​Medicatio​​ns and substances

Midwives are autonomous practitioners who have the education and training to meet the competencies for prescribing, ordering, dispensing, compounding, and administering medications and substances. Midwives practice within the Midwifery Regulation, BCCNM standards, limits and conditions, workplace policies, and individual competence (referred to as the controls on practice) when performing any activities with medications and substances.

The new Registered Midwives Medications and Substances: Standards, Limits and Conditions​ that came into effect March 1, 2023 outlines midwives' scope of practice, accountabilities, and responsibilities when performing activities involving medications and substances. Midwives use critical thinking, knowledge, and clinical and professional judgment when making decisions about prescribing, ordering, dispensing, compounding, and administering medication and substances.

It is the midwife's responsibility to act according to current evidence and to ensure they have access to the most current resources when performing activities and providing services related to medications and substances for clients. 

Prescribing controlled drugs and substances

Prescribing controlled drugs and substances (CDS) is within the scope of practice for registered midwives.

The drugs listed in the B.C. Controlled Prescription Program require the use of a duplicate prescription pad. BCCNM oversees the provision of duplicate controlled prescription pads to midwives who are practising in B.C.​

​Dispen​​sing

Dispensing medications and substances involves preparing and giving medications to a client to take later or when necessary. Dispensing includes ensuring the pharmaceutical and therapeutic suitability of the medication for its intended use and taking steps to ensure its proper use. Midwives can dispense with the involvement of a pharmacist or without their involvement when pharmacy services are unavailable.

Dispensing with a pharm​​acist's involvement

When a pharmacist has already reviewed a medication's suitability and dispensed it for the client, midwives ensure its proper use.

Dispensing without a pharmacist's​ involvement

The Medications and Substances: Standards, Limits and Conditions states:

7.​	​When pharmacy services are not available and dispensing a medica​tion for the client to take home is necessary, midwives:​
​	a.	Ensure th​e product has not expired.​​
​	​b.	​Label the medication with:
​	​	​i.	​Client name
​	​	​ii.	​Medication name, route, strength, and dosage instructions
​	​	​ii.	​​Date and quantity dispensed
​	​	​iv.	​​Intended duration of therapy, specified in days (if applicable)
​	​	​v.	​​Name, designation, and initials of the midwife dispensing the medication
​	​	​vi.	​​​Any other information that is appropriate and/or specific to the medication
​	​c.	Re​​cord dispensing information i​n the client's record.

​ When a pharmacist has not reviewed a medication's suitability (or it's unclear whether this was done), it is recommended midwives consider the medication's pharmaceutical and therapeutic suitability for the client and its proper use by:

• Checking that the medication is appropriate for the client, and the dose and frequency are within usual range

• Verifying the information with client when possible

• Reviewing the client's best available medication history and other personal health information

• Assessing the client's known allergies and ensuring medication allergy information is documented

• Considering potential medication interactions, contraindications, therapeutic duplications, side effects, adverse effects, and any other potential problems

• Considering the client's ability to follow the medication regimen

• Explaining what is ordered and confirming the client is able to take the medication as prescribe

• Handing the medication directly to the client or the client's substitute decision-maker or other authorized delegate. 

Documenting​​

Midwives document the dispensed medication and substances in the client's medical record followi​​ng the Policy on Medical Records and the Standards of Practice.  It is recommended to include:

• Allergies and adverse medication reactions, if available and not already noted in the client's record
• Name, strength, dose, and amount of medication, and date dispensed
• Intended duration of therapy, specified in days (if applicable)
• Directions to client
• Name, signature and title of dispensing practitioner 

​Client Specific Order ​

Often just called an "order," a client-specific order is an instruction or authorization given by an authorized health professional to another health professional to carry out a treatment, medication, intervention, or procedure for a specific client. A consultation, referral or professional recommendation is not an order.

A client-specific order m​​ust:

• Be documented in the client's medical record
  
• Include all information to carry out the activity safely (e.g., time, frequency, dosage, etc.)
  
