

c) a lack of awareness of rights and obligations

d) a lack of confidence in midwives in supplying and

administering drugs

What has been produced? An educational resource.

What is its primary purpose? To clarify and define midwives roles and responsibilities in

relation to medicines and use of the locally agreed midwife

formulary.

Who will own the final product? Healthcare Improvement Scotland with acknowledgement to the pilot site, NHS Lothian, and Edinburgh Napier University.

Over what timeframe was this product

developed?

This time allocated to this allowed the educational

resource to be developed and integrated with the newly

developed formulary and allowed for time to report on

lessons learned to Healthcare Improvement Scotland.

March 2010 – March 2011

Learners

How is the target audience defined

(be as specific as you can)?

Midwives and student midwives The prototype was initially piloted with 20 candidates to include experienced midwives that have had previous administration of medicines training, a supervisor of midwives, student midwives and a newly qualified midwife.

What academic level should the

learning be at?

Graduate (level 9)

Who will be able to access the

learning?

Midwives and student midwives




How will the users access the

materials?

On the Healthcare Improvement Scotland website.

When will the learners learn this new

content? At a specific point in time or

anytime anywhere?

Ongoing learning resource which will initially be rolled out to current staff within clinical areas to build on their existing knowledge

Part of pre-registration programme and

Induction for new start midwives

Where and how do the learners

normally learn?

Blended approach comprising study time for pre-reading, web-based learning and workshops.

What previous knowledge can be

assumed?

Nursing & Midwifery Council, Standards for Medicine Management 2008 There is pre course reading to remind participants of their legal and professional obligations.

What IT facilities does the target

audience have to access the course?

Resource rooms, elearning rooms, access to intranet

What other IT systems do the

learners normally use?

Examples could include Maternity Trak, Learnpro. Intranet

How long should the learning take? Total 15 hours of learning comprising

Pre course reading, web-based learning = 8 hours

Initial multiple choice questionnaire = 30 minutes

Participative workshop = 4 hours including repeat of the

questionnaire and marking at the end of the course.

Subsequent assessment = 2.3 hours

Total 15 hours

Portfolio taken to clinical area and signed off by

pharmacist, or a non-medical prescriber or

a practice educator.

Medical staff could be used in assessment to encourage

engagement.

Facilitators

Will the learning involve any instructor

or is it purely self-directed learning?

Participative workshop = 4 hours Pharmacist/ Lecturer/Midwife Assessor/Practice

Education/ non medical prescriber /member of the

obstetric medical team




Instructional design

What is the learning, teaching and

assessment strategy? How will

learners learn?

The learning and teaching strategy is a blended approach, which will include discursive lectures, skills workshops, web-based learning and self-directed study. This will allow for diversity and flexibility of learning styles. Assessment will be at skill stations (OSCEs could be used for pre registration midwives, written scenarios prepared for others) and completion of reflective portfolio of evidence. This will enable practitioner or student midwife to meet learning outcomes and develop their learning.

What are the learning outcomes? Practice within the legal framework using the formulary to allow the supply and administration of drugs within the current framework of Midwife Exemptions, Midwife Supply and Patient Group Directions

Apply an understanding of PGDs

Describe the use of, side effects, adverse effects and context of medicines within the locally agreed midwifery formulary

Correctly record and document the administration and supply of medicines from the locally agreed midwifery formulary

Reflect on clinical application of the content of the locally agreed midwife formulary on their midwifery practice

Impart information to the woman about medicines used in the locally agreed midwifery formulary.

How will the learning outcomes be

assessed? (formative/summative

assessment)

Skill station assessment, portfolio reflection, clinical skill

area assessment and multiple choice questionnaire (pre

and post workshop)

How formalised is the learning going

to be?

Structured to meet learning outcomes

Will the online learning be integrated

with any other forms of learning (eg

face-to-face undergraduate

modules)?

Blended learning – integration with other learning for midwives would be a local decision.

