Midwifery Formulary for Mothers

Gastro-Intestinal System

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Introduction			V3
Antacids
Co-magaldrox (Mucogel®)	ME	GSL	V3	In Patient admission for duration. Out Patient 1 pack on each occasion. Dose 10 to 20ml 3 to 4 times daily oral.
Alginate antacids (Peptac®, Gaviscon®)	ME	GSL	V2	In Patient admission for duration. Out Patient 1 pack on each occasion. Dose 10 to 20ml 3 to 4 times daily oral.
Peppermint water	ME	GSL	V2	In Patient admission for duration. Dose 20ml PRN oral, for wind up to 4 times daily.
Laxatives
Ispaghula husk (Fybogel®, Regulan®, Senokot High Fibre®)	ME	GSL	V3	In Patient admission for duration. Out Patient 1 pack on each occasion. Dose 1 sachet BD oral.
Lactulose	ME	P	V2	In Patient admission for duration. Out Patient 1 pack on each occasion. Dose up to 15ml BD oral.
Senna	ME	GSL	V3	In Patient max 7 days. Out Patient 1 pack on each occasion. Dose up to 2 tab or 10ml OD oral.
Glycerol (glycerin) Suppository	ME	GSL	V2	In Patient or Out Patient. 1 Dose daily PR for maximum of 2 days.
Docusate sodium microenema (Norgalax®)	ME	P	V2	In Patient or Out Patient. 1 Dose daily PR for maximum of 2 days.
Sodium Citrate Compound Enema	ME	P	V2	In Patient or Out Patient. 1 Dose only PR.
Preparations for haemorrhoids
Anusol® cream and suppositories	ME	GSL	V3	In Patient or Out Patient. One pack of cream and suppositories may be supplied on each occasion. Use in accordance with manufacturer’s instructions.
Anusol HC® ointment	ME	P	V3	In Patient or Out Patient. One pack once only on one occasion. Use topically for maximum of 7 days in accordance with manufacturer’s instructions.
Anusol HC® suppositories	ME	P	V2	In Patient or Out Patient. One pack once only on one occasion. Use PR for maximum of 7 days in accordance with manufacturer’s instructions.
Xyloproct®	ME	POM	V3	In Patient or Out Patient. One pack once only on one occasion. Use topically for maximum of 3 weeks in accordance with manufacturer’s instructions.

Anaphylaxis

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Introduction			V2
Epinephrine (Adrenaline) 1 in 1000	ME	POM	V2	In Patient or Out Patient. 0.5ml IM repeated after 5 min. if required.

