The drug therapy proptocol was a QLD initiative and the Drugs and Poisens Act was changed to support midiwves to , obtain, possess, supply and administer certain drugs. This was a successful and innovative project that was successful. This supported the midwifery profession and assisted in growing the understanding of the midwives professional role

1. Health Management Protocols
for the Drug Therapy Protocol: Midwifery
Drug Therapy Protocol:
Midwifery
2011 Review and Changes
Dr Belinda Maier
Midwifery Advisor
Office of the Chief Nursing Officer
Midwifery Practice and Profession
Dr Belinda Maier
Midwifery Advisor

2. Key Projects for 2011
• Policy -
Breastfeeding
• Policy - Transfer of a
woman and or infant
from a planned home
birth to a Qld Health
Service
• Drug Therapy
Protocol- Midwifery
• Rural Maternity
Initiative Management
• Clinical Governance for
Midwifery Models of
Care
• Review - Midwifery
Models of Care
Implementation Guide
• Collaborative
Arrangements for
Private Practice
Midwives

3. Background Summary
1998 NHMRC Review of Services Offered by Midwives
2005 Re-Birthing: Report of the Review of Maternity
Services
2005 QLD Health Minister endorsed a review of Health Drugs
& Poisons regulation 1996.
2006 QH Midwifery DTP working Party
2007 Health Legislation Amendment passed to Health
Drugs and Poisons Regulation 1996
2008 DG approved DTP: Midwifery and Senior Director
population Health signed off Appendix 1- the list of drugs a
midwife can give
2008 Statewide Health Management Protocols and
education package developed for use in Districts
2010-11 DTP , HMP and education package review and
update

4. Legislation
In 2007 the Health (Drugs and
Poisons) Regulation 1996 was
amended to authorise Midwives to:
“the extent necessary to practice
midwifery: to obtain, possess,
administer or supply a controlled
or restricted drug, under a drug
therapy protocol”

5. DTP: Midwifery is different to PBS
for Eligible Midwives
DTP Midwifery is a resource for Registered
Midwives employed within Queensland
Health.
PBS is different to a DTP and is for Eligible
Midwives.

7. Drug Therapy Protocol: Midwifery
• District Endorsed
• Any registered midwife, who has met the local
requirements, can administer and supply
medications under the Drug Therapy Protocol
• Midwives administer and supply medications
• Once off administration and supply of
medications under specific circumstances
• Specific medications only
• Midwife to complete local education package

8. PBS for Eligible Midwives
• Commonwealth legislation
• Only midwives who hold eligibility registration with NMBA
can prescribe, administer and supply medications under
PBS
• Midwives prescribe, administer and supply medications
• Ongoing prescription, administration and supply of
medications
• Midwives can prescribe medications identified in the PBS as
being authorised for midwives to prescribe (identified as a
midwife item in the PBS schedule)
• Midwife required to have completed a prescribing program
of study that is accredited and approved by NMBA

9. Drug Therapy Protocol: Midwifery
The objective of Drug Therapy Protocols are to
recognise the existence of extended practices by
health practitioners by creating a mechanism
which enables suitably endorsed health
professionals to administer and supply
scheduled drugs and poisons under specific
circumstances.
Appendix 1 list the allowed drugs under the
DTP.

10. Drug Therapy Protocol: Midwifery
Appendix 1
• Restricted Substances (S4)
Antibiotics
– Benzylpenicillin
– Amoxycillin
– Cephalexin
– Nitrofurantoin
– Flucloxicillin
• Controlled Substances (S8)
– Morphine Sulphate
– Pethidine

11. Drug Therapy Protocol: Midwifery
Appendix 1
• Antidotes
– Naloxone (Neonates only)
• Anti-emetic
– Metoclopramide
• Local Anesthetic
– Lignocaine
• Labour Supression
– Nifedipine
• Anti Hypertensives
– Nifedipine

12. Drug Therapy Protocol: Midwifery
Appendix 1
• Corticosteroid
– Betamethosone
• Inhalation Analgesia
– Nitrous Oxide and Oxygen
• Agents Acting on the Uterus
– Oxytocin
– Oxytocin/Ergometrine maleate
– Ergometrine maleate

13. Drug Therapy Protocol: Midwifery
Appendix 1
• Oral Contraceptive
– Levongesterel (including
emergency contraception)
• Specific Vaccines
– Anti D (Rh) immunoglobulin
– MMR
– Hepatitis B Immunoglobulin – VF
– Hepatitis B
– BCG

14. Health Management Protocol
• For the implementation of the DTP the
Health (Drugs and Poisons) Regulation
1996 requires the development of a
Health Management Protocol (HMP)
• This includes either adoption of the
Queensland Health Statewide HMP or
development of a local document.
• Minimum requirements of the HMP are
identified in the DTP

15. Health Management Protocol
The HMP Midwifery is a set of clinical
guidelines that outline the situations and
conditions under which an registered
midwife can administer and supply
medications listed in Appendix One of
the DTP.