Will the learning be accredited? Initially not, but this could be adjusted with subsequent advice from NES

How will the learning be evidenced? Portfolio

How long is the learning going to take

/ how is the learning going to be

structured? (chunks, units, chapters

Pre course materials issued 4 weeks before workshop complete all elements 1 month following workshop total 15 hours of learning over approximately 2 months.




etc)

Is the learning going to be

mandatory?

This would be a local decision dependent on how the

national midwifery formulary resource is to be used locally

Recording and reporting of

learning

Do the learners need to be identified,

counted, reported on etc.? (learner

management, registration)

There may be a local record of learning retained on individual NHS board’s system for professional development Using Patient Group Directions requires a signature The content and appearance of the final certificate should

be considered.

Certificate to be held in the learning portfolio.

Are there any other specific

requirements for learner

management?

Supervisor of Midwives annual review

Personal Development Plan – KSF

Technical issues

Where will the content be hosted? On the Healthcare Improvement Scotland website

How many learners can be expected

to use the system?

Midwives in Scotland

Are there specific hard and software

requirements?

IT accessibility

Will the learning be free or charged

for?

Free to midwives but cost to clinical area to release staff for training and trainers/assessors

Who will deliver the learning? Practice Educators/Midwives/Pharmacists Lecturers/ non medical prescribers/medical obstetric team/ risk coordinator or clinical effectiveness team member




Preparatory reading

Midwives should be aware of their professional and legal rights and responsibilities in

relation to the supply and administration of medicines. To ensure a common base of

information and provide context the pilot workshops provided participants with the

opportunity to refresh their memories.

The pre-reading ensured that participants had been reminded of their professional

and legal obligations, and were also familiar with the different classifications of

medicines and the arrangements under which they could practice, and were aware of

all the local processes and guidelines providing a framework within which they can

supply and administer medicines.

The reading therefore was at different levels;

1 The professional context – to remind participants of their professional

obligations, midwives were directed to foundation documents published

by Nursing & Midwifery Council

eg code of conduct

http://www.nmc-uk.org/Documents/Standards/The-code-A4-20100406.pdf

eg standards for medicines management

http://www.nmc-

uk.org/Documents/Standards/nmcStandardsForMedicinesManagementBo

oklet.pdf

eg guidance for midwives and nurses on record keeping.

http://www.nmc-uk.org/templates/pages/Search?q=record%20keeping

2 The legal context as it relates to midwives – participants were asked to

read ‘Midwives and Medicines’ NHS Education for Scotland republished

April 2011

http://www.healthcareimprovementscotland.org/programmes/reproductive,

_maternal__child/national_midwifery_formulary/education.aspx

The context of medicines; it was suggested that participants became

familiar with accessing websites such as the PGD website

www.pgd.nhs.uk and The British National Formulary available online at

http://www.bnf.org

3 Participants were supplied with copies of the relevant local information on

medicines and practice eg guidelines, processes for supply, discharge,

clinics etc and requested to become familiar with their contents. This

included the monographs selected by the NHS board for local use from

what would be the national collection of monographs (the national

midwifery formulary).

http://www.nmc-uk.org/Documents/Standards/The-code-A4-20100406.pdf

http://www.nmc-uk.org/Documents/Standards/nmcStandardsForMedicinesManagementBooklet.pdf



http://www.nmc-uk.org/templates/pages/Search?q=record%20keeping

http://www.healthcareimprovementscotland.org/programmes/reproductive,_maternal__child/national_midwifery_formulary/education.aspx

http://www.healthcareimprovementscotland.org/programmes/reproductive,_maternal__child/national_midwifery_formulary/education.aspx

http://www.pgd.nhs.uk/

http://www.bnf.org/bnf/bnf/current/openat/104945.htm




Participants in the pilot sites were asked to allow a minimum of eight hours to

undertake this preparatory reading. After this reading participants were invited to

complete a pre course worksheet. Discussion on the worksheet took place in the

workshop session.




Pre-Course Worksheet

This worksheet has been designed for you to develop your knowledge and

understanding of the legislation and mechanisms that will allow you to use the

midwifery formulary.

Question 1

Having completed this workshop, will you be a non-medical prescriber?

Question 2

Define the different classifications of medicines and give examples of where each

different type may be obtained.

