Administration of Medicines by Midwives under Medicine Act Exemptions (GL781)

Transcription

1 Administration of Medicines by Midwives under Medicine Act Exemptions (GL781) Approval Approval Group Job Title, Chair of Committee Date Maternity & Children s Services Clinical Governance Committee Drugs & Therapeutic Committee Chair, Maternity Clinical Governance Committee Chair, Drugs & Therapeutic Committee 2 nd June th August 2017 Change History Version Date Author, job title Reason 4.2 April August 2016 A Weavers (Consultant Midwife) C Harding (Consultant MW), T Hawkins (Blood Transfusion nurse specialist) 4.4 Nov 2016 C Harding (Consultant MW), 5.0 April 2017 C Harding (Consultant MW) Pg 5 Controlled Drugs 32. Amended to MUST be witnessed Pg 17 Maternal prophylaxis / Anti-D immunisation update Appendix 1 Classification table Pg 12 Entonox Pg 15 Peppermint water added Pg 17 Oxygen added Changes throughout due to clarification and change in practice resulting from various drug policies & guidelines being updated Policy Lead: Chief Nurse Version: V5.0 ratified 2/6/17 Mat CG mtg & 15/8/17 DTC This document is valid only on last printed Page 1 of 19

2 Maternity Guidelines Administration of medicines by midwives (GL781) August 2017 Policy Statement 1. The purpose of this Policy is to ensure that practising midwives safely administer those medicines which their legal status exempts them from the need for a prescription from an authorised prescriber or without the need for a specific Patient Group Direction to women during the antenatal, labour and postnatal periods and to neonates. 2. To list medicines that midwives can administer in the course of their professional practice under Medicines Act exemptions i.e. without the need for a prescription from an authorised prescriber or without the need for a specific Patient Group Direction. 3. Medicines not included in this list will require a prescription from an authorised prescriber on the official Trust In-patient, Out-patient Prescription sheet or other authorised prescribing charts or may be given under the terms of a specific Patient Group Direction Scope 4. This Policy applies to all Registered Midwives employed by the Royal Berkshire NHS Foundation Trust. 5. Registered Midwives acting under this Policy must: (a) (b) (c) understand their scope of practice (NMC,2015) and work within it and must be clearly instructed as to what documentation they may and may not complete must have knowledge of locally agreed procedures in relation to of medicines must know the therapeutic uses of the medicine to be administered, its normal doses, side effects, precautions and contra-indications 6. This Policy should be read in conjunction with the Trust s Medicines Management Policy: Consultation 7. This policy was initially drawn up with the active advice of: Supervisors of Midwives Lead Pharmacist for Maternity and Children s Services It has been reviewed in conjunction with the Deputy Lead Pharmacist. Dissemination/Circulation 8. This policy will be placed on the Trust policy hub under Clinical/ Maternity / Professional guidelines/ GL781 Policy Lead: Chief Nurse Version: V5.0 ratified 2/6/17 Mat CG mtg & 15/8/17 DTC This document is valid only on last printed Page 2 of 19

3 Maternity Guidelines Administration of medicines by midwives (GL781) August 2017 Monitoring of Compliance and Effectiveness 9. Every practising midwife should have their notes audited on the of medicines on an annual basis by line manager Any risks identified should be reviewed by the Line Manager and recommendations made with reference to Trust Employment Policies implementation 10. This policy will be implemented by Registered Midwives employed by the Royal Berkshire NHS Foundation Trust and by no other staff Definitions 11. Registered Midwife A midwife registered as a midwife with the Nursing and Midwifery Council 12. Authorised Prescriber A registered medical or dental practitioner or registered nonmedical prescriber Accountabilities 13. The Chief Nurse has overall responsibility for ensuring compliance with this Policy 14. The Chief Pharmacist/Drugs and Therapeutic Committee will ensure that changes in legislation which may affect or alter this policy are appropriately advised 15. The Registered Midwife signing the drug chart or records for the of the exempted medicine has accountability for the of the medicine under Medicines Act Exemptions Background 16. By virtue of their professional status, Registered Midwives have automatic exemption to supply and/or administer specific medications for specific indications for specific patients. These are listed at Appendix 1 Policy Lead: Chief Nurse Version: V5.0 ratified 2/6/17 Mat CG mtg & 15/8/17 DTC This document is valid only on last printed Page 3 of 19

