Northern Ireland Practice and Education Council for Nursing and Midwifery Project Plan for Development of information and resources for Midwives in Northern Ireland relating to Medicines
CONTENTS 1.0 Introduction 1 2.0 Background 1 3.0 Initiative Aim and Objectives 3 4.0 Methodology Overview 4 5.0 Resources 4 6.0 Equality and Governance Screening 5 7.0 Evaluation 5 8.0 Dissemination 6 9.0 References 7 10.0 Appendices 8
1.0 Introduction 1.1 Midwives at the point of registration may supply and/or administer, on their own initiative, any of the substances specified under the midwives exemptions, provided it is in the course of their midwifery practice. 1.2 It is imperative that midwives fully appreciate their professional responsibility in ensuring they keep themselves up to date with current medicine legislations, relevant to their sphere of practice. 1.3 Midwives exemptions allow midwives to supply and administer medication from an agreed list. It is important to note that in this context midwives are not prescribing medication. However despite the current information, there still appears to be some misunderstanding surrounding the difference in prescribing medications to that of supplying and/or administering medications. 1.4 In the interests of professional practice, information governance and public safety, the development of evidence based information, communication and education systems will be necessary to ensure an informed midwifery workforce *. 1.5 Developing these information support systems, will provide clarity of knowledge, skills and practice in this key area of clinical practice for midwives. 1.6 It is also very timely given the recent publication of the new NMC Midwives Rules (2012) and in particular in the context of current DHSSPSNI priorities detailed within the Maternity Strategy (2012). 2.0 Background 2.1 The history framing the legislation which controls the administration and usage of medicines come under two main Acts of Parliament. These are the Medicines Act (1968) and the Misuse of Drugs Act (1971). * Midwifery Workforce - refers to registered and student midwives 1
2.2 The Medicines Act was introduced following the Thalidomide tragedy, which highlighted gaps in controls relating to the manufacture, marketing and supply of medicines. The 1968 Act requires the manufacture and wholesale of medicines to be in accordance with the appropriate market authorisation, unless specified exemption criteria are fulfilled. It also controls the retail sale, supply and administration of medicinal products. Medicinal products fall into one of three categories, general sale list, pharmacy medicines and prescription only medicines. 2.3 General Sale List medicines, known as GSL, need neither a prescription nor the supervision of a pharmacist. These medicines can be obtained over the counter from any retail outlet. A Pharmacy Medicine (P) means a medicinal product which is not a prescription only medicine which can only be sold from pharmacies, either by a pharmacist or by their staff under their supervision. 2.4 Prescription Only Medicines (POMs) are those medicines which may only be sold or supplied in accordance with a prescription of an appropriate practitioner ie someone who has a prescribing qualification for example Doctor/Nurse Prescriber/ Pharmacist. 2.5 The Misuse of Drugs Act consolidated and simplified the legislation relating to dangerous or otherwise harmful drugs. It divides controlled drugs into Class A, B and C according to the perceived degree of harm (Class A, being the most harmful and Class C the least dangerous). 2.6 Controlled drugs are then divided into five schedules corresponding to their therapeutic usefulness and potential for misuse. The persons who are specifically authorised to have controlled drugs in their possession are listed in the Misuse of Drugs Regulations 2001. 2
2.7 In Section 11 of those regulations, it specifies the conditions under which midwives may possess and administer controlled drugs (appendix G). Midwives need to note that this means they cannot possess an opiate for a home birth without having obtained it via a Midwife s Supply Order. In other words they cannot take a controlled drug from a maternity unit for a home birth. 2.8 Midwives supply and administer medication in hospital and in the community setting using Midwives Exemptions. The exemptions from the restriction on administration of prescription only medicines for midwives have most recently been updated and listed in the Human Medicines Regulations 2012. The supply and administration of opiods at a home birth using a Midwife Supply Order has been described in the recent DHSSPSNI publication, Safer Management of Controlled Drugs - A guide to good practice in primary care (Northern Ireland) - Version 3 Revised May 2013. 2.9 Given the brief outline described above, it can be seen that the legislation framing the use and control of medicines may be open to misinterpretation and needs collation for ease of use by midwives. For this reason, the Chief Nursing Officer, Department of Health, Social Services and Public Safety along with the Local Supervising Authority Midwifery Officer (LSAMO) have approached the Northern Ireland Practice and Education Council (NIPEC) for Nursing and Midwifery. 2.10 The objective is to work in partnership to explore and develop evidence based guidance, communication and education support arrangements that will be of benefit and provide clarity to the midwifery workforce of Northern Ireland. 3