Central Nervous System

Medicine as per BNF category	Arrangement for supply or administration	Legal status	Version of page	Scottish National Midwifery Formulary local arrangements
Introduction			V3
Drugs used in nausea
Prochlorperazine Injection	ME	POM	V3	In Patient. Maximum 2 doses 8 hours apart. For antenatal nausea and vomiting in hyperemesis gravidarum as per local guideline or for control of nausea in conjuction with opiate analgesia in labour. Dose 12.5mg deep IM inj. Repeat once after 8 hours if required.
Cyclizine	ME	POM	V3	In Patient. Maximum 2 doses 8 hours apart. For control of nausea in conjunction with opiate analgesia in labour. Dose 50mg deep IM inj. Repeat once after 8 hours if required.
Analgesics
Paracetamol	ME	GSL / P / POM	V3	In Patient max. 4 days. Out Patient 1 pack of tablets on each occasion. Dose 1-2 suppositories of 500mg PR or 1 – 2 tablets every 4 to 6hrs oral as required. Lower dose in women ≤ 50kg. Max. 4 doses in 24 hours.
Ibuprofen	ME	GSL / P / POM	V3	*Practice Alert – postnatal use only.* In Patient max. 4 days. Out Patient 1 pack on one occasion. Dose 200mg to 400mg 3 times daily regularly, or as required allowing a minimum of 4 hrs between doses and up to a maximum of 3 doses in 24 hours oral. Consider lower dose in women ≤ 50kg.
Diclofenac	ME	POM	V3	Practice Alert – postnatal use only. In Patient max. 4 days. Out Patient 1 pack on one occasion. Dose one 50mg or 100mg supp. On one occasion only at perineal repair if required. 25mg or 50mg 3 times a day oral. Max. 3 doses in 24 hours. Consider lower dose in women ≤ 50kg.
Equanox® / Entonox®	ME	P	V3	Inhalation analgesia during labour in accordance with local guidelines. Max. duration 24 hours.
Morphine Sulphate	ME	POM (CD)	V3	In Patient. To be used in accordance with relevant local home birth or Labour Ward Guideline. Dose up to 15mg IM. A further 2 doses may be given at 4 hour intervals if necessary. Maximum of 3 doses to be given prior to referral to medical staff.
Pethidine hydrochloride	ME	POM (CD)	V3	In Patient. To be used in accordance with relevant local home birth or Labour Ward Guideline. Dose up to 100mg IM. A further 2 doses may be given at 1 to 3 hour intervals if necessary. Maximum of 3 doses to be given prior to referral to medical staff.
Dihydrocodeine	PGD	POM (CD)	V3	Use in accordance with local guidelines. Antenatal 30mg oral once only. Postnatal 30mg 4 to 6hrly as required depending on pain score. Do not exceed 180mg in 24 hr period. Maximum of 30 tablets total administered or supplied.
Diamorphine	ME	POM (CD)	V3	In Pt. To be used in accordance with relevant local home birth or Labour Ward Guideline. Dose 5-10mg IM. A further 2 doses may be given at 4 hour intervals if necessary. Maximum of 3 doses to be given prior to referral to medical staff.
Opioid Antagonists
Naloxone - Maternal	ME	POM	V3	In Patient. 400microgram dose IM and can be repeated within 1-2hours depending on the type, dose and frequency of opioids. Observe closely as repeated doses may be required within 1-2 hours as the duration of action of opioids is longer than naloxone.

Endocrine System

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Drugs used in diabetes introduction			V2
Glucagon	Emergency administration	POM	V2	In Patient. One dose only. Dose 1mg IM inj.

Obstetrics

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Introduction to monographs on obstetric medicines			V3
Dinoprostone vag Delivery matrix (Propess® )	PGD	POM	V3	See local guideline for use. Insert one dose (10mg) into the posterior fornix. One dose only, to be removed after 24 hours if not sooner – see PGD and SPC for further information if required.
Dinoprostone vag gel (Prostin®)	PGD	POM	V1	See local guideline for use. Insert one dose (1mg or 2mg) in accordance with guideline high into the posterior fornix. Followed by a second dose (1mg or 2mg) if required, after 6 hours in accordance with guideline; max 3 or 4mg per course.
Dinoprostone vag tablets (Prostin E2®)	PGD	POM	V3	See local guideline for use. Insert 1 tablet high into the posterior fornix. A second tablet may be inserted after 6 to 8 hours if labour is not established. The midwife may administer a max. of 3 doses in GGC – check local arrangements.
Carboprost (Hemabate®)	ME	POM	V3	See local guideline for use. 250 microgram (1ml) by IM injection. If necessary, further doses of 250micrograms may be administered at intervals of about 1.5hrs. In severe cases the interval between doses may be reduced at the discretion of the attending midwife, but it should not be less than 15 minutes. Maximum 8 doses total.
Syntometrine® for PPH	ME	POM	V3	Practice alert - Inadvertent administration to the newborn infant has proved fatal. See local guidelines for use. In Patient or Out Patient 1ml one dose only IM for PPH. Note max. 2 doses in total including any doses given in management of third stage of labour.
Oxytocin (Syntocinon®) for PPH	ME	POM	V3	In Patient Oxytocin injection or infusion to be used in accordance with the applicable home birth or labour ward guidelines for management of third stage, induction or augmentation of labour or postpartum haemorrhage.
Oxytocin (Syntocinon®) for 3rd Stage	ME	POM	V3
Oxytocin (Syntocinon®) for induction and augmentation of labour	ME	POM	V2
Ergometrine maleate	ME	POM	V3	See local postpartum haemorrhage guideline for use. 500microgram (1ml) by IV or IM injection as a single dose. IV route preferred in an emergency, Give slow IV inj. Over 60 seconds.