4 Maternity Guidelines Administration of medicines by midwives (GL781) August 2017 Administration Procedure 17. The midwife must be certain of the woman s/neonate s identity prior to of the medicine both through use of identity band and by verbal checking 18. The midwife must be aware of the woman s plan of care and administer within the context of the woman s condition 19. The midwife must check that the woman is not allergic to the medicine before administering it 20. Before, the midwife must select the medicine and check: (a) (b) (c) (d) (e) (f) the drug, strength and dose, form selected is correct and appropriate for the patient the container label for the symbols P// check the expiry date of the medicine the dosage, route of and timing the name on the label of any dispensed medicines corresponds with the patient s name Individually dispensed items are clearly labelled with correct instructions. 21. The midwife must ensure the medicines are taken before leaving the patient. Medicines must not be left on the patient s bedside table/locker to administer themselves 22. Where the box/drug is labelled, this cannot be administered without a prescription from an authorised prescriber unless the drug is listed in Appendix The midwife must make a clear, accurate and immediate record of the medication administered on official Trust documentation ensuring that the signature is clear and legible. Where a student midwife has administered the drug, the midwife has to countersign the student s signature 24. Administration of drugs to neonates (e.g. Konakion) should be clearly signed by a midwife and a second checker (see below for further clarification) 25. A midwife cannot delegate the of a medicine to a support worker or registered nurse 26. With the exception of controlled drugs, student midwives can administer any of the medicines on the midwives list (appendix 1) under the direct supervision of a registered midwife who is a sign off mentor. If the midwife working with the student is not a sign off mentor, the midwife has to administer the medication. 27. Where a drug is to be administered intravenously (IV), the Trust policy on of IV drugs (April 2017) recommends that 2 registered practitioners check the drug prior to its. In a situation where a midwife is working as a sole practitioner and an emergency situation occurs (for example postpartum haemorrhage in the home), it is acceptable in this instance to administer IV drugs without reference to a second practitioner Policy Lead: Chief Nurse Version: V5.0 ratified 2/6/17 Mat CG mtg & 15/8/17 DTC This document is valid only on last printed Page 4 of 19

5 Maternity Guidelines Administration of medicines by midwives (GL781) August 2017 Controlled Drugs 28. Details of the of controlled drugs should be entered into the Controlled Drugs Register which must be clearly signed both by the midwife and a second checker. 29. A second signatory MUST witness the whole process and sign the drug chart 30. The second signatory should ideally be another registered health care professional (registered midwife, registered nurse or doctor) however a student midwife can fulfil this role 31. Student midwives may not administer controlled drugs given under the midwife exemptions however may participate in the checking and preparation of controlled drugs 32. Student midwives may administer controlled drugs prescribed by a doctor under the direct supervision of a sign off mentor 33. All controlled drugs prepared but not used must be destroyed as outlined in Trust s Controlled Drugs Policy Controlled Drugs and Home Births 34. In a woman s home where a midwife is administering opiates (diamorphine), obtaining a second signatory should be based on local risk assessment. The controlled drug (diamorphine) for community midwifery use is available on Rushey Midwifery Led Unit. To obtain a controlled drug the following procedure must be adhered to: 35. Community midwives must sign out the Controlled Drug they require from the Controlled Drug Record Book. Where the first on call midwife is already with the mother in labour, the controlled drugs required can be collected by the second on call midwife. It is not acceptable practice for student midwives/maternity care assistants to collect controlled drugs from Rushey Birth Centre in this situation 36. Drug is recorded in the maternity record/trust drug chart and also in the Controlled Drug Record Book 37. The need for a second signatory for during a home delivery should be based on local risk assessment, however where 2 midwives have been involved in the procurement of the controlled drugs, both signatures are required 38. Controlled Drugs required for a home delivery must be stored safely in a locked or tamper evident container and at room temperature for transport to the woman s home. 2 cash boxes have been provided for this purpose and these are stored by the controlled drug cupboard on Rushey Birth Centre. 39. Unused Controlled Drugs safely stored can be returned to stock in the Controlled Drug cupboard by correctly completing the appropriate section of the register. The midwife MUST record the amount of drug used and the amount returned. Policy Lead: Chief Nurse Version: V5.0 ratified 2/6/17 Mat CG mtg & 15/8/17 DTC This document is valid only on last printed Page 5 of 19