Question 3

Define what the national midwifery formulary is.

Question 4

Can a midwife delegate the task to another midwife of administering or supplying

medicines to a woman or baby?

Give a rationale for your answer.




Question 5

Define what is meant by Midwives’ Exemptions.

Question 6

What information must you have checked prior to giving a woman any medicine:

With respect to the woman?

With respect to the medicine?

Question 7

Give examples of resources that can give you accurate and up-to-date information on

medicines available in the UK today.

Question 8

Explain what is meant by ‘off license’ / “off label “

Question 9

What is meant by a Patient Group Direction?

Question 10

Do any and all medicines need to be recorded on the medicine kardex in your local

NHS board?




Question 11

If a drug error is identified, how should it be subsequently dealt with?

Question 12 When can a midwife administer parenteral lidocaine or lidocaine hydrochloride?

Question 13

Complex drug calculations are sometimes required in midwifery practice. How

should such calculations be checked?

Question 14

What is a contra-indication to supplying a woman with Paracetamol?

Question 15

List 6 of the potential adverse reactions that can occur if a woman is given Ranitidine

150mg orally.

Question 16

What additional information, if any, should be given to a postnatal woman if you

decide that she needs Iron supplementation?

Question 17

With reference to the national midwifery formulary explain what Diclofenac is used

for.




The workshop – lesson plan

Facilitators :

Practice education midwife

Relevant pharmacist

Session Title:

Midwifery Formulary Workshop

Number of Participants:

20

Date:

Identified Group:

Student Midwives and Midwives

Equipment/Resource/Aids:

Power Point Presentation Flip chart, pens, post its Pre-determined scenarios Reference materials – BNF, Copies of local midwife formulary, Copies of local policies on use of medicines etc Local Medicine Kardex – training copies, NMC booklets, Induction of Labour and Anti D leaflet MCQ, Evaluation, Certificates of attendance

Start time: 08:30

Finish time: 13:00

Duration: 4 ½ Hours incl. breaks

Aim:

By the end of the workshop the participants will be able to clarify and define roles and responsibilities in relation to medicines and use the midwife formulary within sphere of practice

Objectives:

Demonstrate safe practice in the administration of medicines by working within the legal and

ethical framework that underpins the use of Midwife Exemptions, Midwife Supply and Patient

Group Directions.

Apply knowledge of safe and effective medicines management in relation to PGDs, and local

policies and arrangements for medicines.

Apply knowledge of the legal status of medicines and how the status for the same medicine can

vary with pack size, formulation, indication and dosage.

Describe the indication, dosage, contra-indications, caution, side effects and the categorisation of




the medicines within the midwifery formulary.

Document accurately the administration and supply of medicines from the midwifery formulary.

Have knowledge of the medicines used within the midwifery formulary in order that accurate information is given to women.

Session Method of Delivery:

Power point presentation, Group work- scenario, MCQ, Q&A, Discussion

Aspect Activity Teaching Method Time Introductions and

objective of the session

Housekeeping, introductions

to facilitators

Verbal and visual

explanation of the sessions

aims and LOs

Power point 5 mins

Set out the order of the

workshop and discuss

MCQ

Explain midwife

formulary

Explain the order of the

session

Discuss the MCQ – answers

self marked

Discuss midwife formulary

use in clinical area including

midwife accountability, PSA

– incident examples

Facilitator

Power point

10 mins

15 mins

30 mins

Explore the clinical

application in using the

midwife formulary using

scenarios

Divide participants into 4 and

facilitate their problem

solving approaches.

