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PDFWAC 246-834-250

Legend drugs and devices.

A licensed midwife shall have a procedure, policy or guideline for the use of each legend drug and device. A midwife may not administer or prescribe a legend drug or use a legend device for which they are not qualified by education, training, and experience.
(1) A licensed midwife may purchase and use legend drugs and devices as follows:
(a) Dopplers, syringes, needles, phlebotomy equipment, sutures, urinary catheters, intravenous equipment, amnihooks, airway suction devices, electronic fetal monitors, jada system, tocodynamometer monitors, oxygen and associated equipment, glucose monitoring systems and testing strips, neonatal pulse oximetry equipment, hearing screening equipment, centrifuges, and nasopharyngeal or nasal swabs for appropriate testing;
(b) Nitrous oxide as an analgesic, self-administered inhalant in a 50 percent blend with oxygen, and associated equipment, including a scavenging system;
(c) Ultrasound machine used in the real time ultrasound of pregnant uterus for the confirmation of viability, first trimester dating, third trimester presentation, placental location, and amniotic fluid assessment; and
(d) Neonatal and adult resuscitation equipment and medication, including airway devices and epinephrine for neonates.
(2) Pharmacies may issue the following as ordered by a licensed midwife: Lactation pumps, compression stockings and belts, maternity belts, diaphragms and cervical caps, glucometers and testing strips, iron supplements, prenatal vitamins, and recommended vaccines as specified in subsection (3)(e) through (j) of this section.
(3) In addition to prophylactic ophthalmic medication, postpartum oxytocic, vitamin K, Rho (D) immune globulin, 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, five percent Dextrose with Lactated Ringers, and 0.9% sodium chloride;
(b) Sterile water for intradermal injections for pain relief;
(c) Magnesium sulfate for prevention or treatment of peripartum seizures pending transport;
(d) Epinephrine for use in peripartum anaphylaxis and resuscitation and neonatal resuscitation, pending transport;
(e) Measles, Mumps, and Rubella (MMR) vaccine to nonimmune postpartum individuals;
(f) Tetanus, diphtheria, acellular pertussis (Tdap) vaccine for use in pregnancy;
(g) Hepatitis B (HBV) birth dose for any newborn administration;
(h) HBIG and HBV for any neonates born to a hepatitis B positive gestational parent;
(i) Influenza vaccine;
(j) Any vaccines recommended by the Centers for Disease Control and Prevention (CDC) advisory committee on immunization practices for infants in the first two weeks after birth or pregnant or postpartum people;
(k) Terbutaline to temporarily decrease contractions pending emergent intrapartum transport;
(l) Antibiotics for intrapartum prophylaxis of Group B Streptococcus (GBS) per current CDC guidelines;
(m) Antihemorrhagic drugs to treat postpartum hemorrhage including, but not limited to, intravenous tranexamic acid, oxytocins, misoprostol, methylergonovine maleate (oral or intramuscular), and prostaglandin F2 alpha; and
(n) Nifedipine for indication of preterm labor pending transport.
(4) A licensed midwife with a limited prescriptive license extension may prescribe, obtain, and administer the items in subsections (1) through (3) of this section, and the following medications and therapies for the prevention and treatment of outpatient conditions that do not constitute a significant deviation from normal per RCW 18.50.010 during pregnancy or postpartum based on current evidence and practice:
(a) Antibiotics;
(b) Antiemetics;
(c) Antivirals;
(d) Antifungals;
(e) Low-potency topical steroids;
(f) Antipruritic medications and therapies;
(g) Other medications and therapies including, but not limited to:
(i) Galactagogues;
(ii) Topical analgesia for anal, vulvar, and perineal pain;
(iii) Preterm labor preventatives;
(iv) Stool softeners;
(v) Vitamins and minerals for preventing and treating deficiencies;
(vi) Over-the-counter medications as needed;
(vii) Nonopioid medication for therapeutic rest;
(viii) Medications for miscarriage prevention and completion;
(ix) Smoking cessation;
(x) Prescription referrals for IV iron infusions; and
(h) Hormonal and nonhormonal family planning methods.
(5) Pursuant to RCW 18.50.010, a licensed midwife with a license extension that includes medical devices or implants, or both may prescribe, obtain, and administer hormonal and nonhormonal family planning method devices including, but not limited to, copper or other nonhormonal intrauterine devices (IUD), IUDs with levonorgestrel or other progestin, implants or as consistent with current evidence and practice so long as they have a license extension to perform the task.
(6) The client's records must contain documentation of all medications and devices prescribed, ordered, and administered.
[Statutory Authority: RCW 18.50.115, 18.50.135, 43.70.613, 2022 c 289, and 2021 c 276. WSR 24-10-091, § 246-834-250, filed 4/30/24, effective 6/6/24. Statutory Authority: RCW 18.50.135, 18.50.115, 18.50.060, and 2020 c 76. WSR 22-13-079, § 246-834-250, filed 6/10/22, effective 7/11/22. Statutory Authority: RCW 18.50.135 and 18.50.115. WSR 19-15-005, § 246-834-250, filed 7/5/19, effective 8/5/19. Statutory Authority: RCW 18.50.115. WSR 05-06-118, § 246-834-250, filed 3/2/05, effective 4/2/05. Statutory Authority: RCW 43.70.040. WSR 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. WSR 88-12-040 (Order PM 732), § 308-115-250, filed 5/27/88.]
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