Medicines for Prevention of Mendelson's Syndrome

Medicine as per BNF category	Arrangement for supply or administration	Legal status	Version of page	Scottish National Midwifery Formulary local arrangements
Introduction			V3
Omeprazole 20mg capsule	PGD (GGC version)	POM	V1	See local guidelines for use as prophylaxis against acid aspiration (Mendelson’s Syndrome). Elective Caesarean Section (CS) 20mg oral to be given the night before and the morning of the elective CS operation. OP pack of 2 doses. Labour see guideline for inclusion criteria- for “high risk” patients. 20mg every 12 hours until delivery, review after 24 hours. Maximum 3 doses.
Ranitidine Injection	PGD * GGC Version	POM	V7	*Not sent out by editorial board local GGC PGD – see end**
Sodium Citrate	PGD * GGC Version	POM	V7	*Not sent out by editorial board local GGC PGD – see end**

*Available on request from Patient.GroupDirections@ggc.scot.nhs.uk Source acknowledged from NHS Greater Glasgow and Clyde by editorial board.

Medicines used for Vaginal and Vulval Infections

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Introduction			V2
Clotrimazole (Canesten®) cream	ME	GSL / P	V2	In Patient or Out Patient. One pack of cream may be supplied on each occasion. Use in accordance with manufacturer’s instructions. May be repeated once without referral to a doctor.
Clotrimazole (Canesten®) pessary	ME	GSL / P	V2	In Patient or Out Patient. One original pack of pessaries may be supplied on each occasion. Use in accordance with manufacturer’s instructions. May be repeated once without referral to a doctor if infection returns after 7 days.
Miconazole vaginal/vulval cream (Gyno-Daktarin®)	ME	POM	V2	In Patient or Out Patient. One pack of cream may be supplied on each occasion. Use in accordance with manufacturer’s instructions. May be repeated once without referral to a doctor.

Iron and Folic Acid

Medicine as per BNF category	Arrangement for supply or administration	Legal status	Version of page	Scottish National Midwifery Formulary local arrangements
Introduction			V3
Folic Acid 400microgram tablets	ME	GSL	V2	Out Patient. One tablet daily until 12 weeks of pregnancy in women at low risk of conceiving a child with neural tube defect. One original pack of tablets on each occasion. N.B. women with a BMI ≥ 30 require 5mg.
Folic Acid 5mg	PGD	POM	V3	In Patient or Out Patient. One tablet daily until 12 weeks of pregnancy in women at increased risk of conceiving a child with neural tube defect (women with established folate deficiency or sickle-cell disease should continue taking their normal dose of folic acid 5mg daily (or to increase the dose to 5mg daily) and continue this throughout pregnancy). In Patient admission duration. Out Patient one original pack of tablets on each occasion.
Ferrous fumarate with folic acid Galfer FA® Pregaday®	ME	P	V2	In Patient admission duration. Out Patient 1 pack on each occasion. For women during 2nd or 3rd trimester requiring iron and folic acid supplementation. Dose 1 tablet or capsule daily oral.
Ferrous fumarate (Fersaday® Fersamal® ) tablets	ME	P	V3	GGC Guideline – note variation from National Midwifery Formulary Monograph. See local guideline. In Patient admission duration. Out Patient 1 pack on each occasion. Iron deficiency anaemia in accordance with local guidelines. Dose Fersaday® 1 tablet once or twice daily oral. Fersamal® 1 tablet 3 times daily oral.
Ferrous fumarate syrup (Fersamal®) and (Galfer®)	ME	P	V2	In Patient admission duration. Out Patient 1 pack on each occasion. Iron deficiency anaemia in accordance with local guidelines. Dose 10ml twice daily oral.
Ferrous Sulfate	ME	P	V3	In Patient admission duration. Out Patient 1 pack on each occasion. Iron deficiency anaemia in accordance with local guidelines. Dose 1 tablet 3 times daily oral.
Sodium feredetate (Sytron ®)	ME	P	V3	In Patient admission. Out Patient 1 pack on each occasion. Dose 10ml 3 times daily oral.