Ask each group to nominate

scribe for each individual

work workstation scenario

Group Work

Facilitator in each station

Break after 2 workshops

20 mins

per

station =

80 mins

+ break

Feedback finding Facilitators feedback the

group’s findings

Use the pre determined

commentaries to help facilitate the

feedback summarise on flip chart

40 mins

Participants complete

MCQ

20 questions to complete to

achieve 100%

Reference materials available for

participants

30 mins




Summary, Portfolio and

Evaluation

Summarise the workshop

Discuss portfolio including timescale for completion

Ask participants to evaluate the workshop

MCQ results

Verbal

Handouts and evaluation forms

Postit feedback

Certificates of attendance

10 mins

10 mins

10 mins

Learning Support:

Handout (at end of session), pre course reading, essential preparation and completion of pre and post

workshop MCQ, scenario stations, reference materials, power point and portfolio

Participants that do not achieve required 100% at end of the workshop MCQ will have planned individual

remedial work and opportunity to reassess. If failed 2 attempts then involve clinical manager and named

Supervisor of Midwives

Sample of slides used in the workshop

Link to slides on the website




Introduction to the skill stations

The purpose of these skill stations is to give midwives practice in considering the

relevant issues in their practice in relation to medicines.

The size and mix of the group attending will depend on local circumstances. The

most effective sessions reported from the board in which this was piloted had a

mixture of attendees. It was reported that newer entrants to the profession were

encouraged by more experienced midwives. If there is an issue with updating

knowledge and skills it may be more appropriate to run separate refresher courses.

The introduction of a new local formulary can give useful leverage to overcome

resistance to attending.

These local courses are best tailored to a positive occasion eg on the introduction of

a new local formulary.

The course organisers considered a minimum of 4 weeks before the course run to

allow everyone to sign up and to circulate reading.

Resources for all stations

Local selection of monographs from national midwifery formulary

Copy of relevant local protocols and documents eg on safe use of medicines

BNF

NMC booklets

Medicine kardex

Copy of all local leaflets issued to women

Poster paper, pens and postits




Scenario 1 – Antenatal

Claire is a 36-year-old woman who is currently 16 weeks pregnant in her first

pregnancy.

Past Medical History - uncomplicated, BMI 30 and has remained generally healthy.

Plan for care to be managed by midwife.

Blood group AB Rh –ve.

Present - last haemoglobin result has returned as 104 g/l

She has arrived at your midwife clinic this morning complaining of tiredness.

Consider what your midwifery management might be.

Resources


Local policies eg on safe use of medicines

BNF

NMC booklets

Medicine kardex

Anti D leaflet

Poster paper and postits




Scenario 1 – antenatal answers

Antenatal review

Points to consider -

Is she Symptomatic (Tiredness ( all the time), Breathlessness (rest/activity) or

Dizziness (palpitations) – refer to GP, Consultant Obstetrician or D/W triage

depending on severity of symptoms)

Diet – confirm and advise

Full A/N examination - review all results from booking including Hb

eg MSU - infection

Plan using midwife formulary

Anaemia – check feratin levels and if >15 suggestion iron deficiency discuss

care with woman and commence iron supplementation of oral Ferrous

Sulphate 200mgs BD (ferrous fumarate – prescription expensive in hospital

cheaper in community) recheck full blood count in 4 weeks

Advice to woman to optimise iron intake and contraindications of medicine

Document on woman hand held record/trak and medicine kardex and follow

up appointment re prophylactic anti D programme

Remember the 8 Rs

Right drug

Right route

Right time

Right patient

Right dose

Right documentation

Right education

Right effect




Scenario 2 – Antenatal follow up

Clare is now 28 weeks pregnant and returns for antenatal review at midwifery clinic in

the GP surgery.

She is well.

Discuss and document plan of care.




Scenario 2 – Antenatal follow up answers

Antenatal examination

Repeat FBC and review results from last visit (discuss results with GP/Obstetrician)?

Random blood sugar test.

Discuss with Clare Anti D administration and informed consent, document on

medicine kardex and administer using midwifery formulary

check Clare has information leaflet on prophylactic anti D

order anti D from BTS pre appointment – or supplier, storage

BNF – drug interaction

Document Anti D on medicine kardex

Rh bloods prior to administration of Anti D

Administer (if possible) in a GP surgery – with access to emergency

equipment – If woman requests Anti D at home discuss plan

Access to adrenalin

Monitoring arrangements post administration

South East Scotland Blood Transfusion Service Log – to be completed

Document on hand held / trak and follow up appointment

Remember the 8 Rs

Right drug

Right route

Right time

Right patient

Right dose

Right documentation

Right education

Right effect




Scenario 3 – Labour

Claire remains well and at 41 weeks pregnant establishes in labour and gives birth at

home using Equanox to a SVD of a live baby boy weighing 3500gms requiring no

resuscitation. At delivery Claire has blood loss 300mls and a second degree tear

requiring suturing.

