Purpose: WAC 246-834-250 Legend drugs and devices was adopted in January 1991 and has not been amended since. During a governor mandated rules review, the Midwifery Advisory Committee found that this rule needed to be updated. There have been many changes in medicine and pharmacology since 1991. The rules need to be updated to reflect these changes and to assure that patients receive safe midwifery care.

     Citation of Existing Rules Affected by this Order: Amending WAC 246-834-250.

     Statutory Authority for Adoption: RCW 18.50.115.

      Adopted under notice filed as WSR 04-24-086 on December 1, 2004.

     A final cost-benefit analysis is available by contacting Leann Yount, 310 Israel Road S.E., P.O. Box 47860, Olympia, WA 98501, phone (360) 236-4997, fax (360) 236-4626, e-mail leann.yount@doh.wa.gov.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 1, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.

     Date Adopted: January 11, 2005.

M. C. Selecky

Secretary

OTS-6773.2

AMENDATORY SECTION(Amending Order 121, filed 12/27/90, effective 1/31/91)

WAC 246-834-250   Legend drugs and devices.   (1) Licensed midwives may purchase and use legend drugs and devices ((which are deemed integral to providing safe care to the public. Such devices include the following)) as follows:

     (a) Dopplers, syringes, needles, phlebotomy equipment, suture, urinary catheters, intravenous equipment, ((heparin locks,)) amnihooks, ((and "DeLee type" mucous traps;)) airway suction devices, electronic fetal monitoring, toco monitoring, neonatal and adult resuscitation equipment, oxygen, glucometer, and centrifuge; and

     (b) Pharmacies may ((fill orders for)) issue breast pumps, compression stockings and belts, maternity belts, diaphragms ((which have been issued)) and cervical caps, ordered by licensed midwives ((for postpartum women)).

     (2) In addition to ((medications)) prophylactic ophthalmic medication, postpartum oxytocic, vitamin K, Rho immune globulin (human), and local anesthetic medications as listed in RCW 18.50.115, licensed midwives may obtain and administer the following medications:

     (a) Intravenous fluids limited to Lactated Ringers, 5% Dextrose with Lactated Ringers((, and 5% Dextrose with water)) heparin and 0.9% sodium chloride for use in intravenous locks;

     (b) ((Heparin for use in heparin locks,)) Sterile water for intradermal injections for pain relief;

     (c) Magnesium sulfate for prevention of maternal seizures pending transport;

     (d) Epinephrine for use in ((allergic reactions, and Magnesium Sulphate shall be used according to midwifery advisory committee established protocols. Such protocols shall state the indications for use, the dosage and the administration of these medications.

     (c) Licensed midwives may obtain and administer Rubella)) maternal anaphylaxis pending transport;

     (e) Measles, Mumps, and Rubella (MMR) vaccine to nonimmune postpartum women, HBIG and HBV for neonates born to hepatitis B+ mothers;

     (f) Terbutaline for nonreassuring fetal heart tones and/or cord prolapse pending transport;

     (g) Antibiotics for intrapartum prophylaxis of Group B Beta hemolytic Streptococcus (GBS) per current CDC guidelines; and

     (h) Antihemorrhagic drugs to control postpartum hemorrhage, such as misoprostel per rectum (for use only in postpartum hemorrhage), methylergonovine maleate in the absence of hypertension, oral or intramuscular, prostaglandin F2 alpha (hemobate), intramuscular.

     (3) The client's records shall contain documentation of all medications administered.

     (4) ((Whenever Epinephrine or Magnesium Sulfate is administered, a report, on approved forms, shall be submitted within thirty days to the midwifery advisory committee.)) The midwife must have a procedure, policy or guideline for the use of each drug.

[Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-834-250, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 18.50.040(3) and 18.50.115. 88-12-040 (Order PM 732), § 308-115-250, filed 5/27/88.]

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