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Phototherapy and Midwifery Scope of Practice

December 11, 2015

Note: This article was originally posted in our December 2015 newsletter, and has not been updated.

The CMO’s Consultation and Transfer of Care Standard (CTCS) has been revised to clarify the management and treatment of newborn hyperbilirubinemia. College Council passed the motion to change the CTCS consultation from hyperbilirubinemia requiring medical treatment to hyperbilirubinemia unresponsive to phototherapy. While the CMO’s position has been that phototherapy for the treatment of jaundice does not require a consult, the wording of the CTCS did not provide enough clarity. In the CTCS revisions, midwives are still required to consult with a physician for any jaundice that appears within the first 24 hours and to consult for jaundice that does not respond to phototherapy. Additionally, the Standard on Practice Protocols has been updated and requires that midwives ordering phototherapy for clients must develop a relevant practice protocol.
Council’s decision was guided by the work of the Quality Assurance Committee that sought legal and expert opinion and engaged in a literature review and a jurisdictional scan on the issue of phototherapy for the treatment of hyperbilirubinemia.

Phototherapy is not a controlled act under the Regulated Health Professions Act (RHPA); it is in the public domain. The seventh controlled act in section 27 of the RHPA is ‘applying or ordering a prescribed form of energy’. Phototherapy is not a form of energy listed in Regulation 107/96 under the RHPA and is therefore not a ‘prescribed’ form of energy. Phototherapy is also not limited in the Midwifery Act or any of its regulations.

Midwives, however, must have the knowledge, skills and judgment to treat hyperbilirubinemia with phototherapy. The expectation is that midwives will be guided by the Clinical Pathways included in the provincial Quality-Based Procedures (QBP) Clinical Handbook for Hyperbilirubinemia in Term and Late PreTerm Infants.

Council recognizes that the diversity of midwifery practices in the province, including hospital privileges, community standards and the knowledge, skills and judgment of individual practitioners will determine how midwives manage hyperbilirubinemia. The decision is intended to remove a barrier to midwifery scope for midwives and communities where access to phototherapy will improve client care. The decision is not intended to require all midwives to order phototherapy on one’s own authority if the appropriate knowledge, skill and judgment, in addition to other supportive factors are not met. It is the responsibility of midwives to establish whether or not they have the necessary knowledge and skill to manage phototherapy treatment for clients and to determine if hospital policy permits one to do so.

The Association of Ontario Midwives is interested in hearing from midwives who are currently ordering and managing phototherapy treatment for clients, in order to facilitate professional education and knowledge sharing. Please contact Tasha MacDonald at tasha.macdonald@aom.on.ca.

Questions or comments can be directed to Johanna Geraci, QAP Manager, at j.geraci@cmo.on.ca or extension 230.

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