Discuss and plan her care documenting all medicines required

Resources

Local selection of monographs from National Midwifery Formulary

Local policies eg on the safe use of medicines

BNF

NMC Booklets


Induction of labour protocol

Induction of labour leaflet

Anti D protocol

Anti D leaflet

Medicine kardex – woman

Medicine kardex – baby

SMR form




Scenario 3 - Labour answers

Antenatal history and assessment at home.

Plan using midwifery formulary:

Exemption medicines - document on medicine kardex Equanox,

Syntometrine/syntocinon, Lidnocaine for perineal repair

Consider Diclofenic for post perineal pain and regular analgesia

Post natal Anti D

Plan to check 3rd day Hb in view of iron supplementation and last Hb result

Baby – Phytomenadione (Vitamin K )

IM – documented on medicine kardex - new practice

oral - document on baby medicine kardex

Remember the 8 Rs

Right drug

Right route

Right time

Right patient

Right dose

Right documentation

Right education

Right effect




Scenario 4 – Post Delivery

Claire, baby and family are well, breastfeeding baby and community midwife visits on

day 3.

Day 3 Hb result is 100 g/l platelets normal

BTS result Baby blood group A positive Direct Combs negative.

Claire is self-administering Paracetamol and Ibruprofen and also complaining of

constipation.

You are the midwife visiting Claire at home; plan her care using the midwifery

formulary.

Resources


Copies of local policies eg on the safe use of medicines

BNF

NMC Booklets


Copies of local protocols eg Anti D

Local discharge medicine documents

Medicine kardex – woman

Medicine kardex – baby

SMR form

Information sheet




Scenario 4 – Post Delivery answers

Plan using midwifery formulary

Anti D 500iu - midwife exemption

Oral iron therapy – midwife supply – last Hb result platelets – GP for

prescription or purchase from pharmacist

Lactulose – midwife supply – discuss with woman diet/fluid/motion – GP for

prescription or purchase from pharmacist

Check BNF

If mother requests oral phytomenadione plan for subsequent doses to baby

Midwifery formulary– implementation

Midwife can supply and administer or supply for patient to administer certain

medicines approved by the Medicine Act 1968. (Updated 1st July 2010)

And reference to the eight Rs…

Recap - Midwifery formulary– implementation

Midwife can supply and administer or supply for patient to administer certain

medicines approved by the Medicine Act 1968. (Updated 1st July 2010)

Items to acknowledge with participants

1. Consult the formulary and BNF rather than ask others or rely on your memory.

2. Undelegated task – inpatient. This task cannot be delegated irrespective of

whether it is ME, MSA or PGD. So for regular medications such as paracetamol 1g

QDS, each dose (ie four individual doses have to be written up on the once only

section) will have to be written up EACH DAY for inpatient hospital scenario, making

this process cumbersome. Use of several Medicine Charts is a potential source of

error.

3. Community midwives – there is no nationally agreed mechanism for supply for

patients to administer in community. Midwives may be able to obtain supplies from

hospital pharmacy but may not want to carry medicines. Patients may not want to

buy medicines even if very cheap. This is a dilemma.

4. Patients own supply- inpatient - legally if a patient brings in own medicines then

the midwife is not supplying so should not get involved in writing up the request on a




Medicine Chart. The Medicine Act, however, only requires parenteral medicines to be

documented on a medicine chart or prescription (ie prescribed). NHS organisations

across the UK have adopted the good practice of documenting all medications by all

routes administered to all inpatients unless the organisation has a specified policy

exception to this practice.




Sample Final Multiple Choice Questionnaire for Midwifery Formulary Education Workshop

Name.........................................

Consider the following questions and answer as appropriate.

It will be stated where some questions may have more than one correct answer.

