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Still confused by Midwives Exemptions!

Discussion in 'General Midwifery Discussions' started by purple80, Feb 15, 2012.

  1. purple80

    purple80 New Member

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    Is it just me or is the whole 'Midwives Exemptions' thing a bit confusing? It seems to be something that is not very well understood, and any time I try and get clarification from midwives at the trust I am at it seems no one has any clear answers.

    My two main areas of confusion are:

    -What doses are midwives allowed to administer under the Midwives Exemptions? I.e. As far as I am aware a MW can only administer up to 10mls of Lignocaine 1% IM/SC but I cannot find this in writing anywhere.
    I can only find this document NMC Circular 07/2011 Annexe 1 That is a table of the drugs and uses but not dose limits.

    - I am also unsure of the correct documentation of drugs administered under Midwives Exemptions. The NMC recommends that they are documented in the womans hand-held notes as opposed to the drug chart. However in my trust MWs use the drug charts, for example would 'prescribe' co-dyadramol which other midwives (on subsequent shifts) would then use to administer the same drug. But surely under MW exemptions you are only covered for the doses you are giving yourself? Is that right?? But if the medication is only documented in the notes this could be dangerous and may lead to drug errors/over dose and it would not be as clear (as a drug chart) that a drug has been given. (ideally there would be a page that could be added into the chart for medications administered under MW exemptions).

    It would be interesting to hear your thoughts and find out what happens at other trusts. Also if anyone knows of a document that discusses dosages I would like to be able to read this.

    Thanks :)
  2. Azalea

    Azalea Educational Moderator and RM Staff Member Plus! Member

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    In my trusts there are a number of different drugs charts in use. Typically a woman may have three drugs charts on the front of their notes... One is the 'standard' drugs chart the docs will use, next there is the fluids and infusions chart and the third is the 'midwives exemptions and pgd' chart. So it depends on what drug a woman is having as to which chart it goes on. Many women only have the midwives exeotion chart as the syntocinon, paracetamol etc all go on there.
  3. Strawberry

    Strawberry Well-Known Member

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    I get really confused about these things.... so the things on the midwives exemption list midwives can give to a woman, with no doctors involved? I have seen midwives ask doctors to prescribe Hartmann's for women before?! I thought those things midwives could just give to women with no doctors signature?
  4. iolaus

    iolaus RM and Head of Clinical Practice Staff Member

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    We had things changed recently as we'd all fill in on the prescription bit for midwives exemptions, then we were told we can't and ANY midwives exemption has to be under a one off dose on the front of the drugs chart
  5. DisneyPrinces

    DisneyPrinces Member

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    Thats what we do, it is not actually written as a px for a few days, its only written on the front and signed by the midwife giving it. If another mw took over care, she would then have to write the exemption out herself.
  6. purple80

    purple80 New Member

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    Potbella, that sounds like a good way of doing things and what I feel we should have. It's interesting to hear what happens elsewhere.

    Strawberry - in the reading I have done, as far as I can see Hartmann's, Gelofusine and 0.9% Sodium Chloride are on the Midwives Exemptions but only for maternal resusitation (and IV flush in the case on NaCl!)

    Does anyone have any knowledge about the doses midwives exemptions cover??

    :)
  7. Curly

    Curly Moderator Staff Member

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    Midwives can only give IV fluids in an emergency without a prescription.

    A midwives exemption has specific parameters placed upon it but the documentation in my trust is that we put it on the front of the drug chart as a one of dose. This way it there is no confusion as to how many midwives exemption doses are given - as certain drugs such a fybogel for example can only be a maximum of two midwives exemtion doses before needing to obtain a prescription.

    I'll look up the midwives exemptions quantities of allowed administration and let you know X
  8. iolaus

    iolaus RM and Head of Clinical Practice Staff Member

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    Also apparently if you write it on the PRN side you are also signing for ALL FUTURE adminstrations as well, which we aren't allowed to do.

    I do think we, by we I mean those who work in MLU, need a seperate drug chart as we have to standard hospital one and only the front ever gets written on, what a waste of paper
  9. Mkunga

    Mkunga Guest


    We have a mega drug chart, which is a folded chart with about 8 pages to cover prescribed one off doses, antibiotic therapy, regular drugs, IV infusions, Post-operative drugs (like Morphine) etc. We have a teeny tiny box for PDG drugs, which has signature boxes for first and second administration. We then also have a separate, single sheet chart for when the PGD bit is full, on which we can add our midwives' exemptions. This then means that for low-risk women, we're not using a whole, huge chart, just the one sheet where it might only have syntometrine and paracetamol documented. It sounds complicated, but it works quite well.
  10. Roo

    Roo Well-Known Member

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    We write it in red on the PRN page but do not sign in the signature box- instead, every time it is administered we sign and write RM underneath to show what authority it was administered under.

    All of our PGDs are done in the same way as above but do not need RM added to the signature. The PGDs have a list of reasons we are allowed to administer them and dosages etc. all if this is set by the trust.

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