Ontario Regulation 188/24 made under the Midwifery Act, 1991 Made: March 8, 2024 Approved: April 25, 2024 Filed: May 3, 2024 Published on e-Laws: May 6, 2024 Published in The Ontario Gazette: May 18, 2024 Designated Drugs and Substances CONTENTS 1. Prescribing drugs 2. Administration by inhalation 3. Administration by injection, general 4. Administration by injection, controlled substances 5. Use, etc. on order 6. Non-prescription drugs and substances 7. Revocation 8. Commencement Schedule 1 Drugs that may be prescribed Schedule 2 Substances that may be administered by inhalation Schedule 3 Substances that may be administered by injection Schedule 4 Controlled drugs and substances       Prescribing drugs 1. (1) For the purposes of paragraph 6 of section 4 of the Act, a member may, on the member’s own responsibility, prescribe a drug set out in Schedule 1 to this Regulation, subject to any conditions noted in that Schedule. (2) For the purposes of paragraph 6 of section 4 of the Act, a member may prescribe a drug set out in Schedule 4 to this Regulation for the purpose of being administered in a public hospital, if the member complies with the standards of practice set out in subsection (3) of this section. (3) It is a standard of practice of the profession that a member who prescribes a drug set out in Schedule 4 shall first have either, (a) satisfied the Registrar or the Registration Committee that the member has sufficient knowledge, skill and judgment, based on the member’s formal education and training, to safely and competently prescribe drugs set out in Schedule 4; or (b) successfully completed a course approved by the Council on prescribing drugs set out in Schedule 4. Administration by inhalation 2. For the purposes of paragraph 5 of section 4 of the Act, a member may, on the member’s own responsibility, administer by inhalation a substance set out in Schedule 2 to this Regulation. Administration by injection, general 3. For the purposes of paragraph 5 of section 4 of the Act, a member may, on the member’s own responsibility, administer by injection a substance set out in Schedule 3 to this Regulation. Administration by injection, controlled substances 4. (1) For the purposes of paragraph 5 of section 4 of the Act, a member may, in a public hospital, on the member’s own responsibility, administer by injection a substance set out in Schedule 4 to this Regulation, if the member complies with the standards of practice set out in subsection (2) of this section. (2) It is a standard of practice of the profession that a member who administers by injection a substance set out in Schedule 4 shall first have either, (a) satisfied the Registrar or the Registration Committee that the member has sufficient knowledge, skill and judgment, based on the member’s formal education and training, to safely and competently administer by injection substances set out in Schedule 4; or (b) successfully completed a course approved by the Council on administering by injection substances set out in Schedule 4. Use, etc. on order 5. (1) In the course of engaging in the practice of midwifery, a member may use any drug on the order of a member of the College of Physicians and Surgeons of Ontario or on the order of a member of the College of Nurses of Ontario who holds an extended certificate of registration as a registered nurse. (2) In the course of engaging in the practice of midwifery, a member may administer any substance by injection or inhalation on the order of a member of the College of Nurses of Ontario who holds an extended certificate of registration as a registered nurse.  