2011 10 10 MWF Background To Education Pack V 4

Introducing the National Midwifery Formulary
A sample education resource

16 September 2011
Contents of education resource
Introduction 3
Preparatory reading 8
Pre-Course worksheet 10
The workshop – Lesson plan 13
The slides used in the workshop – link 15
Final multiple choice questionnaire 26
Assessment of competence (sample) 30
File Name: 2011 10 10 MWF Sample education materials to

Version: 2 Date: 10 Oct 2011
introduce formulary v 4
Produced by: Healthcare Improvement Scotland Page: 2 of 38
Introduction
These resources were produced as part of the national midwifery formulary project.
For background to the national midwifery formulary project please see the documents
at
www.healthcareimprovementscotland.org (maternal and reproductive health

programme).
As the steering group oversaw the development of the national midwifery formulary, it
became apparent that local NHS boards in Scotland would wish to adopt only a
selection of the monographs on medicines in the national midwifery formulary
resource. Selection of these would be a local decision and it would be the
responsibility of the Head of Midwifery, to whom the monographs would be sent, to
ensure that these monographs would be taken through their local governance
processes and used either as hard copies or accessed via their local intranet.
The steering group agreed that the national midwifery formulary would have an
accompanying and supporting resource to prepare midwives to use it. This would be:
‘…a fit for purpose education resource for midwives to learn about their roles and
responsibilities in the use of drugs and to support them in learning how to use the
midwife formulary.’
To this end NHS Quality Improvement Scotland supported NHS Lothian to develop
and pilot materials to support their midwives in preparing for local change to
medicines practice in midwifery. (This included the introduction of a new version of a
local formulary and changes to medicines distribution in its hospitals.) This enabled
the materials to be tested by midwives and subsequently refined locally before being
available for national use.
It was agreed that the resource would be developed following the principles below:
The content would be fit for purpose and pitched at an appropriate

level and with clear learning outcomes.
The design would be fit for purpose, containing elements which make
the presentation of the work compatible with web use eg use of bullets
and short segments of text, rather than paragraphs, use of tables,
diagrams and visual material where possible, and giving opportunity
for reflection, responses, and self assessment.
The resource would be easily accessed and implemented.
The question and answer framework overleaf identifies the thinking and key
parameters that informed the steering group in requesting an educational resource
be developed at the pilot site.

Framework for the education support for the midwifery formulary
Question Answer
What problems does this resource Currently there is:

address?
a) a lack of clarity around the midwife’s professional role
in relation to medicines
b) no clear source of where to find information about

midwife rights and obligations in relation to the use of
medicines
c) a lack of awareness of rights and obligations
d) a lack of confidence in midwives in supplying and

administering drugs
What has been produced? An educational resource.
What is its primary purpose? To clarify and define midwives roles and responsibilities in
relation to medicines and use of the locally agreed midwife
formulary.
Who will own the final product? Healthcare Improvement Scotland with acknowledgement
to the pilot site, NHS Lothian, and Edinburgh Napier
University.
Over what timeframe was this product This time allocated to this allowed the educational
developed? resource to be developed and integrated with the newly
developed formulary and allowed for time to report on
lessons learned to Healthcare Improvement Scotland.
March 2010 – March 2011
Learners
How is the target audience defined Midwives and student midwives

(be as specific as you can)? The prototype was initially piloted with 20 candidates to
include experienced midwives that have had previous
administration of medicines training, a supervisor of
midwives, student midwives and a newly qualified midwife.
What academic level should the Graduate (level 9)
learning be at?
Who will be able to access the Midwives and student midwives

learning?