6 Maternity Guidelines Administration of medicines by midwives (GL781) August All controlled drugs prepared but not used should be destroyed as outlined in Trust s Destruction of Controlled Drugs Standard Operating Policy of Records 41. Midwives are required to keep accurate and detailed records of the supply/ of medicines 42. Midwives who administer medicines should ensure that these are always recorded on the woman s and/or neonatal drug chart and/or records (see the table below for clarification) 43. To simplify the documentation of medicines, all midwives should ensure that: (a) (b) (c) (d) The patient s name, address, NHS number and hospital number is on the drug chart together with the relevant drug history and known drug/food allergies Any medicine that is likely to be administered once or twice under professional exemption is documented in the Once only Drugs section (e.g. Ergometrine) In the box Prescribers signature state Midwives Administration to indicate that the is initiated by a Midwife under professional exemptions. The record should be signed on the date and time when the medicine is administered. Any medicines likely to be administered more than twice under professional exemption (e.g. paracetamol) are to be written in the As required prescriptions section of the drug chart. The use of the As required section does not imply a prescription for a course of treatment but indicates where midwives who administer under professional exemption record concurrent s in the same sections thus lessening the possibility of accidental overdose 44. Registered Nurses working within the maternity unit are not permitted to administer medicines from this section of the drug chart unless prescribed by an authorised prescriber 45. Where a limit to the number of s of a medicine is indicated, it is recommended that the midwife indicates this limit on the drug chart by drawing a line after the proposed number of doses. If further medication is required referral to a medical practitioner is required Protection of patients and staff from adverse incidents 46. If a Registered Midwife makes or observes an error or near miss, they must take any action to prevent any potential harm to the woman or neonate and report as soon as possible to their line manager. If necessary inform medical aid. A incident report form must be completed 47. If a woman experiences an adverse drug reaction to a medication, a Registered Midwife must take any action to remedy harm caused by the reaction. This must be recorded in the woman s notes and an incident report form initiated 48. For the destruction of unused drugs and drug packaging, see SAFE DISPOSAL of MEDICINES (CG216) on Trust Intranet site. Policy Lead: Chief Nurse Version: V5.0 ratified 2/6/17 Mat CG mtg & 15/8/17 DTC This document is valid only on last printed Page 6 of 19

7 Maternity Guidelines Administration of medicines by midwives (GL781) August 2017 References (a) (b) (c) Nursing and Midwifery Council (2015) The Code London Nursing and Midwifery Council Circular 1/2005 Medicines Legislation what it means for midwives: available online at: Nursing and Midwifery Council Circular 07/2011 Changes to Midwives Exemptions (d) Medicines Policy (CG078) (2017) (e) Intravenous Drug Administration Policy CG210 (April 2017) (f) Medicines Policy: Standard Operating Policy no 14 Administration of Medicines CG 088 (2017) (g) Department of Health (May 2010) CNO Letter to SHA Directors of Nursing: Implementation of Medicines for Human Use (Miscellaneous Amendments) Order 2010 midwives exemptions list British Thoracic Society (2017) Guideline for Oxygen use in adults in Healthcare and Emergency settings. Thorax An international Journal of Respiratory Medicine Vol 72 Supplement 1 Policy Lead: Chief Nurse Version: V5.0 ratified 2/6/17 Mat CG mtg & 15/8/17 DTC This document is valid only on last printed Page 7 of 19