3.0 Initiative Aim and Objectives 3.1 Aim To explore and develop evidence based guidance, communication and education support arrangements that will be of benefit and provide clarity to the midwifery workforce in relation to medicines legislation and safe, best practice. 3.2 Objectives I. Collate evidence based information on the current legislation relating to medicines management relevant to midwifery practice II. III. IV. Search and review national and international systems which will be of benefit and inform midwives of their roles and responsibilities relating to medicine legislation / management Develop a range of guidance and educational learning tools on medicine legislation /management relating to midwifery practice Develop an implementation strategy for the dissemination of learning systems through the Public Health Agency (LSA) to the midwifery workforce through education and the development of practice V. Provide a mechanism to monitor and audit practice in relation to medicine management VI. VII. Review and support the development of a Regional Medicine Kardex for Maternity Services Develop and agree mechanisms to review medicine monographs for midwives, that will provide consistent information on medicines they use in their practice 4
VIII. Disseminate the products of this work to midwives and health related professions. 4.0 Methodology Overview 4.1 It is intended to deliver the initiative over a period of one year. A work programme is attached at Appendix One, designed to achieve the objectives outlined above. 4.2 A Steering Group will be established to oversee the project direction, chaired by Verena Wallace, Local Supervising Authority Midwifery Officer (LSAMO, PHA) (CNO Letter dated 30 th Nov 2012). 4.3 Senior Professional Officer, Brenda Devine (NIPEC) will lead the project in partnership with the LSAMO. 4.4 Suggested membership (appendix two) of the Steering Group 4.5 Throughout the project, appropriate engagement and representation from midwives and their managers will be conducted via mechanisms agreed through the direction of the Steering Group. 4.6 Throughout the project, there may need to be the establishment of subgroups to address certain areas, through the direction of the Steering Group 4.7 Engagement with relevant multi-professional stakeholders will be conducted as appropriate, agreed through the direction of the Steering Group. 4.8 The ongoing progress and evaluation of the initiative will be available to view on NIPEC s website. 5.0 Resources 5.1 NIPEC will co-ordinate, host and provide midwifery professional expertise as well as administrative support to the project, applying a project management approach. Individuals on the Steering Group and any additional groups, have a responsibility to represent their organisation effectively, by full attendance at meetings relating to the project. 5
5.2 Participating organisations will undertake to ensure that relevant staff are released for all required meetings for the duration of the project, and will support further participation in activities/groups if required, to achieve the objectives of the project. 6.0 Equality and Governance Screening 6.1 To ensure NIPEC and its stakeholders are meeting its legal obligations and responsibilities under various Equality and Governance areas, the project plan, its aims and objectives and outcomes have been examined and screened for any issues relating to the following areas: Risk Management Equality and Human Rights Privacy Impact Assessment (PIA) Personal Public Involvement (PPI) 6.2 A summary of these considerations and any action required is documented in Appendix 3. 7.0 Evaluation 7.1 The project will be evaluated on an on-going basis, evidenced through the verification of the accuracy of data presented. 7.2 On-going progress will be reported to the Chief Nursing Officer and Executive Directors of Nursing and Midwifery through Executive Nurse Directors/Chief Nursing Officer meetings. 8.0 Dissemination 6
8.1 Dissemination of the outputs and report of the project will be the responsibility of the Public Health Agency via the Local Supervising Authority Midwifery Officer. Bibliography Department Health Social Services and Public Safety (DHSSPSNI 2012) Maternity Strategy 2012-2018 Belfast DHSSPSNI (2013) Safer Management of Controlled Drugs - A guide to good practice in primary care (Northern Ireland) - Version 3 Revised May 2013. Belfast. The Human Medicines Regulations 2012. http://www.legislation.gov.uk/uksi/2012/1916/pdfs/uksi_20121916_en.pdf Nursing and Midwifery Council (NMC 2006) Standards of proficiency for nurse and midwife prescribers London Nursing and Midwifery Council (NMC 2011) Changes to Midwives Exemptions (NMC Circular 07/11) London Nursing and Midwifery Council (NMC 2012) Midwives Rules and Standards London NHS education for Scotland (NES 2011) Midwives and Medicines Second Edition, Edinburgh www.nes.scot.nhs.uk/media/14194/midwives_and_medicines_third_edition_nov2012.pdf interactive version (accessed May 2013) 7