How will the users access the On the Healthcare Improvement Scotland website.
materials?
When will the learners learn this new Ongoing learning resource which will initially be
content? At a specific point in time or rolled out to current staff within clinical areas to
anytime anywhere? build on their existing knowledge
Part of pre-registration programme and
Induction for new start midwives
Where and how do the learners Blended approach comprising study time for pre-reading,
normally learn? web-based learning and workshops.
What previous knowledge can be Nursing & Midwifery Council, Standards for Medicine
assumed? Management 2008
There is pre course reading to remind participants of their
legal and professional obligations.
What IT facilities does the target Resource rooms, elearning rooms, access to intranet
audience have to access the course?
What other IT systems do the Examples could include Maternity Trak, Learnpro. Intranet
learners normally use?
How long should the learning take? Total 15 hours of learning comprising
Pre course reading, web-based learning = 8 hours
Initial multiple choice questionnaire = 30 minutes
Participative workshop = 4 hours including repeat of the

questionnaire and marking at the end of the course.
Subsequent assessment = 2.3 hours
Total 15 hours
Portfolio taken to clinical area and signed off by
pharmacist, or a non-medical prescriber or
a practice educator.
Medical staff could be used in assessment to encourage

engagement.
Facilitators
Will the learning involve any instructor Participative workshop = 4 hours

or is it purely self-directed learning? Pharmacist/ Lecturer/Midwife Assessor/Practice
Education/ non medical prescriber /member of the
obstetric medical team

Instructional design
What is the learning, teaching and The learning and teaching strategy is a blended approach,
assessment strategy? How will which will include discursive lectures, skills workshops,
learners learn? web-based learning and self-directed study. This will allow
for diversity and flexibility of learning styles.
Assessment will be at skill stations (OSCEs could be used
for pre registration midwives, written scenarios prepared
for others) and completion of reflective portfolio of
evidence.
This will enable practitioner or student midwife to meet
learning outcomes and develop their learning.
What are the learning outcomes? Practice within the legal framework using the
formulary to allow the supply and administration of
drugs within the current framework of Midwife
Exemptions, Midwife Supply and Patient Group
Directions
Apply an understanding of PGDs
Describe the use of, side effects, adverse effects
and context of medicines within the locally agreed
midwifery formulary
Correctly record and document the administration
and supply of medicines from the locally agreed
midwifery formulary
Reflect on clinical application of the content of the
locally agreed midwife formulary on their midwifery
practice
Impart information to the woman about medicines
used in the locally agreed midwifery formulary.
How will the learning outcomes be Skill station assessment, portfolio reflection, clinical skill
assessed? (formative/summative area assessment and multiple choice questionnaire (pre
assessment) and post workshop)
How formalised is the learning going Structured to meet learning outcomes

to be?
Will the online learning be integrated Blended learning – integration with other learning for
with any other forms of learning (eg midwives would be a local decision.
face-to-face undergraduate
modules)?
Will the learning be accredited? Initially not, but this could be adjusted with subsequent
advice from NES
How will the learning be evidenced? Portfolio
How long is the learning going to take Pre course materials issued 4 weeks before workshop
/ how is the learning going to be complete all elements 1 month following workshop total 15
structured? (chunks, units, chapters hours of learning over approximately 2 months.

etc)
Is the learning going to be This would be a local decision dependent on how the
mandatory? national midwifery formulary resource is to be used locally
Recording and reporting of

learning
Do the learners need to be identified, There may be a local record of learning retained on
counted, reported on etc.? (learner individual NHS board’s system for professional
management, registration) development
Using Patient Group Directions requires a signature
The content and appearance of the final certificate should
be considered.
Certificate to be held in the learning portfolio.
Are there any other specific Supervisor of Midwives annual review

requirements for learner
management? Personal Development Plan – KSF
Technical issues
Where will the content be hosted? On the Healthcare Improvement Scotland website
How many learners can be expected Midwives in Scotland

to use the system?
Are there specific hard and software IT accessibility

requirements?
Will the learning be free or charged Free to midwives but cost to clinical area to release staff
for? for training and trainers/assessors
Who will deliver the learning? Practice Educators/Midwives/Pharmacists

Lecturers/ non medical prescribers/medical obstetric team/
risk coordinator or clinical effectiveness team member