8 Appendix 1: Notification from the MHRA (2012) - Under the Human Medicines Regulations 2012; medicines which are classified as pharmacy (P) medicines may be sold or supplied only through registered pharmacies by or under the supervision of a pharmacist (regulation 220). Prescription Only Medicines () are subject to an additional requirement: they may only be sold or supplied through pharmacies in accordance with a prescription given by an appropriate practitioner (regulation 214). General Sale List () medicines may be sold more widely through other retail outlets (regulation 221). Exemptions from the general rules are permitted for midwives. Provided it is in the course of their professional practice, midwives have the following exemptions under medicines legislation to administer medication: All medicinal products on a General Sale List and all P medicines - medicines listed under these categories which are commonly stocked in the ward areas are listed below. Certain Prescription Only Medicines () for parenteral use to which the exemption applies are also listed below: This document is valid only on date last printed Page 8 of 19

9 Oxytocics Oxytocin injection 10 units in 1ml ampoule Syntometrine injection 1ml ampoule Ergometrine maleate injection 500mcg/1ml ampoule Routine drug for active management of third stage in women at low risk of PPH Active management of third stage of labour with or after delivery of shoulders First line management for Postpartum haemorrhage following active management with Oxytocin 10iu Postpartum haemorrhage 10 iu intramuscularly Low risk of Postpartum haemorrhage Women under Midwife care and women who are under Obstetric care for indications that do not increase their risk of excessive bleeding For use in third stage of labour Oxytocin 5 units and Ergometrine Maleate 500 micrograms (mcg) I.M. x 1ml 250mcg - 500mcg I.M. /I.V. Maximum dosage 1000mcg in total (including Syntometrine) Oxytocin infusion Postpartum haemorrhage 30units in 500mls 0.9% Sodium Chloride infusion: administered as per protocol For use in the third stage of labour only Caution with: history of vascular disease, impaired pulmonary, hepatic and renal function, sepsis, severe cardiac disease, severe hypertension, pre eclampsia. For use in the third stage of labour only to control bleeding Caution with: history of vascular disease, impaired pulmonary, hepatic and renal function, sepsis, severe cardiac disease, severe hypertension, pre eclampsia For use in the third stage of labour only to control bleeding Oxytocin for the third stage of labour should be prescribed by an obstetrician for women with medical indications for oxytocin rather than Syntometrine. e.g. Cardiac concerns/hypertension Administration to upper central aspect of thigh and not buttock Can be given I.V. without I.V. cannula in emergency situation Follow protocol: Oxytocin regime for augmentation of labour/pph: available via Trust Intranet obstetric and midwifery guidelines Recorded on the care pathway on the third stage record or electronic patient record Recorded on the care pathway within the third stage record or electronic patient record front of the drug chart IV infusion of the drug chart This document is valid only on last printed Page 9 of 19