Non-prescription drugs and substances 6. A member may administer, prescribe or order any drug or substance that may lawfully be purchased or acquired without a prescription. Revocation 7. Ontario Regulation 884/93 is revoked. Commencement 8. This Regulation comes into force on the later of March 1, 2024 and the day this Regulation is filed. SChedule 1 drugs that may be prescribed Vaccines and Immune Globulins 1. Covid-19 vaccine. 2. DTaP-IPV-Hib. 3. Hepatitis B immune globulin. 4. Hepatitis B vaccine. 5. Influenza vaccine. 6. Measles-mumps-rubella virus vaccine. 7. Pneumococcal conjugate. 8. Respiratory syncytial virus (RSV) vaccine. 9. RhD immune globulin. 10. Rotavirus (Rot-1). 11. Tdap vaccine. 12. Varicella vaccine. 13. Varicella Zoster immune globulin. Anti-infectives 14. Mupirocin-betamethasone valerate-miconazole. Antibacterials 15. Amoxicillin. 16. Amoxicillin-clavulanic acid. 17. Azithromycin. 18. Cefixime. 19. Cephalexin. 20. Ciprofloxacin. 21. Clindamycin. 22. Cloxacillin. 23. Doxycycline. 24. Erythromycin. 25. Metronidazole 26. Nitrofurantoin. 27. Penicillin VK. 28. Sulfamethoxazole-trimethoprim. 29. Trimethoprim. Antifungals 30. Clotrimazole. 31. Fluconazole. 32. Miconazole. 33. Nystatin. Antivirals 34. Acyclovir. 35. Famciclovir. 36. Valacyclovir. Hormonal Contraceptives 37. Hormonal contraceptives, all types. Analgesics and Antipyretics 38. Diclofenac. Antiemetics 39. Doxylamine succinate-pyridoxine hydrochloride. 40. Ondansetron. 41. Prochlorperazine. Dopamine Agonists 42. Cabergoline. Vitamins, Minerals and Fluid Replacements 43. Vitamins, minerals and fluid replacements, all types. Oxytocics and Prostaglandins (For the purposes of preventing and treating postpartum haemorrhage, inducing or augmenting labour, cervical ripening and for the management of spontaneous early pregnancy loss or retained placental tissue.) 44. Dinoprostone. 45. Ergonovine. 46. Misoprostol. 47. Misoprostol-Mifepristone. Galactagogues 48. Domperidone. Corticosteroids 49. Hydrocortisone anorectal therapy compound. Proton Pump Inhibitors 50. Omeprazole. Histamine Blockers 51. Ranitidine. SCHEDULE 2 SUBSTANCES THAT MAY BE ADMINISTERED BY INHALATION 1. Oxygen (therapeutic). 2. Nitrous oxide. SCHEDULE 3 SUBSTANCES THAT MAY BE ADMINISTERED BY INJECTION Vaccines and Immune Globulins 1. Covid-19 vaccine. 2. DTaP-IPV-Hib. 3. Hepatitis B immune globulin. 4. Hepatitis B vaccine. 5. Influenza vaccine. 6. Measles-mumps-rubella virus vaccine. 7. Pneumococcal conjugate. 8. Respiratory syncytial virus (RSV) vaccine. 9. RhD immune globulin. 10. Rotavirus (Rot-1). 11. Tdap vaccine. 12. Varicella vaccine. 13. Varicella Zoster immune globulin. Antibacterials 14. Ampicillin. 15. Benzathine Penicillin G. 16. Ceftriaxone. 17. Cefazolin. 18. Ciprofloxacin. 19. Clindamycin. 20. Cloxacillin. 21. Erythromycin. 22. Gentamicin. 23. Penicillin G. Adrenergic Agents 24. Epinephrine hydrochloride. Hormonal Contraceptives 25. Hormonal contraceptives, all types. Local Anaesthetics 26. Bupivacaine. 27. Lidocaine hydrochloride with or without epinephrine. Antiemetics 28. Dimenhydrinate. 29. Ondansetron. 30. Prochlorperazine. Opiate Antagonists 31. Naloxone hydrochloride. Vitamins, Minerals and Fluid Replacements 32. Vitamins, minerals and fluid replacements, all types. Oxytocics and Prostaglandins 33. Carbetocin. 34. Carboprost tromethamine. 35. Ergonovine. 36. Oxytocin. Haemostatics 37. Tranexamic acid. Antihistamines 38. Diphenhydramine hydrochloride. SCHEDULE 4 CONTROLLED drugs and SUBSTANCES Opioid Analgesics 1. Fentanyl citrate. 2. Meperidine. 3. Morphine sulfate. 4. Nalbuphine. Made by: Pris par : Council of the College of Midwives of Ontario: Le Conseil de l’Ordre des sages-femmes de l’Ontario : Claire Ramlogan-Salanga Chair of Council Kelly Dobbin Registrar & CEO Date made: March 8, 2024 Pris le : 8 mars 2024   Français