Intravenous Fluids

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Introduction			V3
Compound Sodium Lactate IV infusion (Hartmann’s)	ME	POM	V2	Antenatal or postnatal women requiring resuscitation with IV fluids including hypotension, haemorrhage. Diluent for oxytocin infusion for PPH 500ml maximum. Maternal resuscitation (incl. sudden drop in systolic blood pressure) 500ml or 1 litre by rapid IV infusion. Haemorrhage up to 2 litres (unless no colloid or blood is available and woman still haemorrhaging – continue until help arrives). If giving for any other reason, maximum 1 litre.
Gelofusine® IV Infusion	ME	POM	V3	Antenatal or postnatal women requiring resuscitation with IV fluids post haemorrhage. To be used after initial treatment with crystalloids or fluid to maintain circulatory volume until blood is available. 500ml may be given over 5 to 10 minutes until signs of hypovolaemia are relieved. Rate of subsequent infusion will depend on clinical state. Maximum of 1.5 litres. (In its guideline the RCOG recommends a maximum of 1.5 litres to be given, with the simultaneous seeking of urgent medical help. If no blood is available this could be given up to a maximum of 2 litres).
Plasma-Lyte 148® IV Infusion	PGD	POM	V1	Antenatal or postnatal women requiring resuscitation with IV fluids including hypotension, haemorrhage. Maternal resuscitation (incl. sudden drop in systolic blood pressure) 500ml or 1 litre by rapid IV infusion. Haemorrhage up to 2 litres (unless no colloid or blood is available and woman still haemorrhaging – continue until help arrives). If giving for any other reason, maximum 1 litre.
Sodium Chloride 0.9% IV Infusion	ME	POM	V3	IV flush 5ml to 10ml Antenatal or postnatal women requiring resuscitation with IV fluids including hypotension, haemorrhage. Diluent for oxytocin infusion for PPH 500ml maximum. Maternal resuscitation (incl. sudden drop in systolic blood pressure) 500ml or 1 litre by rapid IV infusion. Haemorrhage up to 2 litres (unless no colloid or blood is available and woman still haemorrhaging – continue until help arrives). If giving for any other reason, maximum 1 litre.

Local Anaesthesia

Medicine as per BNF category	Arrangement for supply or administration	Legal status	Version of page	Scottish National Midwifery Formulary local arrangements
Introduction			V3
Ametop gel® (Tetracaine )	ME	P	V2	In Patient or Out Patient. Use topically in accordance with manufacturer’s instructions on each occasion.
Emla® cream	ME	P	V2	In Patient or Out Patient. Use topically in accordance with manufacturer’s instructions on each occasion.
Lidocaine hydrochloride 1% inj. (for perineum)	ME	POM	V2	Consider patient weight when administering 1% lidocaine; if any queries contact anaesthetist. Women requiring an episiotomy or requiring perineal suturing after delivery:* 5ml to 10ml for infiltration prior to episiotomy followed by 10ml to 15ml for subsequent repair. Maximum volume 0.3 ml/kg (up to a maximum of 20 ml) divided between sites to be repaired. Women requiring repair of spontaneous perineal trauma: Maximum volume 0.3 ml/kg (up to a maximum of 20 ml) divided between sites to be repaired.
Lidocaine 1% inj. for cannulation	PGD	POM	V2	Up to 0.5ml infiltrated at site of cannulation. Maximum of 3 doses on each occasion.
Instillagel®	ME	P	V2	Women requiring urinary catheter insertion. 6ml to 11ml instilled into urethra and wait 3 to 5 min. before catheterisation. May be used prior to each catheterisation.