• Include the health professional's unique identifier (written signature or electronic identifier)
  

 
Midwives give client-specific orders for clients. Midwives may also act on client-specific orders given by physicians and nurse practitioners for activities outside the midwifery autonomous scope of practice.

For example, midwives may compound, dispense, or administer other Schedule I or IA medications not included in the drug categories and for purposes as set out in Tables 1, 2, and 3 within the standard only if they have consulted with and received an order from a physician or nurse practitioner (Midwives Regulation, 6(3) & 5(1) (k)).​​​

​FA​Qs​

What are some resources I can access to stay current in midwifery prescribing?

Midwives are autonomous practitioners who have the education and training to meet the competencies for prescribing, ordering, dispensing, compounding and administering medications and substances. Midwives are responsible for providing medications and substances to clients using current medical resources. This may include consulting:

• With pharmacists
• Workplace resources (i.e., Lexicomp, Micromedex, Parenteral Drug Therapy Manual, Compendium of Pharmaceuticals and Specialties)
• Canadian drug guides
• Resources from the Midwives Association of BC
• Resources from Perinatal Services BC​

What is Pharmanet access and PRIME? Why do I have to enrol?

Midwives in all midwifery practices need to enrol in PRIME to gain access to PharmaNet. You can read more about the PRIME initiative in this announcement.

All PharmaNet users must enrol in PRIME during specified time periods in 2022 or 2023. Registered Midwives have until April 30, 2023 to enrol in PRIME. Additional resources can be found at British Columbia PRIME.

Please direct all questions to: PrimeSupport@gov.bc.ca or 1-844-397-7463.​

What are the main changes in the new medications and substances standard?

The four existing prescribing standards have been revised and combined into one new medications and substances practice standard. The changes clarify midwifery scope related to medications and substances, as the new standard sets out the expectations, limits and conditions for all potential medication activities a midwife may perform (i.e., prescribing, ordering, compounding, dispensing, administering), both within autonomous scope of practice and with a client-specific order.

Another change is how the standard looks. The long lists of drugs and the accompanying information have been removed and replaced with tables that outline drug categories, drug purposes, and any BCCNM limits or conditions that apply.

Also, two new drug categories beyond those listed in Schedules A and B of the Midwives Regulation have been added to allow for the two emergency medications already named within the inclusive list.

As well, we have clarified the expectations when midwives act on a client-specific order.

Other changes include:

• Removing limits on the types of sexually transmitted infections (STIs) that may be treated by midwives with specialized practice certification (with the exception of HIV, which remains a limit).
• Removing the limit on specific routes of administration for hormonal contraceptives.

• Removing ​​the limit around anticoagulants for the prophylaxis of VTE. The new standard allows midwives in hospital settings to prescribe or administer anticoagulants for the prophylaxis of VTE in accordance with hospital protocol/ guidelines. ​
  

Is ordering or administering packed red blood cells in scope for midwives?

Yes, ordering packed red blood cells for the purpose of preventing or treating dehydration or blood loss, resuscitation or other emergency measures is within the scope of midwifery practice. See Table 4: Substances in Schedule A Limits and Conditions. ​​

Resources​​​

• Midwifery Scope and Model of Practice​​
• Standards of Practice
• Specialized Practice
• Midwives Association of BC
• Perinatal Service BC
• Rapid Access to Consultative Expertise (RACE)  (604) 696-2131 or 1-877-696-2131
• Electronic Consultative Access to Specialist Expertise (eCASE)
• PharmaCare: information for prescribers
• Ministry of Health—access to PharmaNet
• British Columbia  Centre on Substance Use
• Federal Controlled Drugs and Substances Act
• Federal Food and Drug Regulations
  

Need help or support?​

For further guidance on understanding and applying the standards of practice, contact our team by completing the Standards Support intake form.​​​​

For questions specifically about the Controlled Prescription Program, email cpp@bccnm.ca.​