Appendix 1 Work Programme 2013 Project Information and for Midwives in the use of Medicines Commence Jun 2013 May 2014 Activity Target Related objective 1. Joint letter of invitation to key stakeholders of representation from midwifery services for steering group June 2013 All 2. Establishment of a Steering Group June 2013 All 3 Agree project Plan and format of engagement June 2013 All 4a. Secure and establish an agreed format for collating data collected on current practices/policies. 4b Review literature (nationally and internationally) of exemplars of good practice 5. Develop a range of information learning on medicine legislation /management relating to midwifery practice Oct 2013 Dec 2013 I, II, III, VI,V, III 6.Develop an implementation strategy for the dissemination of learning systems through the Public Health Agency 7. Review and support the development of a Regional Medicine Kardex for Maternity Services 8. Develop and agree mechanisms to review medicine monographs for midwives, that will provide consistent information on medicines they use in their practice Feb 2014 March 2014 April 2014 IV VI VII 9 Provide a mechanisms to monitor and audit practice in relation to medicine management April 2014 V 10. Completion of Final Report, Tools and resources May 2014 All 11. Present to CNO - DHSSPS June 2014 All 8
Appendix 2 Suggested membership of the Steering Group Name Designation Organisation Verena Wallace Local Supervising Authority Midwifery Officer Public Health Agency (PHA) Brenda Devine Senior Professional Officer NIPEC (Project Lead) Zoe Boreland Midwifery and Children s Services Nursing Officer Department Health Social Services and Public Safety Anne Witherow Assistant Director of Nursing WHSCT and Midwifery (Governance) Brenda Kelly Midwife SHSCT Shona Hamilton Consultant Midwife NHSCT Denise Boulter Midwife Consultant PHA Zoe Menielly Amanda Sayers, Clinical Midwife (x2) SEHSCT WHSCT Angela Carrington Margaret Rogan Kathy McCandless Pharmacist Consultant Midwife Practice Development Midwife BHSCT BHSCT BHSCT Lynn Watt Pharmacist SHSCT?Jill MacIntyre Pharmacist SEHSCT Maureen Ritchie Practice Development Midwife SEHSCT Dorothy Patterson Higher Educational Institute QUB Marlene Sinclair Professor of Midwifery UUJ Research at the Maternal, Fetal and Infant Research Centre Fiona Bradley Midwifery Education Consultant Clinical Education Centre Breedagh Hughes Director Royal College of Midwives Paul Davidson Mark Mawhinney Lay Representative or Council Member Virtual Members Patient Client Council or NIPEC DHSSPSNI Mark Neill Pharmacist PSNI General Practitioner Obstetrician RCGP RCOG 9
Terms of Reference (agreed) TOR 1 To agree the project plan and timescales TOR 2 To contribute to the achievement of the project aims and objectives TOR 3 To undertake ongoing monitoring of the project against the planned activity TOR 4 To agree a mechanism of progress reports to Chief Nursing Officer Note: The Steering Group will meet on approximately on six weekly intervals through the lifespan of the project. Membership of Steering Group is non-transferrable except in exceptional circumstances and with prior agreement of the Chair. 10
Outcome of Equality and Governance Screening Appendix 3 Area Comments Risk Management questions Have any risks been identified? What is the potential impact of these? How can these be mitigated or have alternatives options been identified which would have a lower risk outcome? Where negative impacts are unavoidable, has clarity been given to the business need that justifies them? Equality and Human Rights questions What is the likely impact on equality of opportunity for those affected by this policy for each of the Section 75 equality categories (minor/major/none)? Are there opportunities to better promote equality of opportunity for people within the Section 75 equality categories? To what extent is the policy likely to impact on good relations between people of a different religious belief, political opinion or racial group (minor/major/none)? Are there opportunities to better promote good relations between people of a different religious belief, political opinion or racial group? NB please refer to NIPEC s Equality Screening Policy and Screening Templates to assist in considering equality and human rights Privacy Impact Assessment (PIA) questions Will the project use personal information and/or pose genuine risks to the privacy of the individual? Will the project result in a change of law, the use of new and intrusive technology or the use of private or sensitive information, originally collected for a limited purpose, to be reused in a new and unexpected way? Personal and Public Involvement (PPI) questions Has a requirement for PPI been identified, and if so, what level of PPI will be required for the project? NB please refer to and use NIPEC s PPI Decision Tree/Algorithm to assist in considering PPI 11
For further Information, please contact NIPEC Centre House 79 Chichester Street BELFAST, BT1 4JE Tel: 028 9023 8152 Fax: 028 9033 3298 This document can be downloaded from the NIPEC website www.nipec.hscni.net Sept 2013