HEALTH LICENSING OFFICE Board of Direct Entry Midwifery 1430 Tandem Ave. NE, Suite 180, Salem, OR 97301-2192 Phone: (503) 378-8667 | Web: www.oregon.gov/oha/ph/hlo

DIRECT ENTRY MIDWIFERY LEGEND AND DEVICES

40 HOUR INITIAL CONTINUING EDUCATION

Revised 01/01/2021 Page 1 of 7 HEALTH LICENSING OFFICE

Board of Direct Entry Midwifery 1430 Tandem Ave. NE, Suite 180, Salem, OR 97301-2192 Phone: (503) 378-8667 | Web: www.oregon.gov/oha/ph/hlo

LEGEND DRUGS AND DEVICES OVERVIEW 40 Hours During the course of study, the candidate must receive theory instruction, guided practical experience and assessment of skills under an organization that has been approved to offer continuing education. The amounts of time a candidate devotes to theory and practice are flexible provided the minimum hour requirements listed below have been met.

Course / Description: Hours Required: 10 hours Administration of through Injection 4 hours Treatment of Shock 4 hours I.V. Therapy 12 hours Suturing 10 hours TOTAL HOURS: 40 HOURS

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Board of Direct Entry Midwifery 1430 Tandem Ave. NE, Suite 180, Salem, OR 97301-2192 Phone: (503) 378-8667 | Web: www.oregon.gov/oha/ph/hlo

PHARMACOLOGY 10 Hours Objectives:  Define a .  Explain use of drug references.  Define “legend drugs and devices" Define and explain  For each of the legend drugs and devices authorized the following: for use by Licensed Direct Entry Midwives (LDM),  Action and effect; explain and discuss the following:  Adverse reactions;  Mechanism of pharmacological action;  Agonists and antagonists;  Indications;  Tolerance;  Therapeutic effects;  Interactions;  Side effects/adverse reactions;  Placebo effects; and  Contraindications;  Compliance.  Incompatibilities/drug interactions; and  Discuss various routes of administration.  Administration including:  Explain placental transfer of to the fetus. • Dosage;  Explain how a drug moves through the body: • Dosage form and packaging;  Absorption rate; • Onset of action;  ; and • Peak effect;  Excretion. • Duration of action/half-life Storage, transport  Chart the use of authorized legend drugs and devices. and security; and  Devise system for tracking legend drugs in a home- • Disposal. based midwifery practice, including expiration dates,  Expiration of medications. per OAR.  Dosage guidelines for approved legend drugs and devices identified in Oregon Administrative Rules (OAR) including Group B Streptococcal prophylaxis. Standards for Instructors: Instructors may include but are not limited to the following:  Licensed Pharmacist  Licensed Registered Nurse  Licensed Physician  Naturopathic Physician  Physician Assistant  Licensed Direct Entry Midwife

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Board of Direct Entry Midwifery 1430 Tandem Ave. NE, Suite 180, Salem, OR 97301-2192 Phone: (503) 378-8667 | Web: www.oregon.gov/oha/ph/hlo

ADMINISTRATION OF MEDICATIONS THROUGH INJECTION 4 Hours Objectives:  Describe and utilize universal precautions.  Differentiate intradermal, subcutaneous, intramuscular  List equipment needed for medication administration: and intravenous therapy. medication administration  Needles – size (length and bore) sites.  Filter Needles (for use with glass ampules)  Differentiate between intramuscular technique and dose  Syringes – including sizes and locks for newborn and adult.  Skin surface disinfectants -alcohol, povidone iodine  List appropriate sites for medication injection  Medication containers:  Explain the three-point check technique and when to • Glass ampules perform: • Multidose container • Date on medication, type, dosage; • Single use vials • Repeat after drawing up medication; and  Dosage guidelines for approved legend drugs and • Repeat after administering medication and chart. devices identified in Oregon Administrative Rules  List steps for administering drug IM. Chapter 332, Division 026.  List steps for administering drug SQ.  Explain appropriate care of equipment used in administering medications.  Demonstrate use of filter needle with glass ampule.  Demonstrate use of multi-dose vial.  Demonstrate I.M. injection.  Demonstrate subcutaneous injection.  Demonstrate administration of sterile water papules.  Demonstrations do not have to be on live models. Standards for Instructors: Instructors may include but are not limited to the following:  Licensed Pharmacist  Licensed Registered Nurse  Licensed Physician  Naturopathic Physician  Physician Assistant  Licensed Direct Entry Midwife

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Board of Direct Entry Midwifery 1430 Tandem Ave. NE, Suite 180, Salem, OR 97301-2192 Phone: (503) 378-8667 | Web: www.oregon.gov/oha/ph/hlo