Preparatory reading
Midwives should be aware of their professional and legal rights and responsibilities in
relation to the supply and administration of medicines. To ensure a common base of
information and provide context the pilot workshops provided participants with the
opportunity to refresh their memories.
The pre-reading ensured that participants had been reminded of their professional
and legal obligations, and were also familiar with the different classifications of
medicines and the arrangements under which they could practice, and were aware of
all the local processes and guidelines providing a framework within which they can
supply and administer medicines.
The reading therefore was at different levels;
1 The professional context – to remind participants of their professional

obligations, midwives were directed to foundation documents published
by Nursing & Midwifery Council
eg code of conduct
http://www.nmc-uk.org/Documents/Standards/The-code-A4-20100406.pdf
eg standards for medicines management
http://www.nmc-
uk.org/Documents/Standards/nmcStandardsForMedicinesManagementBo
oklet.pdf
eg guidance for midwives and nurses on record keeping.
http://www.nmc-uk.org/templates/pages/Search?q=record%20keeping
2 The legal context as it relates to midwives – participants were asked to

read ‘Midwives and Medicines’ NHS Education for Scotland republished
April 2011
http://www.healthcareimprovementscotland.org/programmes/reproductive,
_maternal__child/national_midwifery_formulary/education.aspx
The context of medicines; it was suggested that participants became

familiar with accessing websites such as the PGD website
www.pgd.nhs.uk and The British National Formulary available online at
http://www.bnf.org
3 Participants were supplied with copies of the relevant local information on

medicines and practice eg guidelines, processes for supply, discharge,
clinics etc and requested to become familiar with their contents. This
included the monographs selected by the NHS board for local use from
what would be the national collection of monographs (the national
midwifery formulary).

Participants in the pilot sites were asked to allow a minimum of eight hours to
undertake this preparatory reading. After this reading participants were invited to
complete a pre course worksheet. Discussion on the worksheet took place in the
workshop session.

Pre-Course Worksheet
This worksheet has been designed for you to develop your knowledge and
understanding of the legislation and mechanisms that will allow you to use the
midwifery formulary.
Question 1
Having completed this workshop, will you be a non-medical prescriber?
Question 2
Define the different classifications of medicines and give examples of where each
different type may be obtained.
Question 3
Define what the national midwifery formulary is.
Question 4
Can a midwife delegate the task to another midwife of administering or supplying
medicines to a woman or baby?
Give a rationale for your answer.

Question 5
Define what is meant by Midwives’ Exemptions.
Question 6
What information must you have checked prior to giving a woman any medicine:
With respect to the woman?
With respect to the medicine?
Question 7
Give examples of resources that can give you accurate and up-to-date information on
medicines available in the UK today.
Question 8
Explain what is meant by ‘off license’ / “off label “
Question 9
What is meant by a Patient Group Direction?
Question 10
Do any and all medicines need to be recorded on the medicine kardex in your local
NHS board?

Question 11
If a drug error is identified, how should it be subsequently dealt with?
Question 12
When can a midwife administer parenteral lidocaine or lidocaine hydrochloride?
Question 13
Complex drug calculations are sometimes required in midwifery practice. How
should such calculations be checked?
Question 14
What is a contra-indication to supplying a woman with Paracetamol?
Question 15
List 6 of the potential adverse reactions that can occur if a woman is given Ranitidine
150mg orally.
Question 16
What additional information, if any, should be given to a postnatal woman if you
decide that she needs Iron supplementation?
Question 17
With reference to the national midwifery formulary explain what Diclofenac is used
for.

The workshop – lesson plan
Facilitators :
Practice education midwife
Relevant pharmacist
Session Title: Number of Participants:
Midwifery Formulary Workshop 20
Date: Identified Group:
Student Midwives and Midwives
Equipment/Resource/Aids: Start time: 08:30
Power Point Presentation

Flip chart, pens, post its
Pre-determined scenarios Finish time: 13:00
Reference materials –
BNF,
Copies of local midwife formulary,
Copies of local policies on use of medicines etc Local Duration: 4 ½ Hours incl. breaks
Medicine Kardex – training copies, NMC booklets,
Induction of Labour and Anti D leaflet
MCQ,
Evaluation,
Certificates of attendance
Aim:
By the end of the workshop the participants will be able to clarify and define roles and responsibilities in
relation to medicines and use the midwife formulary within sphere of practice
Objectives:
Demonstrate safe practice in the administration of medicines by working within the legal and
ethical framework that underpins the use of Midwife Exemptions, Midwife Supply and Patient
Group Directions.
Apply knowledge of safe and effective medicines management in relation to PGDs, and local
policies and arrangements for medicines.
Apply knowledge of the legal status of medicines and how the status for the same medicine can
vary with pack size, formulation, indication and dosage.
Describe the indication, dosage, contra-indications, caution, side effects and the categorisation of

the medicines within the midwifery formulary.
Document accurately the administration and supply of medicines from the midwifery formulary.
Have knowledge of the medicines used within the midwifery formulary in order that accurate
information is given to women.
Session Method of Delivery:
Power point presentation, Group work- scenario, MCQ, Q&A, Discussion
Aspect Activity Teaching Method Time

