Where RTs Get The Authority To Do What They Do
RTs gain their legal authority to perform controlled acts in one of three ways:
RT’s do not require delegation to intubate as they are legislatively permitted to do so under the Respiratory Therapy Act. Only an order (and competence to do so) is required.
RT’s do not require delegation to administer a vaccine as they are legislatively permitted to administer a substance by injection. Only an order (and competence to do so) is required.
RT’s require delegation and an order to perform allergy testing because they are not permitted legislatively to do so.
RT’s require delegation and an order to use a defibrillator because they are not permitted legislatively to apply a form of energy.
RT’s can not accept delegation to perform a controlled act that is outside of their professional scope, for example, casting a fracture.
If, in an emergency, an RT was required to defibrillate and there was no one available to delegate it to them (e.g., physician), nor someone else who was legislatively authorized to do so, it would be reasonable, and in the patient’s best interest, for the RT to defibrillate. This would be considered a task that was not anticipated and/or an emergency. There may or not be an order at the time.
Did You Know?
The Ontario Ministry of Health has now amended the Controlled Acts Regulation (s. 7.1 (1) – O. Reg. 107/96 ) to enable Respiratory Therapists to utilize diagnostic ultrasound in their practice under the order of a physician or nurse practitioner.
Authority the right to act – usually related to jurisdiction provided in a statute or to terms, conditions or limitations imposed on a certificate of registration – individually specified (by a panel) or related to an entire class of certificates of registration (specified by Council or a panel).
Authorized Act is a controlled act, or portion of a controlled act, that is authorized within a health profession act for a health professional to perform [there are four acts authorized to Respiratory Therapists by the Respiratory Therapy Act, that are created from three controlled acts defined in the RHPA]; the controlled acts authorized to Respiratory Therapists are:
- Performing a prescribed procedure below the dermis;
- Intubation beyond the point in the nasal passages where they normally narrow or beyond the larynx;
- Suctioning beyond the point in the nasal passages where they normally narrow or beyond the larynx;
- Administering a substance by injection or inhalation; and
- Administering a prescribed substance by inhalation.
Controlled Act one of the following 14 acts defined in the RHPA [section 27(2)] when it is performed “with respect to an individual”:
- Communicating to the individual or his or her personal representative a diagnosis identifying a disease or disorder as the cause of symptoms of the individual in circumstances in which it is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis.
- Performing a procedure on tissue below the dermis, below the surface of a mucous membrane, in or below the surface of the cornea, or in or below the surfaces of the teeth, including the scaling of teeth.
- Setting or casting a fracture of a bone or a dislocation of a joint.
- Moving the joints of the spine beyond the individual’s usual physiological range of motion using a fast, low amplitude thrust.
- Administering a substance by injection or inhalation.
- 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.
- Applying or ordering the application of a form of energy prescribed by the regulations under this Act.
- Prescribing, dispensing, selling or compounding a drug as defined in subsection 117 (1) of the Drug and Pharmacies Regulation Act, or supervising the part of a pharmacy where such drugs are kept.
- Prescribing or dispensing, for vision or eye problems, subnormal vision devices, contact lenses or eye glasses other than simple magnifiers.
- Prescribing a hearing aid for a hearing impaired person.
- Fitting or dispensing a dental prosthesis, orthodontic or periodontal appliance or a device used inside the mouth to protect teeth from abnormal functioning.
- Managing labour or conducting the delivery of a baby.
- Allergy challenge testing of a kind in which a positive result of the test is a significant allergic response.
- Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception, or memory that may seriously impair the individual’s judgement, insight, behavior, communication or social functioning.
Competence having the requisite knowledge, skills and judgement to perform the procedure.
Delegatee the person receiving the authority to perform a procedure.
Delegator when the patient/client is apparently experiencing severe suffering or is at risk, if the procedure or treatment is not administered promptly, of sustaining serious bodily harm.
Emergency the person conferring the authority for another to perform a procedure.
Forms of Energy the following forms of energy are prescribed in regulation:
- Electricity for,
- aversive conditioning
- cardiac pacemaker therapy
- electroconvulsive shock therapy
- nerve conduction studies, or
- transcutaneous cardiac pacing
- Electromagnetism for magnetic resonance imaging
- Soundwaves for,
- diagnostic ultrasound, or
- Electricity for,
HPPC Health Professions Procedural Code – RHPA; Schedule 2.
Member a member of a regulatory college under the RHPA.
Reasonably sensible, rational often referred to as the reasonable person test – determined by case law – in the case of the CRTO, a panel would determine whether or not an individual, giving consideration to all circumstances, acted in a sensible, rational manner in the matter under discussion.
Respiratory Therapist a Member of the CRTO (refers to RRT, GRT, PRT, Inactive Member).
RHP / Regulated Health Professional a health care provider who is a member of a College and is regulated by the RHPA (e.g., nurse, physician, dentist, massage therapist, physiotherapist, dietitian, occupational therapist, etc).
RHPA Regulated Health Professions Act, 1991.
RTA Respiratory Therapy Act, 1991.
REFERENCES & LEGISLATION
College of Nurses of Ontario (2020). Practice standard: Decisions about procedures and authority. Retrieved from https://www.cno.org/globalassets/docs/prac/41071_decisions.pdf
College of Physicians and Surgeons of Ontario (2021, March). Delegation of controlled acts. Retrieved from https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Delegation-of-Controlled-Acts
College of Respiratory Therapists of Ontario (2020, March). Professional practice guideline: Interpretation of authorized acts. Retrieved from https://interpretation.crto.on.ca
Health Profession Regulators of Ontario. An Interprofessional Guide on the use of Orders, Directives and Delegation for Regulated Health Professionals (2021). Retrieved from: http://www.regulatedhealthprofessions.on.ca/orders%2c-directives%2c-delegation.html
Regulated Health Professions Act, 1991. (see s.27)
Respiratory Therapy Act, 1991. (see s.4)
Prescribed Substance Regulation O. Reg. 596/94: GENERAL (ontario.ca) (see Part VII.1)