Delegation

The controlled acts authorized to Respiratory Therapists in the Respiratory Therapy Act, 1991 (RTA) are:

The RTA requires an order for all controlled acts authorized to Respiratory Therapists (regardless of practice setting) except* for:

If you have terms, conditions or limitations prohibiting you from performing any respiratory therapy procedures that involve controlled acts, you cannot accept delegation for those procedures. (See CRTO Policies and Fact Sheets: Graduate Certificate of Registration Policy; Supervision Policy; Inactive Certificate of Registration Fact Sheet, TCL Fact Sheet)

Registered Respiratory Therapists with a General certificate of registration (with no terms, conditions, or limitations)

Emergency Class and Graduate Respiratory Therapists:

Student Respiratory Therapists:

An assignment of responsibility and/or duties is not delegation. Even if you are “assigned” to care for patient/client(s) by your supervisor (e.g., a physician, midwife, nurse practitioner or dentist), you would require proper delegation (and orders) to perform any specific procedures involving controlled acts that are not authorized to you. Another regulated health professional asking or instructing you perform a controlled act in the moment, does not constitute the process of “delegation” or the transfer of their authority to you.

“Assisting” a Regulated Health Professional to perform controlled acts does not mean that their authority to perform the controlled act has been transferred to you. In this case, you are only assisting with the procedure and do not require delegation.

Teaching someone to perform a controlled act (e.g., a regulated; non-regulated health care provider, or other caregiver) may not be enough. Delegation is a process. For more information regarding the standards of practice of teaching versus delegation and a variety of common practice scenarios, please refer to the Respiratory Therapists Providing Education .

If the procedure is not a controlled act, it is in the public domain and delegation is not required. In this case, you may perform the procedure provided you have the competency to perform it. Depending on your practice setting you may require an order to proceed.

If a procedure involves a controlled act and you do not have the authority to perform it (i.e. the procedure is not one authorized to Respiratory Therapists), you may perform the controlled act in one of the following exceptions allowed by the RHPA [as listed and numbered in the RHPA]:

Giving first aid or temporary assistance in an emergency.

You may perform a controlled act in giving first aid, provided you have the competency (knowledge, skills and judgment) to perform the procedure.

If a Respiratory Therapist faces an emergency situation, they should not let fear of prosecution for performing a controlled act hinder their response. The CRTO also encourages Respiratory Therapists and their employers who face emergencies on a regular basis to proactively develop policies and procedures, guidelines, processes for delegation and medical directives to help guide their response. (e.g.,The use of AED’s in a facility where it is anticipated that the RT’s will be required to participate as a first responders should have a formal delegation process for that controlled act, which includes education and training). These documents may also serve to provide evidence of competency training and ongoing quality assurance to support the practice of Respiratory Therapists in emergent situations.

Fulfilling the requirements to become a member of a health profession and the controlled act is within the scope of practice of the profession and is done under the supervision or direction of a member of the profession.

Student Respiratory Therapists do not require delegation to perform controlled acts provided they are enrolled in a CRTO approved program to become Respiratory Therapists AND the controlled acts are within the scope of practice AND a Member of the CRTO is supervising or directing them.

Treating a person by prayer or spiritual means in accordance with the tenets of the religion of the person giving the treatment.

If you are performing a controlled act in treating a person by prayer or spiritual means in accordance with the principles of your religion, you do not need to have the act delegated to you.

Treating a member of the person’s household and the act is controlled act 1, 5 or 6 (as numbered in the RHPA); and, the acts that may be performed when treating a member of your household are:

1. Communicating to the member of your household, or their personal representative, a diagnosis identifying a disease or disorder as the cause of symptoms of the member of your household, in circumstances in which it is reasonably foreseeable that the member of your household, or their personal representative, will rely on the diagnosis.
2. Administering a substance by injection or inhalation;
3. Putting an instrument, hand or finger;
   • beyond the external ear canal,
   • beyond the point in the nasal passages where they normally narrow,
   • beyond the larynx,
   • beyond the opening of the urethra,
   • beyond the labia majora,
   • beyond the anal verge, or
   • into an artificial opening into the body.