Introductions and Housekeeping, introductions Power point 5 mins
objective of the session to facilitators
Verbal and visual

explanation of the sessions
aims and LOs
Set out the order of the Explain the order of the Facilitator 10 mins
workshop and discuss session
MCQ
Discuss the MCQ – answers
self marked Power point 15 mins
Explain midwife Discuss midwife formulary

formulary use in clinical area including 30 mins
midwife accountability, PSA
– incident examples
Explore the clinical Divide participants into 4 and Group Work 20 mins
application in using the facilitate their problem
midwife formulary using solving approaches. Facilitator in each station per
scenarios station =
Ask each group to nominate Break after 2 workshops 80 mins
scribe for each individual + break
work workstation scenario
Feedback finding Facilitators feedback the Use the pre determined 40 mins
group’s findings commentaries to help facilitate the
feedback summarise on flip chart
20 questions to complete to Reference materials available for 30 mins

Participants complete achieve 100% participants
MCQ

Summary, Portfolio and Summarise the workshop Verbal 10 mins
Evaluation
Discuss portfolio including
timescale for completion
Handouts and evaluation forms
Ask participants to evaluate
the workshop Postit feedback 10 mins
MCQ results Certificates of attendance 10 mins
Learning Support:
Handout (at end of session), pre course reading, essential preparation and completion of pre and post
workshop MCQ, scenario stations, reference materials, power point and portfolio
Participants that do not achieve required 100% at end of the workshop MCQ will have planned individual
remedial work and opportunity to reassess. If failed 2 attempts then involve clinical manager and named
Supervisor of Midwives
Sample of slides used in the workshop

Link to slides on the website

Introduction to the skill stations
The purpose of these skill stations is to give midwives practice in considering the
relevant issues in their practice in relation to medicines.
The size and mix of the group attending will depend on local circumstances. The
most effective sessions reported from the board in which this was piloted had a
mixture of attendees. It was reported that newer entrants to the profession were
encouraged by more experienced midwives. If there is an issue with updating
knowledge and skills it may be more appropriate to run separate refresher courses.
The introduction of a new local formulary can give useful leverage to overcome
resistance to attending.
These local courses are best tailored to a positive occasion eg on the introduction of
a new local formulary.
The course organisers considered a minimum of 4 weeks before the course run to
allow everyone to sign up and to circulate reading.
Resources for all stations
Local selection of monographs from national midwifery formulary

Copy of relevant local protocols and documents eg on safe use of medicines
BNF
NMC booklets
Medicine kardex
Copy of all local leaflets issued to women
Poster paper, pens and postits

Scenario 1 – Antenatal
Claire is a 36-year-old woman who is currently 16 weeks pregnant in her first

pregnancy.
Past Medical History - uncomplicated, BMI 30 and has remained generally healthy.
Plan for care to be managed by midwife.
Blood group AB Rh –ve.
Present - last haemoglobin result has returned as 104 g/l
She has arrived at your midwife clinic this morning complaining of tiredness.
Consider what your midwifery management might be.
Resources

Local policies eg on safe use of medicines
BNF
NMC booklets
Medicine kardex
Anti D leaflet
Poster paper and postits

Scenario 1 – antenatal answers
Antenatal review
Points to consider -
Is she Symptomatic (Tiredness ( all the time), Breathlessness (rest/activity) or
Dizziness (palpitations) – refer to GP, Consultant Obstetrician or D/W triage
depending on severity of symptoms)
Diet – confirm and advise
Full A/N examination - review all results from booking including Hb
eg MSU - infection
Plan using midwife formulary

Anaemia – check feratin levels and if >15 suggestion iron deficiency discuss
care with woman and commence iron supplementation of oral Ferrous
Sulphate 200mgs BD (ferrous fumarate – prescription expensive in hospital
cheaper in community) recheck full blood count in 4 weeks
Advice to woman to optimise iron intake and contraindications of medicine
Document on woman hand held record/trak and medicine kardex and follow
up appointment re prophylactic anti D programme
Remember the 8 Rs
Right drug
Right route
Right time
Right patient
Right dose
Right documentation
Right education
Right effect

Scenario 2 – Antenatal follow up
Clare is now 28 weeks pregnant and returns for antenatal review at midwifery clinic in
the GP surgery.
She is well.
Discuss and document plan of care.

