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Autumn On Call – Designated Drugs Regulation Frequently Asked Questions

November 15, 2019

Note: This article was originally published in our Autumn 2019 edition of our On Call newsletter, and has not been updated.

A reminder that the College is accepting feedback and comments to the proposed Designated Drugs Regulation until November 22, 2019.

On May 30, 2019, the College received a letter from the Health Minister Christine Elliott requesting that the College amend its Designated Drugs Regulation made under the Midwifery Act, 1991 to include categories of drugs and substances.

Removing the lists of individual drugs and substances currently outlined in the Designated Drugs Regulation will allow midwives to access more drugs and substances to be prescribed and administered within midwifery scope of practice, and within the boundaries of midwives’ individual competencies.

The proposed changes to the Designated Drugs Regulation will not expand the midwifery scope of practice. The scope of practice is defined and set out in the Midwifery Act, 1991 and will remain unchanged with the implementation of this proposed regulation.

Frequently Asked Questions

What are the AFHS pharmacologic-therapeutic classification categories?

The Ministry requested that the College propose categories using the AHFS pharmacologic-therapeutic classification. The AHFS is a system of organizing drugs developed and maintained by the American Society of Health-System Pharmacists (ASHP) and has been used for organizing drugs in institutional, governmental, and other settings since 1959. The classification system is based on a hierarchical numeric structure and the drugs are classified together with other drugs with similar pharmacological, therapeutic, and/or chemical characteristics in a 4-tier hierarchy. The hierarchy begins with Tier 1 as the broadest category whereas Tier 4 consists of specific categories that fall under Tiers 1 to 3. There are 31 classifications in the first tier, 200 in the second tier, 285 in the third tier, and 112 in the fourth tier.

What AHFS categories does the College propose to include in the amended regulation?

The Ministry requested that the College propose categories at a Tier 3 level citing both flexibility and specificity that can be achieved at this level. For instance, in the below example, Cephalosporins is a Tier 3 category of anti-infective agents.

In some categories, the College has requested Tier 1 or Tier 2 rather than Tier 3. This was done either because there were no Tier 3 categories (e.g. there are no Tier 3 categories in Electrolytic, Caloric and Water Balance but only Tier 1 and Tier 2) or because many of the drugs or categories in Tier 1 or Tier 2 a midwife requires access to (e.g. Anti-infective agents).

When will the regulation be approved?

Once the consultation closes, the results will be brought back to Council in December for its final review and approval. If approved, the regulation will be formally submitted to the Ministry at the end of December, as requested by the Minister. Based on our preliminary discussion with the Ministry, it is expected that the regulation will be approved in the winter of 2020.

What happened to the College’s previous submission requesting broad prescribing and administering?

In January 2018, the College made a submission to the Ministry requesting that the list of drugs and substances in the current Designated Drugs Regulation be rescinded to instead allow midwives access to any drug or substance approved by Health Canada, within the scope of midwifery practice.  At this stage, however, the Ministry is not willing to move from lists to broad prescribing and will only consider including categories of drugs and substances in the drug regulation.

While the College still believes that the public will be best served by midwifery care when clients receive the treatments that are in their midwives’ scope of practice, we acknowledge that rescinding the current list in the Designated Drugs regulation and moving to the category approach will bring positive change as midwives and their clients will have more access to up-to-date treatments than they currently have.