Immunological Products and Vaccines

Medicine as per BNF category	Arrangement for supply or administration	Legal status	Version of page	Scottish National Midwifery Formulary local arrangements
Introduction to Anti D			V2
Anti D Immunoglobulin 1500 units D Gam® and Rhophylac ® Postnatal Or alternative product/ strength as supplied by BTS	ME	POM	V3	See local guideline for use. Dose as instructed by BTS. IM injection within 72 hours of delivery but check results of Kleihauer elution test. Blood Transfusion Service (BTS) will advise on increased dose(s) if required. Maximum 1 dose or as advised by BTS.
AntiD Immunoglobulin- Human 1500 units D- Gam ® and Rhophylac® Routine antenatal	ME	POM	V3	See local guideline for use. 1500 international units at 28 to 30 weeks of pregnancy by IM injection after a blood sample has been obtained and sent to BTS for antibody testing. 1 dose only to be given.
Anti D Immunoglobulin - human (D Gam®) 500 units Routine antenatal	ME	POM	V3	See local guideline for use. 500 international units at both 28 and 34 weeks of pregnancy by IM injection after a blood sample has been obtained and sent to BTS for antibody testing. 2 doses only to be given.
Anti D Immunoglobulin – human (Rhophylac®) Antenatal - for potential sensitising event	ME	POM	V3	See local guideline for use. Up to 12 weeks gestation 1500 international units by IM injection per incident. After 12 weeks gestation at least 1500 international units per incident. A test for the size of the fetal maternal haemorrhage should be performed when anti-D is given after 20 weeks and additional doses of anti-D should be administered. BTS will advise on dosage. To be given as soon as possible and within 72 hours. Seek further advice if more time has elapsed. Maximum of 1 dose per incident or as advised by BTS.
Anti-D Immunoglobulin – Human (D-Gam®) Antenatal for potential sensitising event	ME	POM	V3	See local guideline for use. Up to 20 weeks gestation 500 international units by IM injection per incident. After 20 weeks gestation 500 international units per incident. A test for the size of the fetal maternal haemorrhage should be performed when anti-D is given after 20 weeks and additional doses of anti-D should be administered. BTS will advise on dosage. To be given as soon as possible and within 72 hours. Seek further advice if more time has elapsed. Maximum of 1 dose per incident or as advised by BTS.

GGC Patient Group Directives

Below is the additional list of locally agreed PGD’S for use by midwives in GG&C.

*Available on request from Patient.GroupDirections@ggc.scot.nhs.uk Source acknowledged from NHS Greater Glasgow and Clyde by editorial board.