10 Analgesics Diclofenac Sodium 100mg Suppository Postpartum pain relief 100mg rectally (single dose) immediately following perineal repair once only dose P Used for reducing perineal pain Not for use in antenatal period Not for use if allergic to aspirin or Other NSAID Not for use with other NSAID painkillers (e.g. Ibuprofen, Aspirin) Not for use with history of stomach ulcer, perforation or bleeding Before oral of Ibuprofen check whether suppository has been administered Ibuprofen not to be administered within 12hrs ** of Diclofenac suturing of the intrapartum record or the electronic patient record and on the front of the drug chart Not for use with history of asthma, liver, heart / kidney/ bowel problems NB. deranged PET blood tests Paracetamol 500mg tablets Paracetamol soluble 500mg tablet Mild to moderate pain Mild to moderate pain 500mg-1000mg Orally 1 2 tablets every 4-6 hours Maximum 4g in 24hrs 500mg-1000mg Orally 1 2 tablets every 4-6 hours Maximum 4g in 24hrs General Sale List () medicines General Sale List () medicines For use antenatally, intrapartum and postnatally For use antenatally, intrapartum and postnatally Check other analgesic prescribing so that maximum dosage is not exceeded Check other analgesic prescribing so that maximum dosage is not exceeded as required This document is valid only on last printed Page 10 of 19

11 Co-codamol Tablets 8mg/500mg Codeine Phosphate and Paracetamol Ibuprofen 400mg tablets Pethidine Hydrochloride injection (CD) 50mg/ml 100mg/2ml ampoule Acute moderate pain Mild to moderate pain and anti-inflammatory 8mg-16mg/500mg- 1000mg Orally 1-2 tablets every 4-6 hours Maximum of 4 doses in 24hrs 400mg orally up to three times a day. Leave at least 4hours between doses Maximum 3 doses (1200mg) in 24hours. Pain in labour 50mg-100mg IM every 3-4 hours Maximum dosage 400mg in 24hours P For use antenatally, intrapartum and postnatally Caution with use in postpartum period with women who are breastfeeding link with infant death For postnatal use, commonly used for perineal pain Not for use in antenatal period Not for use if allergic to aspirin or Other NSAID. Not for use with other NSAID painkillers (e.g. Diclofenac, Aspirin) Not for use with history of stomach ulcer, perforation or bleeding Not for use with history of asthma, liver, heart / kidney / bowel problems For use in early labour and/or first stage of labour Not for use with history of alcoholism, renal impairment or cardiac arrhythmias Check other analgesic prescribing so that maximum dosage is not exceeded CHECK WHEN DICLOFENAC SUPPOSITORY WAS ADMINISTERED Ibuprofen not to be administered within 12hrs ** of Diclofenac suppository Do not offer to dispose of client s supply encourage women to do so in own home Destroy unused Pethidine as per Trust Policy Administration to upper central aspect of thigh and not buttock front of the drug chart This document is valid only on last printed Page 11 of 19

12 Diamorphine injection (CD) 5mg, 10mg ampoules. Entonox Inhalational analgesia Pain in labour Moderate severe pain 5 mg IM or SC repeated doses of 2.5mg 5mg 4 hourly if needed Client led P For use in early labour and/or first stage of labour Can be used as an alternative analgesia to Pethidine For use in labour and in immediate postnatal period during suturing procedure/vaginal examination Beware of respiratory depressant effect both mother/neonate Must not be administered by a student midwife Do not offer to dispose of client s supply encourage women to do so in own home Destroy unused Diamorphine as per Trust Policy Administration to upper central aspect of thigh and not buttock Must not be administered by a student midwife Store size C/D and smaller cylinders horizontally at room temperature. It must be secured in boot of car out of sight front of the drug chart Record within the intrapartum record/electronic record Anusol cream Anusol Suppositories Pain from haemorrhoids Pain from haemorrhoids Cream apply twice daily, night & morning & after each bowel movement 1 Suppository rectally twice daily night and morning after bowel movement Cream: topical use only Restrict to 7 days use Supply to in-patients only out patients require prescription from GP Record within the drug chart on the as required This document is valid only on last printed Page 12 of 19

