AAs execute medical orders and directives as prescribed by anesthesiologists. The RTA
requires an order for all controlled acts authorized to Respiratory Therapists (regardless of practice setting) except* for:
Administering a prescribed substance by inhalation
* Please note: depending on the practice setting, other legislation may require an order even for these acts (e.g., the Public Hospitals Act). Almost all controlled acts authorized to Respiratory Therapists require a valid order.
Both direct orders and medical directives are valid authorizing mechanisms and either be used by an RRT providing anesthesia services. The only exception to this is when controlled substances are administer, in which case a direct order must be used. More information on this can be found in the section entitled Controlled Substances.
More information on authorizing mechanisms can be found in the CRTO’s Orders for Medical Care Professional Practice Guideline.
Delegation is the transfer of legal authority to perform a controlled act to a person not authorized to perform that controlled act. When the task to be performed is neither authorized to Respiratory Therapists nor part of the public domain, it must be delegated to the RRT from another competent, regulated health care professional who has the authority to perform the controlled act. The following are examples of tasks that RRTs might receive delegation for when providing anesthesia services:
Application of a form of energy for nerve conduction studies, cardioversion, defibrillation or transcutaneous cardiac pacing
As of January 1, 2019, RRTs who wish to use ultrasound in their practice (e.g., for guided arterial line insertions) will require delegation.
Therefore, two things are needed to continue using ultrasound in your practice:
1. An order
- As outlined in the CRTO Orders for Medical Care Professional Practice Guideline (PPG) (pp. 10 – 11) & the CRTO Position Statement on Medical Directives, there are two types of orders:
i. A direct order (naming an individual patient)
ii. A medical directive (for a broad group/type of patient)
- As outlined in the CRTO Delegation PPG, delegation is the transfer of legal authority from a profession who has the authority (e.g., a physician) to someone who does no (in this case, an RRT or group of RRTs).
The Federation of Health Regulatory Colleges of Ontario (FHRCO) has additional information on these processes, as well as templates that combine a medical directive with a delegation document.
RRTs are authorized to administer controlled substances and other medications to a particular patient or group of patients, provided they have a valid order. It is essential to first determine if a controlled substance is being administered or dispensed. If the obtained medication is prepared and administered at that time to a patient, then it’s considered to be administration and not dispensing (e.g., providing procedural sedation to a patient in the OR).
The Controlled Drugs and Substances Act states that the physician who orders a controlled substance must name the individual patient in the prescription. Because of this restriction, medical directives for a broad range of patients cannot be used to gain possession of a controlled substance.
More information on controlled substances can be found in the CRTO’s Handling, Administration and Dispensing of Controlled Substances Position Statement.
The RTA does not authorize RTs to dispense medication, however, this controlled act can be delegated to an RT from a regulated health care professional who has the authority to delegate dispensing. In addition, RTs can obtain possession of a controlled substance through a prescription issued by an authorized practitioner; usually a physician.
More information on Dispensing can be found in the CRTO’s Administering & Dispensing Medications Professional Practice Guideline.