Please indicate which of the following statements are true or false

1. Diclofenac suppository 100mg was written up by Midwife X on a medicine kardex. It

was noted that it had not been signed as administered. Midwife Y now in attendance

can still administer this medicine:

a. True

b. False

2. A telephoned order given by a doctor to a midwife, which states the woman’s name,

the medicine, the dose and the times of administration is an acceptable way of

prescribing a medicine:

a. True b. False

3. Cyclizine is included in the midwife formulary and classed as a Midwife Exemption medicine.

a. True b. False

4. Ibuprofen 400mg 4 hourly regularly up to a maximum 4 tablets in 24 hours is the

correct administration

a. True

b. False 5. Oxytocin can be stored at 30 C for up to 3 months (mark revised expiry date on box)

a. True

b. False

6. A manufacturer’s patient information leaflet should be available for an administration

medicine, or given to the women if a medicine has been supplied, or, if a patient

requests one, for any medicine:

a. False

b. True

7. The second line treatment for haemorrhoids is Anusol HC for up to 7 days

a. False

b. True




8. Lidocaine for cannulation can be administered under a Midwife Exemption

arrangement

a. True

b. False

9. In your local NHS board any medicine, unless specified by local policies and

procedures, must be recorded on a prescription and administration chart

a. False

b. True

10. A student midwife can administer a medicine under a Patient Group Direction arrangement under the direct supervision of a Midwife

a. True b. False

Consider the following questions and indicate the correct answer. It will be stated where some

questions have more than one correct answer.

11. What is a General Sales List medicine?

a. A medicine that is only obtainable with a prescription. b. A medicine that can be sold from a pharmacy on the condition that a pharmacist

supervises the sale. c. A medicine that can be bought at various retail outlets. d. Medicines that are supplied to hospitals only.

12. What is a midwife exemption medicine?

a. A medicine that a midwife can administer only if prescribed by a

medical /non medical prescriber.

b. A medicine that the midwife can supply or administer in the sphere of

midwifery practice without a prescription or PGD

c. A medicine that a midwife may sell to a woman

d. Only medicines that can be given to woman and not babies

13. You are about to administer a medicine prescribed to a woman by a doctor but you are

uncertain if the correct dose has been prescribed. Do you:

a. Check with other member of staff.

b. Check BNF for correct pharmaceutical form, strength, dose and route of

administration.

c. Ask the woman how many tablets she had been given before.

d. None of the above.

14. By use of a PGD, Dihydrocodeine tablet 30mg was written up by Midwife A. The dose

was delayed as the woman was out of ward. Midwife B can:




a. Rewrite another dose without assessment.

b. Assess the woman’s requirements and document that dose written by Midwife A

was not given.

c. Administer dihydrocodeine to the woman as written up by Midwife A without

an assessment.

d. Ask a doctor to write up woman for dihydrocodeine.

15. A mother requests that her newborn baby have oral phytomenadione. As the midwife

using the national midwifery formulary you can:

a. Obtain a prescription from a paediatrician. b. Administer oral phytomenadione using a Patient Group Direction. c. Administer oral Phytomenadione as a Midwife Exemption Administration. d. Ask mother to obtain a prescription from her GP.

16. What is a pharmacy medicine (P)?

a. A medicine that can be obtained only from a pharmacy under the supervision of a Pharmacist but does not require a prescription.

b. A medicine that is available from the healthcare aisle in large supermarkets.

c. A medicine that can be dispensed only by a hospital Pharmacist. d. A medicine that requires a prescription from a Doctor.

17. Contraindications to Anti – D postnatal are:

a. known RH(d) positive individuals including those who are Du

positive, RH(d) negative individuals known to have immune Anti-D

antibodies, hypersensitivity to any of the components, consent not

given.

b. known RH(d) positive individuals including those who are Du positive,

hypersensitivity to any of the components, consent not given.

c. known RH(d) positive individuals including those who are Du positive,

RH(d) negative individuals know to have immune Anti –D

antibodies, hypersensitivity to any of the components.

d. RH(d) negative individuals known to have immune Anti-D antibodies,

hypersensitivity to any of the components, consent not given.