16. Processes
• OCNO developed statewide DTP: Midwifery
• DTP: Midwifery requires endorsement by the
Chief Executive Officer of the Health Service
District
• If services choose to adopt the statewide HMP
it also requires sign off by CEO of the HSD.
• The statewide HMP cannot be changed at a
district level
• Midwifery HMP complementary to PCCM for
RIPERN midwives
• The DTP and HMP must be reviewed every
two years

17. Endorsement signed by District Chief
Executive Officer
• The Health Management Protocol for the
Drug Therapy Protocol – Midwives
• in ……………………………………………
district has been endorsed by:
• District Chief Executive Officer
…………………………………..
• Signature:
…………………………………………….
Date: / /
• Name……………………………………………
……………………………

18. Implementation Drug Therapy Protocol
Health Management Protocol for Midwives
Flowchart
• Drug Therapy Protocol: Midwifery approved by the Chief Health Officer 2011
↓
• District Director of Nursing / Director of Nursing will identify plan for implementation and
evaluation of progress and midwifery role expansion regarding DTP
↓
• District Director of Nursing to ensure Chief Executive Officer has endorsed DTP/HMP
↓
• District Director of Nursing to notify Directors of Nursing and Nurse/Midwifery Unit
Managers of endorsement, implementation and evaluation plans
↓
• District Director of Nursing to notify the Midwifery Advisor in the Officer of the Chief
Nursing Officer of endorsement
↓
• Nurse/Midwifery Unit Manager/Nurse/Midwifery Educator
• Implement DTP/HMP
↓
• Nurse/Midwifery Unit Manager/Nurse/Midwifery Educator
• Report progress evaluation back up management lines
↓
• Feedback, reporting to Belinda Maier, Midwifery Advisor,
Officer of the Chief Nursing Officer
Belinda_Maier@health.qld.gov.au 073234 1441

19. OCNO review 2011
• Feedback requested from all
HSD’s regarding implementation
and usefulness in practice
• DTP, HMP and education package
all reviewed with feedback from
services included

20. 2011 Review
Addition
• Morphine Sulphate: Pain Relief in Labour
– Morphine has a shorter half life than
Pethidine.
– Important for breastfeeding initiation
and maintenance, for both mother and
infant

21. 2011 Review
Removed
• Indomethacin as not recommended in the SMNCN
Guideline : Assessment and management of
preterm labour.
• Clindamycin as unable to be supplied under the
Queensland Health List of Approved Medicines
(LAM)
• Levongestrel/Ethinyloestradiol as unable to be
supplied under the Queensland Health List of
Approved Medicines (LAM)

22. 2011 Review
Revised dosages
• Nifedipine: Hypertension disorders in
pregnancy
– Dosage changed to 10 – 20mg
– Inline with SMNCN guideline: Hypertensive
disorders in pregnancy
• Nifedipine: Suppression of preterm labour
– Dosage changed to 20mg
– Inline with SMNCN guideline: Assessment
and management of preterm labour

23. 2011 Review
Revised dosages
• Ergometrine: Postpartum haemorrhage
– IV dosage added
– Inline with SMNCN guideline: Primary
postpartum haemorrhage
• Levonorgestrel: Emergency contraception
– Dosage changed to one 1.5mg tablets stat
– Inline with Primary Clinical Care Manual 6th
Edition and Therapeutic Guidelines

24. 2011 Review
Revised dosages
• Pethidine: pain relief
– Dosage increased to up to 150mg
– Inline with Primary Clinical Care Manual
6th Edition
• Antibiotic dosage changed from 10 days to 5
days in line with Therapeutic Guidelines

25. Endorsement process
• If already using DTP: Midwifery, the district
may continue using until review date
• The Chief Executive Officer of the Health
Service District needs to re-endorse the
revised DTP and HMP
• Initial endorsement: The DTP and HMP must
be endorsed by the Chief Executive Officer
of the Health Service District

26. Endorsement Process of HMP
• Developed as per DTP requirements
– Steering group with representation from:
• Medical Practitioner
• Registered Midwife
• Immunisation Program Nurse
• Pharmacist

27. Implementation in Service
• Endorsement of DTP and HMP by CEO utilising
template provided on OCNO website
• Education package available on OCNO website
and has been reviewed to reflect changes to
the DTP and HMP

28. Local Implementation
• Some medications will require local
processes for packaging for supply by
Registered Midwives under the DTP
• The Midwifery Advisor OCNO welcomes
feedback from services to contribute to
future reviews of the DTP: Midwifery

29. For More Information
Visit the Office of the Chief Nursing Officer website
Internal
http://qheps.health.qld.gov.au/ocno/content/midwifery.htm
External
http://www.health.qld.gov.au/ocno/midwifery.asp