Scenario 2 – Antenatal follow up answers
Antenatal examination
Repeat FBC and review results from last visit (discuss results with GP/Obstetrician)?
Random blood sugar test.
Discuss with Clare Anti D administration and informed consent, document on

medicine kardex and administer using midwifery formulary
check Clare has information leaflet on prophylactic anti D
order anti D from BTS pre appointment – or supplier, storage
BNF – drug interaction
Document Anti D on medicine kardex
Rh bloods prior to administration of Anti D
Administer (if possible) in a GP surgery – with access to emergency
equipment – If woman requests Anti D at home discuss plan
Access to adrenalin
Monitoring arrangements post administration
South East Scotland Blood Transfusion Service Log – to be completed
Document on hand held / trak and follow up appointment
Remember the 8 Rs
Right drug
Right route
Right time
Right patient
Right dose
Right documentation
Right education
Right effect

Scenario 3 – Labour
Claire remains well and at 41 weeks pregnant establishes in labour and gives birth at
home using Equanox to a SVD of a live baby boy weighing 3500gms requiring no
resuscitation. At delivery Claire has blood loss 300mls and a second degree tear
requiring suturing.
Discuss and plan her care documenting all medicines required
Resources
Local selection of monographs from National Midwifery Formulary

Local policies eg on the safe use of medicines
BNF
NMC Booklets
Induction of labour protocol
Induction of labour leaflet
Anti D protocol
Anti D leaflet
Medicine kardex – woman
Medicine kardex – baby
SMR form

Scenario 3 - Labour answers
Antenatal history and assessment at home.
Plan using midwifery formulary:

Exemption medicines - document on medicine kardex Equanox,
Syntometrine/syntocinon, Lidnocaine for perineal repair
Consider Diclofenic for post perineal pain and regular analgesia
Post natal Anti D
Plan to check 3rd day Hb in view of iron supplementation and last Hb result
Baby – Phytomenadione (Vitamin K )
IM – documented on medicine kardex - new practice
oral - document on baby medicine kardex
Remember the 8 Rs
Right drug
Right route
Right time
Right patient
Right dose
Right documentation
Right education
Right effect

Scenario 4 – Post Delivery
Claire, baby and family are well, breastfeeding baby and community midwife visits on
day 3.
Day 3 Hb result is 100 g/l platelets normal
BTS result Baby blood group A positive Direct Combs negative.
Claire is self-administering Paracetamol and Ibruprofen and also complaining of
constipation.
You are the midwife visiting Claire at home; plan her care using the midwifery
formulary.
Resources

Copies of local policies eg on the safe use of medicines
BNF
NMC Booklets
Copies of local protocols eg Anti D
Local discharge medicine documents
Medicine kardex – woman
Medicine kardex – baby
SMR form
Information sheet

Scenario 4 – Post Delivery answers
Plan using midwifery formulary

Anti D 500iu - midwife exemption
Oral iron therapy – midwife supply – last Hb result platelets – GP for
prescription or purchase from pharmacist
Lactulose – midwife supply – discuss with woman diet/fluid/motion – GP for
prescription or purchase from pharmacist
Check BNF
If mother requests oral phytomenadione plan for subsequent doses to baby
Midwifery formulary– implementation
Midwife can supply and administer or supply for patient to administer certain
medicines approved by the Medicine Act 1968. (Updated 1st July 2010)
And reference to the eight Rs…

Recap - Midwifery formulary– implementation
Midwife can supply and administer or supply for patient to administer certain
medicines approved by the Medicine Act 1968. (Updated 1st July 2010)
Items to acknowledge with participants