18. As a midwife you are about to administer a medicine to a woman. Which of

the following statements is true with respect to your accountability?

a. You must be certain of the identity of the person. b. You must ensure that the person does not have an allergy to the prescribed

medication. c. You must be aware of the therapeutic use, dosage, side effects, precautions,

contraindications and expiry date. d. You must ensure the correct prescription is documented. e. All of the above.




19. Right time, right patient, right medicine, right route, right dose, and right education.

The missing elements are:

a. right effect , right dose

b. right documentation, right effect

c. right prescription, right documentation

d. right effect, right prescription

20. A mother requests her baby have oral phytomenadione. As the midwife using the

national midwifery formulary you know the correct dose and frequency are:

a. 2mg (0.2ml) oral at birth and repeated at 4 days- exclusively breastfed

babies will require a further dose at one month, max 3 doses

b. 2mg (0.2ml) oral at birth and repeated at 7 days - exclusively breastfed

babies will require a further dose at one month, max 3 doses

c. 2mg (0.2ml) oral at birth and repeated at 4 - 7 days - exclusively

breastfed babies will require a further dose at one month, max 3

doses

d. 2mg (0.2ml) oral at birth and repeated at 4 -7 days - exclusively breastfed

babies will require a further dose at one month, max 2 doses.




Assessment of competence (sample)

This consists of three elements

1. Portfolio of evidence to demonstrate the understanding of the medicines in the local

formulary and the role of the midwife in the use of

Exemption list medicines

GSL medicines

P medicines

POM medicines

PGD medicines

Discharge procedure

Other local practice in relation to medicines eg supporting self administration by

women

2. Completion of multiple-choice questionnaire

3. Clinical assessment – in a skill station format

Clinical assessment by a designated midwife or pharmacist in the use of the Lothian

Midwife formulary to administer, supply and discharge medicines including PGDs ( where

appropriate ) Assessor will observe practice and midwife will demonstrate use of the

formulary in

Exemption list medicines

GSL medicines

P medicines

POM medicines

PGD medicines

Discharge procedure

Other local practice in relation to medicines eg one stop dispensing

On successful completion of these elements within 3 months of completing the workshop

the midwife will be confirmed on the statement of achievement as competent to use the

midwifery formulary and this will be recorded into the personal training file in empower

management system.




If you do not achieve 100% on the post course multiple-choice questions you will have

only one further attempt, but more details will be given regarding support.

The midwife in her personal development portfolio must retain a copy of the statement of

achievement.




Sample Record of Practice

Exemption List Medicines

Indication(s) for Use Midwife evaluation

and reflection

Assessor Feedback

…………………………….. …………………………….

Assessor Signature Assessor name Print

…………………………….. …………………………….

Designation Date





General Sales List

Medicines


and reflection

Assessor Feedback

…………………………….. …………………………….


…………………………….. …………………………….

Designation Date





Pharmacy Medicines


and reflection

Assessor Feedback

…………………………….. …………………………….


…………………………….. …………………………….

Designation Date





Prescription Only

Medicine


and reflection

Assessor Feedback

…………………………….. …………………………….


…………………………….. …………………………….

Designation Date





Patient Group Direction

Medicines


and reflection

Assessor Feedback

…………………………….. …………………………….


…………………………….. …………………………….

Designation Date




Statement of Achievement

The following midwife has completed the learning programme and has demonstrated accountability, safe and competent practice using the administration and supply of medicines including PGDs in the midwifery formulary.

Name………………………………………………………………………

Components of Programme

1. Open Learning programme

Portfolio in demonstrating the use of

Exemption List Medicine

GSL medicine

P medicine

POM medicine

PGD medicine Completed all multiple choice questionnaire This is to certify the above named person has completed all these elements

Signature, print and designation of assessor ………………………………………………………………………………….

Date……………………………………………………………………………

2. Supervised practice by a midwife, pharmacist, medical practitioner and

non medical prescriber in the administration and supply medicines including PGD using the local midwifery formulary.

Signature, print and designation of assessor

…………………………………………………………………………………

Date……………………………………………………………………………

Ensure a copy is held in the relevant central file eg for training and retain the master for your Personal Development Folder for your own records.