TREATMENT OF SHOCK 4 Hours Objectives:  Define Shock.  List three levels of care in the resuscitation of a patient  Identify pathophysiology of shock. in shock.  List and explain four cellular phases of shock.  Demonstrate special positioning needs when treating  List four types of shock. pregnant women for shock and explain rationale and  Explain three stages of shock. physiology.  List signs and symptoms of shock.  Reasons for using I.V. therapy including treatment of  Describe how to assess a patient in shock: shock, dehydration, clinical exhaustion, hyperemesis.  Define "primary survey" and list its three components;  Define "secondary survey" and list its two components; and  List locations of palpating a pulse.  Dosage guidelines for approved legend drugs and devices identified in Oregon Administrative Rules Chapter 332, Division 026. Standards for Instructors: Instructors may include but are not limited to the following:  Licensed Pharmacist  Licensed Registered Nurse  Licensed Physician  Naturopathic Physician  Physician Assistant  Certified Paramedic  Licensed Direct Entry Midwife

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Board of Direct Entry Midwifery 1430 Tandem Ave. NE, Suite 180, Salem, OR 97301-2192 Phone: (503) 378-8667 | Web: www.oregon.gov/oha/ph/hlo

CORE CURRICULUM FOR INTRAVENOUS THERAPY 12 Hours Objectives:  Reasons for using intravenous therapy (I.V.) including  List dangers of inappropriately placed or maintained I.V. treatment of shock, dehydration, clinical exhaustion,  List risks associated with I.V. therapy. hyperemesis.  Identify appropriate antihemorrhagic medication for use  List necessary equipment and supplies for in an I.V. solution. administration of I.V. fluids.  List three aspects of I.V. fluid to check before  Explain appropriate care of equipment and supplies administration. used in I.V. administration.  List actions the midwife can take to prevent  List and explain appropriate use of I.V. solutions when administering or changing an I.V. approved in OAR.  Demonstrate on live model non-invasive treatment  Explain and describe rectal administration of I.V. fluids. including appropriate positioning for shock.  Explain in detail the appropriate procedure for  Demonstrate, on mannequin, appropriate steps for administration of I.V. fluids. administering an I.V.  Explain the difference between isotonic, hypertonic, and  Demonstrate how to change-out a bag of I.V. fluid. hypotonic solutions.  Demonstrate, on live model, correct administration and  Describe appropriate flow rates for I.V. administration. discontinuation of four I.V.’s.  List reasons why I.V. flow can be impeded.  Identify s/s of I.V. failure (infiltration).  Dosage guidelines for approved legend drugs and devices identified in Oregon Administrative Rules.  Chapter 332, Division 026. Standards for Instructors: Instructors may include but are not limited to the following:  Licensed Pharmacist  Licensed Registered Nurse  Licensed Physician  Naturopathic Physician  Physician Assistant  Certified Paramedic  Licensed Direct Entry Midwife

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Board of Direct Entry Midwifery 1430 Tandem Ave. NE, Suite 180, Salem, OR 97301-2192 Phone: (503) 378-8667 | Web: www.oregon.gov/oha/ph/hlo

CORE CURRICULUM FOR SUTURING 10 Hours Objectives:  Explain basic female pelvic floor and genital anatomy.  Discuss which instruments are needed for perineal  List methods for preventing perineal damage. repair, including sizes and styles of needle holders,  Define degrees of perineal damage. clamps, forceps and scissors.  Explain steps to evaluate pelvic floor and genital area  Explain special techniques for working with curved for damage following birth. Identify circumstances when needles. perineal damage may not require repair.  Demonstrate correct use of needle holder to make an  Discuss steps to take if a woman declines repair. instrument tie.  List types of perineal damage which requires referral for  Discuss pros and cons of instrument ties. repair.  Demonstrate dual instrument suturing techniques and  Explain the consequences of a poorly done repair to a other practitioner safety techniques. woman's health.  Discuss pros and cons of hand ties.  Discuss pros and cons of two forms of local  Demonstrate hand tie suturing techniques and other  Amide vs. ester based. practitioner safety techniques.  Discuss use of epinephrine in – pros  Demonstrate four basic stitches: and cons.  Interrupted  Explain use of approved local , including  Basting route of administration.  Lock blanket  List equipment needed to effect repair of 1st degree,  Running mattress 2nd degree, 3rd degree and labial lacerations.  List steps for 1st degree repair.  Explain differences between synthetic and organic  List steps for 2nd degree repair. suture.  List steps for 3rd degree repair.  Explain differences in needle size and cutting edge and  List steps for labial repair. most appropriate use of each:  Explain how to maintain aseptic technique while  Taper suturing.  Cutting  Discuss pros and cons of subcuticular closure in  Taper-cutting perineal repair. Standards for Instructors: Instructors may include but are not limited to the following:  Licensed Physician  Naturopathic Physician  Physician Assistant  Licensed Direct Entry Midwife

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