We have a midwife who practices in our area. For her Rh negative patients, she would like to bring samples from baby and mom for post part workup. She would then like to take the RhoGAM to the patient's home for injection. We currently give RhIg to outpatients if they come in with a doctor's order. The RhIg injection seems to be covered under the midwife's license.

Is there any reason we can't do this?

We have a midwife who practices in our area. For her Rh negative patients, she would like to bring samples from baby and mom for post part workup. She would then like to take the RhoGAM to the patient's home for injection. We currently give RhIg to outpatients if they come in with a doctor's order. The RhIg injection seems to be covered under the midwife's license.

Is there any reason we can't do this?

This is what we do for patients who have opted to go home very soon after the birth. The midwife visits anyway so her giving the RhIg in the comfort of the patient's home doesn't seem to incovenience them. It is always issued on a named patient basis with the same patient ID checks as when giving blood.

Fully competency for the midwives should be assessed - I've heard of one 'old school' midwife who gave the anti-D to the dad!! Fortunately during her long career (which was ended by this incident) no births resulted in future HNFN - she insisted it was the only time she had given it to the dad but she also didn't know why she shouldn't be giving it to the dad. So who knows...

:disbelief

I've heard of one 'old school' midwife who gave the anti-D to the dad!!

Oh WOW!!!

In the early years there were docs who gave the RhIg to Rh= babies of Rh+ mothers . . . Anyway, no reason you can't give it to the mdiwife.

I'm just curious, is this a nurse midwife or a lay midwife?

:coffeecup

I know this is not our job to police nursing services but, these are just process considerations.

How is this getting documented in the medical record? still a Drug under FDA supervision from the Blood Bank.

Specimen Transportation, it’s a biological (training needed) and needs to be temperature controlled.

Do you directly label the vial or syringe or just the box? Could be an issue with patient safety,

Check The Joint Commission standard if you’re a member hospital.

This comes under the same regulations that limit ED's from "dispensing" drugs for off-site use. At least that is what our lawyer told us when one of our OB docs wanted us to issue RhIg for use in his office. I do know others do it, but we did not because our lawyer advised us not to.

Gosh! Thanks for all of the great input.

The record would be maintained in our computer system, capturing the lot number and expiration date.

We would be billing the patient rather than the provider so there is no "resale".

The queation about cridentials made do some investigation - There is quite a jumble of initials. Even worse than for lab professionals! The person in question an apprentice-trained and state licensed. I will need to look further into the regulation about "dispensing for off site use". That may be just what we have been missing. You have made me think about what documentation I will require. Hummm.

My first job out of school, the blood bankers gave the mom the Rhig shot! That was a skill that I didn't learn in school.

My first job out of school, the blood bankers gave the mom the Rhig shot! That was a skill that I didn't learn in school.

You mean gave her the Rhig to inject herself?

You mean gave her the Rhig to inject herself?

No, the blood bank tech administered the injection!

In this case the Blood Bank is acting to some extent like a Pharmacy and so perhaps we should look to the Pharmacy for guidence in Policy, Practice, and Procedure. Otherwise, maybe we should allow the Pharmacy to handle the distribution of all off-site injectables; ie.. RhoGam.