13 Anaesthetics Lidocaine 1% plain injection: 2ml, 5ml, 10ml and 20ml vials Pain relief prior to: Performing episiotomy SC use only Injection 1% plain up to 5mls or 0.5% up to 10mls Do not use with previous allergic reaction Do not use preparations containing adrenaline Record within the intrapartum record/electronic record Perineal Repair Injection 1% Plain - up to 20mls Contraindicated in complete heart block and hypovolaemia IV cannulation Up to 2mls SC Lidocaine Hydrochloride Instillagel 2% Prior to urinary catheterization 6-11ml into urethra Record within the intrapartum record/electronic record Agents to reverse respiratory effects of opiates Naloxone Hydrochloride Injection 400mcg/ml Naloxone Hydrochloride Reversal of respiratory depression in neonates Reversal of respiratory depression in the woman 200mcg IM as a single dose at birth 100mcg 200mcg as a single dose preferably IV route Repeat doses of 100mcg can be given IM if required Only administer when: Airway secured HR>100 bpm Mother has had opiate Not for use if mother is known drug misuser Only administer for respiratory depression in the mother after opioid use. Will also reverse the analgesic effect of opioid It is not a resuscitation drug Referral to Obstetrician is required. If at HOME birth, call 999 for immediate transfer to main unit Record within the neonatal record front of the drug chart This document is valid only on last printed Page 13 of 19

14 Antihistamines Chlorphenamine Tablets 4mg Symptomatic relief of allergy such as hay fever, urticaria Bowel preparations and laxatives 4mg orally 4 hourly Maximum 24mg per day P Inpatient use only can be used antenatally and postnatally Senna tablets Constipation 7.5mg sennosides in 1 tablet 2-4 tablets orally at night initial dosage should be low Lactulose Solution Constipation 15ml twice daily orally adjusted to patient s needs Do not use where history of lactose intolerance Where used as part of treatment programme for third/fourth degree tear must be prescribed as TTO by Medical Practitioner This document is valid only on last printed Page 14 of 19

15 Glycerol Suppositories 4gm (Adult size) Constipation 1 Rectal suppository (4g) as required Moisten with water prior to use Movicol Sachet Chronic Constipation Faecal impaction 1-3 sachets orally in divided doses 4 sachets on day 1 increase in steps of 2 sachets per day to a maximum of 8 sachets. Total dose to be drunk within a period of 6 hours. 4 sachets to be dissolved in 250ml of water Use up to 2 weeks Keep in refrigerator and drink within 6 hrs of making up. This dosage maximum of 3 days Micolette micro enema Micralax enema Constipation Single dose 5ml rectally Occasional use only Adequate fluid intake should be maintained the drug chart. This document is valid only on last printed Page 15 of 19

16 Anti-emetics, antacids & indigestion remedies Prochloperazine Maleate Anti-emetic 12.5mg IM as required followed by oral dose 6hrs later if necessary 5 10mg orally up to 3 times daily P For management of actual or potential nausea and vomiting the drug chart. Cyclizine Lactate Anti-emetic 50mg IM up to 3 times daily Gaviscon Advance Suspension Relief of heartburn/ indigestion in pregnancy/ postnatally 5-10mls after meals and at bedtime Peppermint Water Antispasmodic mls orally up to 4 times a day For management of actual or potential nausea and vomiting particularly with of opioids Supply and to inpatients only. Other women can obtain through prescription from GP For relief of abdominal colic and distension Sedatory effects therefore avoid use in liver disease (HELLP syndrome). Cautious use with history of epilepsy Be considerate that occasionally heartburn can be confused with epigastric pain therefore be alert for other signs of pre eclampsia. May be mixed with warm water the drug chart. This document is valid only on last printed Page 16 of 19

