Transforming and Supporting Patient Care - Health Professions ...

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238Chapter 10 – Profession of Midwiferyof these recommendations will address the request for regulation by classrather than individual drug.Specific Classes of DrugsReadiness for ChangeHPRAC’s review of the drug education of midwives in Ontario concludedthat the program is comprehensive. It includes pathophysiology/diagnosis,drug history (including limitations), pharmacodynamics, pharmacokinetics,toxicology and patient communication and monitoring.Midwives currently have prescribing rights, and in HPRAC’s view, midwivesare educated and trained on an on-going basis to prescribe the mostcurrent drugs to treat conditions within their scope of practice. HPRACfound that there is a high level of consistency in midwifery programs acrossthe country, and precedent for prescribing drugs within the midwiferyscope of practice.Members of the CMO support moving to classes from individual drugs inregulation, and they support the addition of the specific classes that theCMO is requesting. The CMO held formal consultations with its membersregarding the proposed changes to the scope of practice. Of those whoresponded (64 percent of members), 98 percent supported the addition ofantibiotics for the treatment of GBS, mastitis, UTIs and bacterial vaginosis.Ninety percent supported the inclusion of antibiotics for the treatment ofsome STIs.Managing the Risk of HarmMembers are expected to maintain clinical competency as part of theirroutine professional development. As well, members are required toparticipate in continuing education as part of the CMO’s quality assuranceprogram. These requirements include continued competency inpharmacology. The CMO will determine any additional training andupgrading that is needed to ensure midwives are trained to prescribe andadminister new classes of drugs that are approved.Supporting CollaborationThe proponents have noted that giving midwives the authority to prescribecertain drugs, antibiotics in particular, will enable them to participate morefully in interprofessional teams. HPRAC heard that this will also relieve thestrain on physician-midwife relationships by eliminating unnecessaryconsultations and referrals.Individual Classes of DrugsAntibioticsIn its scope of practice review, HPRAC heard that, within the current scopeof practice, Ontario midwives do not have the authority to orderHPRAC Critical Links January 2009
239Chapter 10 – Profession of Midwiferyantibiotics, unlike other Canadian jurisdictions, where there is broadauthority to prescribe antibiotics.HPRAC remains concerned that midwives are not authorized to prescribeantibiotics for Group B streptococcus. During the scope of practice reviewconsultations, HPRAC heard numerous examples of the need to prescribeantibiotics to provide appropriate and safe patient care.While there are risk of harm issues concerning the misuse of antibiotics,such as the development of antibiotic drug resistance and opportunisticinfections, on balance HPRAC is convinced of the need for midwives to havethe authority to prescribe antibiotics within their scope of practice, andthat these risks can be mitigated by appropriate education, training andstandards of practice.Continuous Infusion MaintenanceHPRAC heard that there is some variability in midwives monitoringcontinuous infusion maintenance for in-hospital births across Ontario. Incertain hospitals midwives monitor and adjust infusions whereas in othersthis task is performed by nurses. In either case, a prescriber has orderedthe infusion and an anaesthesiologist has administered the injection.HPRAC agrees that midwives are competent to monitor and adjustcontinuous infusion maintenance but feels that this is an issue best left forindividual hospitals to decide.GalactagoguesHPRAC heard that Galactagogues (domperidone) are a relatively new classof drugs that assist women with milk production. HPRAC’s review of thisclass of drugs indicates that they are safe to use, and that midwives havethe competencies to prescribe them to treat inadequate milk supply.Immune GlobulinsHPRAC heard that this class falls within the drugs that midwives normallyprescribe for occasional cases. It is part of the regular care for low-riskbirths. The profession is requesting the authority to prescribe varicellazoster immune globulin within this class of drug to treat women who havebeen exposed to the varicella zoster virus (chicken pox). HPRAC notes thatthis is a standard treatment for women who have been exposed to thisvirus and is important to prevent maternal infections. HPRAC agrees thatthis drug should be added to the immune globulins class to enablemidwives to treat women who may be at risk from exposure to the varicellazoster virus. Midwives have the education and training needed to prescribethis drug, and will have appropriate standards of practice in place forprescribing and administering the drug.Non-steroidal Anti-inflammatories (NSAIDs)This is a first line treatment for postpartum pain and prescribing thesedrugs is within the competencies of midwives. HPRAC agrees that there isvery little variety in the drugs within this class, and that it makes sense forHPRAC Critical Links January 2009
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20Chapter 2 - Excellence in Health
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186Chapter 8 - Profession of Dental
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340Chapter 14 - Profession of Pharm
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378Chapter 16 - Profession of Respi
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394Chapter 17 - Conclusionscontinui
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398Chapter 18 - Summary of Proposal
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