1. Consult the formulary and BNF rather than ask others or rely on your memory.
2. Undelegated task – inpatient. This task cannot be delegated irrespective of
whether it is ME, MSA or PGD. So for regular medications such as paracetamol 1g
QDS, each dose (ie four individual doses have to be written up on the once only
section) will have to be written up EACH DAY for inpatient hospital scenario, making
this process cumbersome. Use of several Medicine Charts is a potential source of
error.
3. Community midwives – there is no nationally agreed mechanism for supply for
patients to administer in community. Midwives may be able to obtain supplies from
hospital pharmacy but may not want to carry medicines. Patients may not want to
buy medicines even if very cheap. This is a dilemma.
4. Patients own supply- inpatient - legally if a patient brings in own medicines then
the midwife is not supplying so should not get involved in writing up the request on a

Medicine Chart. The Medicine Act, however, only requires parenteral medicines to be
documented on a medicine chart or prescription (ie prescribed). NHS organisations
across the UK have adopted the good practice of documenting all medications by all
routes administered to all inpatients unless the organisation has a specified policy
exception to this practice.

Sample Final Multiple Choice Questionnaire for
Midwifery Formulary Education Workshop
Name.........................................
Consider the following questions and answer as appropriate.
It will be stated where some questions may have more than one correct answer.
Please indicate which of the following statements are true or false
1. Diclofenac suppository 100mg was written up by Midwife X on a medicine kardex. It

was noted that it had not been signed as administered. Midwife Y now in attendance
can still administer this medicine:
a. True
b. False
2. A telephoned order given by a doctor to a midwife, which states the woman’s name,
the medicine, the dose and the times of administration is an acceptable way of
prescribing a medicine:
a. True
b. False
3. Cyclizine is included in the midwife formulary and classed as a Midwife

Exemption medicine.
a. True
b. False
4. Ibuprofen 400mg 4 hourly regularly up to a maximum 4 tablets in 24 hours is the

correct administration
a. True
b. False
5. Oxytocin can be stored at 30 C for up to 3 months (mark revised expiry date on box)
a. True
b. False
6. A manufacturer’s patient information leaflet should be available for an administration

medicine, or given to the women if a medicine has been supplied, or, if a patient
requests one, for any medicine:
a. False
b. True
7. The second line treatment for haemorrhoids is Anusol HC for up to 7 days

a. False
b. True

8. Lidocaine for cannulation can be administered under a Midwife Exemption
arrangement
a. True
b. False
9. In your local NHS board any medicine, unless specified by local policies and
procedures, must be recorded on a prescription and administration chart
a. False
b. True
10. A student midwife can administer a medicine under a Patient Group Direction
arrangement under the direct supervision of a Midwife
a. True
b. False
Consider the following questions and indicate the correct answer. It will be stated where some
questions have more than one correct answer.
11. What is a General Sales List medicine?
a. A medicine that is only obtainable with a prescription.

b. A medicine that can be sold from a pharmacy on the condition that a pharmacist
supervises the sale.
c. A medicine that can be bought at various retail outlets.
d. Medicines that are supplied to hospitals only.
12. What is a midwife exemption medicine?
a. A medicine that a midwife can administer only if prescribed by a

medical /non medical prescriber.
b. A medicine that the midwife can supply or administer in the sphere of
midwifery practice without a prescription or PGD
c. A medicine that a midwife may sell to a woman
d. Only medicines that can be given to woman and not babies
13. You are about to administer a medicine prescribed to a woman by a doctor but you are
uncertain if the correct dose has been prescribed. Do you:
a. Check with other member of staff.

b. Check BNF for correct pharmaceutical form, strength, dose and route of
administration.
c. Ask the woman how many tablets she had been given before.
d. None of the above.
14. By use of a PGD, Dihydrocodeine tablet 30mg was written up by Midwife A. The dose
was delayed as the woman was out of ward. Midwife B can:

a. Rewrite another dose without assessment.
b. Assess the woman’s requirements and document that dose written by Midwife A
was not given.
c. Administer dihydrocodeine to the woman as written up by Midwife A without
an assessment.
d. Ask a doctor to write up woman for dihydrocodeine.
15. A mother requests that her newborn baby have oral phytomenadione. As the midwife
using the national midwifery formulary you can:
a. Obtain a prescription from a paediatrician.
b. Administer oral phytomenadione using a Patient Group Direction.
c. Administer oral Phytomenadione as a Midwife Exemption Administration.
d. Ask mother to obtain a prescription from her GP.
16. What is a pharmacy medicine (P)?
a. A medicine that can be obtained only from a pharmacy under the