17 Cough Preparations Simple Linctus Dry Cough 5mls orally 3-4 times daily Not for use where allergy to saccharin, sodium benzoate and citric acid exists Iron Supplementation Ferrous Sulphate tablets Intravenous fluids Sodium Chloride 0.9% Antenatal/postnatal iron supplementation for low HB For use as a medium to administer Oxytocin in the augmentation of labour/management of PPH For use to keep vein patent in conjunction with Oxytocin therapy Use as a flush to keep cannula/vein patent Maternal resuscitation 200mg orally 1-3 times a day As per Oxytocin regime 500 mls titrated as necessary to keep vein patent 5mls as peripheral vein flush 6 hourly Supply and administer on wards only. Other women can have iron supplementation prescribed by GP. Caution with use in pre eclampsia, hypertension, cardiac problems balance may need to be restricted seek advice from medical colleague Antenatal low HB is defined by NICE as <11g/dl prior to 12 weeks gestation and <10.5g/dl at weeks Follow Oxytocin guideline on Policy hub under Maternity/ Intrapartum/ GL925 Record within the drug chart on the as required IV infusion of the drug chart IV infusion of the drug chart Record within the drug chart on the as required, sticker is available IV infusion of the drug chart This document is valid only on last printed Page 17 of 19

18 Gelofusine For maternal resuscitation: to maintain blood volume in shock Up to 1L Postpartum Haemorrhage Use whilst waiting for blood transfusion IV infusion of the drug chart Maternal Prophylaxis Anti-D immunoglobulin Maternal use only to protect against haemolytic disease of the fetus and newborn Treatment of Maternal Anaphylaxis Adrenaline Maternal use for treatment of anaphylactic shock For sensitising events (e.g. APH) > 12 weeks 500iu 1500 iu Routine anti-d prophylaxis at 30 weeks 500iu postnatal prophylaxis IN HOSPITAL : 500mcg IM (0.5 ml 1:1000) as stat dose IN COMMUNITY: JEXT pen or EPIPEN: preloaded syringe of 300mcg stat then 300mcg after 5-15 minutes as required until patient in hospital. Routine anti-d prophylaxis is offered to all non-sensitised pregnant women who are (Rh) D negative Postnatal anti-d is dependent on blood group of cord sample taken at delivery and then result of Kleihauer test Emergency treatment for acute anaphylaxis Do not give IV specialist use only In pregnancy, may reduce placental perfusion and can delay second stage of labour Follow guidance: Anti D guidelines: available on Policy hub under Maternity/ Antenatal/ GL786 Administer midpoint in anterolateral thigh (through material if necessary) Leave pen in situ in thigh for 10 secs following to allow absorption of drug, then remove pen and rub thigh vigorously If repeat dose required administer in opposite thigh muscle. front of the drug chart front of the drug chart This document is valid only on last printed Page 18 of 19

19 Refer to medical aid Oxygen Oxygen At home during neonatal resuscitation. Women who suffer major trauma, sepsis or acute illness during pregnancy 10l via face mask If the neonate requires cardiac compressions and / or ventilation support, or is having breathing difficulties commence Oxygen in the home at 10L regardless of the availability of Saturation monitoring. Administer via nonrebreathing face mask with target saturation range of 94-98% Oxygen Obstetric emergency Administer via nonrebreathing face mask with target saturation range of 94-98% Neonatal Drugs For emergency use in presence of maternal hypoxaemia (oxygen saturations less than 94%) Only to be administered in presence of maternal hypoxaemia (oxygen saturations less than 94%) When possible the Oxygen should be titrated to the saturation readings when reliable monitoring is available. neonatal record drug chart or patient records Record on drug chart or patient records Phytomenadione (Vitamin K) injection Konakion MM Paediatric 2mg/0.2ml oral/im use Nystatin oral Suspension 100,000 units /ml Prophylaxis against Haemolytic Disease of the Newborn Treatment of oral thrush Oral: 2mg Konakion at birth, 4-7 days of age and 1 month (if exclusively breast feeding) IM: 1mg at birth Oral: units/ml after feeding 4 times daily P Infants of greater risk of HDN are recommended IM injection Be aware that different preparations have different licensed routes for. Babies having oral course of treatment require TTO neonatal record Repeated oral doses to be the postnatal booklet Record within the postnatal booklet This document is valid only on last printed Page 19 of 19