Assisting a person with their routine activities of living and the act is controlled act 5 or 6 (as numbered in the RHPA). The acts that may be performed when assisting an individual with their activities of daily living are:

1. Administering a substance by injection or inhalation;
2. Putting an instrument, hand or finger;
   • beyond the external ear canal,
   • beyond the point in the nasal passages where they normally narrow,
   • beyond the larynx,
   • beyond the opening of the urethra,
   • beyond the labia majora,
   • beyond the anal verge, or
   • into an artificial opening into the body.

These exceptions mean that a person is not in contravention of the RHPA if they perform the controlled acts under the exceptions listed above.

In all practice scenarios not covered by the “public domain” or included in the RHPA “exceptions”, the authority to perform a controlled act other than the acts authorized to Respiratory Therapists MUST come from delegation from another competent, regulated health care professional who has the authority to perform the controlled act and who is not prohibited from delegating the procedure by their specific College.

Yes, you may accept delegation of controlled acts not authorized to CRTO Members under the RTA when all of the following conditions are met:

1. You reasonably believe that the delegator has the authority and competence to perform and to delegate the controlled act. In other words, you have no reason to believe that the delegator is not permitted to delegate the controlled act; and
2. You have the authority to perform the controlled act safely, effectively, competently and ethically. In other words, you have no terms, conditions or limitations on your certificate of registration which may prohibit you from performing the delegated controlled act; and
3. You have the competency to perform the controlled act. In other words, your competency to perform the delegated controlled act has been confirmed either directly or indirectly by a regulated health care professional who is also competent and has the authority to perform the procedure; and
4. You have determined that receiving delegation of the controlled act is appropriate giving due consideration to:
1. the best interest of the patient/client
2. the known risks and benefits of performing the procedure for the patient/client(s),
3. the predictability of the outcomes of performing the procedure,
4. the patient/client’s wishes,
5. the safeguards and resources available in the situation; and
6. other elements specific to the situation.

When making the decision to accept delegation to perform a controlled act that is not authorized to you under the RTA, you are reminded that authority alone is not reason enough to perform the procedure. You must have the competency to perform the delegated procedure and most importantly, performing the procedure must be in the patient/client’s best interests.

As specified in the RHPA, a Regulated Health Professional with the authority to perform a controlled act is the only person who may delegate a controlled act. (e.g., delegation cannot be received from a committee). It is possible for more than one profession to have the authority to perform and delegate the same controlled act.

You must not accept delegation from individuals who themselves have received delegation to perform a controlled act procedure. For example, you cannot accept delegation as the authority to perform the controlled act of administering a form of energy (defibrillation) from an unregulated health care provider. E.g., an EMS paramedic, who has received delegation from a physician to perform the procedure. In this scenario, the paramedic, does not have the authority to delegate a controlled under the RHPA. Further, delegated controlled acts may not be delegated over again to another person. This amounts to the concept of “sub-delegation” which is not permitted.

You are responsible for the performance of the procedure to the standard of the profession of the delegator or the generally accepted standard of practice of health care practitioners providing similar care. In other words, you must have the requisite competency (knowledge, skills and judgment) to perform the procedure before you accept delegation.

You should also maintain proper documentation of your actions by keeping a record of what activities you accepted delegation and who delegated the activities to you. The preferred method of doing this is to keep records of delegation (and other professional development) in your learning log and Quality Assurance (QA) Portfolio Online for Respiratory Therapists (PORTfolio^OM). Your competency records regarding delegation should include the following:

Remember that just because you can accept delegation doesn’t necessarily mean that you should accept delegation. CRTO Members must consider whether it is appropriate, safe, and ethical and in the best interest of the patients/clients that they are caring for.

Most employers will have policies and procedures regarding delegation detailing their process for giving and receiving delegation. You should check your employer’s policies before accepting delegation. Your employer may also have specific requirements regarding documentation when you accept delegation to perform a controlled act procedure. For more information regarding documentation obligations, please see CRTO’s Documentation PPG (crto.on.ca)