supervision of a Pharmacist but does not require a prescription.
b. A medicine that is available from the healthcare aisle in large
supermarkets.
c. A medicine that can be dispensed only by a hospital Pharmacist.
d. A medicine that requires a prescription from a Doctor.
17. Contraindications to Anti – D postnatal are:
a. known RH(d) positive individuals including those who are Du

positive, RH(d) negative individuals known to have immune Anti-D
antibodies, hypersensitivity to any of the components, consent not
given.
b. known RH(d) positive individuals including those who are Du positive,
hypersensitivity to any of the components, consent not given.
c. known RH(d) positive individuals including those who are Du positive,
RH(d) negative individuals know to have immune Anti –D
antibodies, hypersensitivity to any of the components.
d. RH(d) negative individuals known to have immune Anti-D antibodies,
hypersensitivity to any of the components, consent not given.
18. As a midwife you are about to administer a medicine to a woman. Which of

the following statements is true with respect to your accountability?
a. You must be certain of the identity of the person.

b. You must ensure that the person does not have an allergy to the prescribed
medication.
c. You must be aware of the therapeutic use, dosage, side effects, precautions,
contraindications and expiry date.
d. You must ensure the correct prescription is documented.
e. All of the above.

19. Right time, right patient, right medicine, right route, right dose, and right education.
The missing elements are:
a. right effect , right dose

b. right documentation, right effect
c. right prescription, right documentation
d. right effect, right prescription
20. A mother requests her baby have oral phytomenadione. As the midwife using the
national midwifery formulary you know the correct dose and frequency are:
a. 2mg (0.2ml) oral at birth and repeated at 4 days- exclusively breastfed

babies will require a further dose at one month, max 3 doses
b. 2mg (0.2ml) oral at birth and repeated at 7 days - exclusively breastfed
babies will require a further dose at one month, max 3 doses
c. 2mg (0.2ml) oral at birth and repeated at 4 - 7 days - exclusively
breastfed babies will require a further dose at one month, max 3
doses
d. 2mg (0.2ml) oral at birth and repeated at 4 -7 days - exclusively breastfed
babies will require a further dose at one month, max 2 doses.

Assessment of competence (sample)
This consists of three elements
1. Portfolio of evidence to demonstrate the understanding of the medicines in the local

formulary and the role of the midwife in the use of
Exemption list medicines
GSL medicines
P medicines
POM medicines
PGD medicines
Discharge procedure
Other local practice in relation to medicines eg supporting self administration by
women
2. Completion of multiple-choice questionnaire
3. Clinical assessment – in a skill station format

Clinical assessment by a designated midwife or pharmacist in the use of the Lothian
Midwife formulary to administer, supply and discharge medicines including PGDs ( where
appropriate ) Assessor will observe practice and midwife will demonstrate use of the
formulary in
Exemption list medicines
GSL medicines
P medicines
POM medicines
PGD medicines
Discharge procedure
Other local practice in relation to medicines eg one stop dispensing
On successful completion of these elements within 3 months of completing the workshop

the midwife will be confirmed on the statement of achievement as competent to use the
midwifery formulary and this will be recorded into the personal training file in empower
management system.

If you do not achieve 100% on the post course multiple-choice questions you will have
only one further attempt, but more details will be given regarding support.
The midwife in her personal development portfolio must retain a copy of the statement of
achievement.