GGC PGD Medicine	Arrangement for supply or administration	Legal Status	Version of page	Greater Glasgow and Clyde Midwifery Formulary local arrangements
Antibiotics
Benzylpenicillin 600mg inj. GBS	PGD *	POM	V7	See Local Obstetric Group B Strep guideline and Neonatal GBS Infection guideline. Intrapartum Antibiotic Prophylaxis. During labour: Loading dose – Benzylpenicillin 3g IV infusion , over 30 minutes as soon as possible after the onset of labour and maintenance dose 1.8g every 4 hours until delivery. If patient allergic to penicillin, Teicoplanin to be administered, please refer to Teicoplanin PGD. Note: Refer to medical staff for additional antibiotic cover if GBS with suspected chorioamnionitis or sustained pyrexia.
Teicoplanin	PGD *	POM	V1	Under development at present.
Calcium Gluconate 10% inj. (1g/10mls)	PGD *	POM	V6	Community Midwifery Unit (CMU) Midwives Emergency treatment for hypermagnesaemia following magnesium sulphate treatment for eclampsia and severe eclampsia in pregnant women. Inclusion criteria: Pregnant women undergoing emergency magnesium sulphate treatment for eclampsia who are experiencing loss of reflexes and respiratory depression. Pregnant women: 1gram in 10mls IV slowly over 10mins by slow IV push. One dose only. Contact medical staff at CLU for advice immediately.
Etonogestrel Single Rod Contraceptive Implant	PGD *	POM	V9	Long acting reversible sub dermal contraceptive implant for women aged 13 years and above requesting contraceptive implant. See PGD on information for use by midwives.
Influenza vaccine (seasonal). Inactivated TETRA and TRIVALENT 2019-2020	PGD *	POM	V19	PGD – for individuals for whom live attenuated intranasal vaccine (LAIV) is contraindicated e.g. pregnancy or unacceptable due to porcine gelatin content. See PGD for information on use by midwives.
Labetalol 200mg tablets	PGD *	POM	V6	Community Midwifery Unit (CMU) Midwives in accordance with CMU Protocol – Control of Severe hypertension. Contact Consultant Obstetrician at CLU for immediate advice prior to administration. Pregnant women: 200mg as a single dose oral prior to transfer to CLU. Note exclusion criteria, if applicable Nifedipine may be administered as an alternative please refer to Nifedipine 10mgs PGD.
Magnesium sulphate IM	PGD * Magnesium Sulphate IM	POM	V4	Community Midwifery Unit (CMU) Midwives in accordance with CMU Protocol – Eclampsia and Severe Pre-eclampsia. Contact Consultant Obstetrician at CLU for immediate advice prior to administration. Emergency treatment for eclampsia and severe pre-eclampsia to prevent recurrent seizures prior/during transfer to Consultant Led Unit (CLU). Dose: Magnesium Sulphate 10g IM divided into 2 separate site injections (5g + 5g). One dose only. Note warnings and monitoring advice.
Magnesium Sulphate Infusion	PGD *	POM	V6	Community Midwifery Unit (CMU) Midwives in accordance with CMU Protocol – Eclampsia and Severe Pre-eclampsia. Contact Consultant Obstetrician at CLU for immediate advice prior to administration. Pregnant women: Loading Dose: 4g/8ml given IV diluted in 12ml of 0.9% sodium chloride IV solution over 5 mins. By slow manual infusion. Maintenance dose: By syringe driver at a rate of 1g/hour continuous intravenous infusion. i.e. 5mls /hour. Draw up 20mls (10g) of Magnesium Sulphate 50% inj. Then add to 30mls of 0.9% Sodium Chloride inj. Note exclusion criteria and cautions.
Medroxyprogesterone injectable contraception	PGD *	POM	V7	PGD for contraception - Any woman aged 13 years or more to 50 years with no known risk factors or contraindications, who has been informed of the mode of action, method of administration , advantages, disadvantages and potential side effects in particular the effects on bone mineral density. See PGD for information on use by midwives.
Misoprostol	PGD *	POM	V4	See GGC Obstetric Guideline – Post Partum Haemorrhage (PPH) Management. Emergency treatment of women having a PPH: Misoprostol 200microgram tablets (oral) give 800microgram (4 tablets) rectal – preferred route, for one dose only as per guideline and CLU advice. Note exclusion criteria.
Nifedipine	*PGD Nifedipine 10mgs capsule**	POM	V4	Community Midwifery Unit (CMU) Midwives in accordance with CMU Protocol – Control of Severe hypertension. Contact Consultant Obstetrician at CLU for immediate advice prior to administration. Pregnant women: 10mg nifedipine capsule as a single dose oral prior to transfer to CLU. Note exclusion criteria and warnings.
Omeprazole 20mg capsule	PGD (GGC version)	POM	V1	See local guidelines for use as prophylaxis against acid aspiration (Mendelson’s Syndrome). Elective Caesarean Section (CS) 20mg oral to be given the night before and the morning of the elective CS operation. OP pack of 2 doses. Labour see guideline for inclusion criteria- for “high risk” patients. 20mg every 12 hours until delivery, review after 24 hours. Maximum 3 doses.
Pertussis vaccine	PGD *	POM	V8	1 dose for immunisation of pregnant and newly delivered women against pertussis (whooping cough) in line with the latest CMO letter. In accordance with PGD.
Progesterone only oral contraception	PGD *	POM	V8	PGD for contraception - Any woman aged 13 years or more to 50 years with no known risk factors or contraindications, who has been informed of the mode of action, method of administration , advantages, disadvantages and potential side effects. See PGD for information on use by midwives.
Ranitidine 50mg/2ml inj.	PGD *	POM	V7	See local guideline. 50mg as a single dose IM or IV for all women in labour, or of greater than 20 weeks gestation or less than 3 days postpartum who require emergency general anaesthesia.
Sodium Citrate 0.3Molar Oral Solution in 30ml	PGD *	POM	V7	To increase the pH of gastric contents before general anaesthesia. See local guideline. 30ml as a single dose oral for all women in labour, or of greater than 20 weeks gestation or less than 3 days postpartum who require emergency general anaesthesia.

Right Decision Service newsletter: June 2024

1. Issues with RDS

2.Redesign and improvements to RDS

3.Evaluation

3.1 Usage statistics

3.2 Palliative care

3.3 Standard evaluation survey form

4. Training and communications

4.2 Google analytics training

5. New toolkits

6. Toolkits in development

7. Implementation projects