Sample Record of Practice
Exemption List Medicines Indication(s) for Use Midwife evaluation

and reflection
Assessor Feedback
…………………………….. …………………………….
Assessor Signature Assessor name Print
…………………………….. …………………………….
Designation Date

General Sales List Indication(s) for Use Midwife evaluation

Medicines and reflection
Assessor Feedback
…………………………….. …………………………….
…………………………….. …………………………….
Designation Date

Indication(s) for Use Midwife evaluation

Pharmacy Medicines and reflection
Assessor Feedback
…………………………….. …………………………….
…………………………….. …………………………….
Designation Date

Prescription Only Indication(s) for Use Midwife evaluation

Medicine and reflection
Assessor Feedback
…………………………….. …………………………….
…………………………….. …………………………….
Designation Date

Patient Group Direction Indication(s) for Use Midwife evaluation

Medicines and reflection
Assessor Feedback
…………………………….. …………………………….
…………………………….. …………………………….
Designation Date

Statement of Achievement
The following midwife has completed the learning programme and has
demonstrated accountability, safe and competent practice using the
administration and supply of medicines including PGDs in the midwifery
formulary.
Name………………………………………………………………………
Components of Programme
1. Open Learning programme

Portfolio in demonstrating the use of
Exemption List Medicine
GSL medicine
P medicine
POM medicine
PGD medicine
Completed all multiple choice questionnaire
This is to certify the above named person has completed all these elements
Signature, print and designation of assessor

………………………………………………………………………………….
Date……………………………………………………………………………
2. Supervised practice by a midwife, pharmacist, medical practitioner and

non medical prescriber in the administration and supply medicines
including PGD using the local midwifery formulary.
Signature, print and designation of assessor

…………………………………………………………………………………
Date……………………………………………………………………………
Ensure a copy is held in the relevant central file eg for training and retain the master
for your Personal Development Folder for your own records.


2011 10 10 MWF Background To Education Pack V 4

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Introducing the National Midwifery Formulary

A sample education resource

The workshop – Lesson plan 13

The slides used in the workshop – link 15

Final multiple choice questionnaire 26

Assessment of competence (sample) 30

File Name: 2011 10 10 MWF Sample education materials to

www.healthcareimprovementscotland.org (maternal and reproductive health

The content would be fit for purpose and pitched at an appropriate

The resource would be easily accessed and implemented.

File Name: 2011 10 10 MWF Sample education materials to

What problems does this resource Currently there is:

b) no clear source of where to find information about

c) a lack of awareness of rights and obligations

d) a lack of confidence in midwives in supplying and

What has been produced? An educational resource.

How is the target audience defined Midwives and student midwives

Who will be able to access the Midwives and student midwives

File Name: 2011 10 10 MWF Sample education materials to

Pre course reading, web-based learning = 8 hours

Initial multiple choice questionnaire = 30 minutes

Participative workshop = 4 hours including repeat of the

Subsequent assessment = 2.3 hours

Portfolio taken to clinical area and signed off by

pharmacist, or a non-medical prescriber or

Medical staff could be used in assessment to encourage

Will the learning involve any instructor Participative workshop = 4 hours

File Name: 2011 10 10 MWF Sample education materials to

How formalised is the learning going Structured to meet learning outcomes

File Name: 2011 10 10 MWF Sample education materials to

Recording and reporting of

Certificate to be held in the learning portfolio.

Are there any other specific Supervisor of Midwives annual review

How many learners can be expected Midwives in Scotland

Are there specific hard and software IT accessibility

Who will deliver the learning? Practice Educators/Midwives/Pharmacists

File Name: 2011 10 10 MWF Sample education materials to

The reading therefore was at different levels;

1 The professional context – to remind participants of their professional

2 The legal context as it relates to midwives – participants were asked to

The context of medicines; it was suggested that participants became

3 Participants were supplied with copies of the relevant local information on

File Name: 2011 10 10 MWF Sample education materials to

File Name: 2011 10 10 MWF Sample education materials to

Give a rationale for your answer.

File Name: 2011 10 10 MWF Sample education materials to

With respect to the woman?

With respect to the medicine?

File Name: 2011 10 10 MWF Sample education materials to

File Name: 2011 10 10 MWF Sample education materials to

Practice education midwife

Session Title: Number of Participants:

Midwifery Formulary Workshop 20

Date: Identified Group:

Student Midwives and Midwives

Equipment/Resource/Aids: Start time: 08:30

Power Point Presentation

File Name: 2011 10 10 MWF Sample education materials to

Session Method of Delivery:

Power point presentation, Group work- scenario, MCQ, Q&A, Discussion

Aspect Activity Teaching Method Time

Verbal and visual

Explain midwife Discuss midwife formulary