FAQs

  1. If my facility has a new piece of equipment, does my manager have to provide a formal in-service on it before I can use it?

  2. Am I authorized by the CRTO to care for patients outside the province of Ontario? Will my liability insurance cover me? Who can I take orders from outside of Ontario?

  3. Is it permissible for me to perform procedures that are outside my scope of practice if I have the knowledge and skill to do so?

  4. How do I verify that I am competent to do an activity/ procedure?

  5. As an RT, how does the use of Automatic External Defibrillators (AED’s) differ in the hospital as compared to when it is used in a community setting?

  6. What should I do if I disagree with a physician’s order? Do I have the right not to do what is asked of me?

  7. We now have Physician’s Assistants (PAs) at our hospital. The hospital says that the plan is to have the physicians delegate ordering of procedures to the PAs via a Medical Directive. That way, the PAs can then order the RTs to perform the procedures, such as ABGs. Can I accept an order from a PA?

  8. When I am taking medication out of an automated medication dispensing unit, am I then “dispensing” medication?

  9. We are proposing to start providing Rapid Sequence Induction (RSI) for neonates at my hospital. Is there a prescribed list of medications that an RT can give?

  10. I am an RT functioning as an Anaesthesia Assistant (AA) in my hospital and I am presently enrolled in the Michener AA program. The physicians in the OR wants me to sign our flow sheets “AA”. Is that a proper designation?

  1. If my facility has a new piece of equipment, does my manager have to provide a formal in-service on it before I can use it?

    In accordance with the CRTO Standards of Practice, it is the individual RT's responsibility to "engage in continuous quality improvement to maintain and improve his/ her quality of care". A manager/ professional practice lead is generally accountable to their organization to take the step necessary to ensure that his/her staff provides safe patient care.  However, as a Member of the CRTO, each RT has a direct accountability to the public of Ontario.  This means that where possible, the RT should avail themselves of all in-services and other educational opportunities that their employer provides. However, if such opportunities are not made available, or if for whatever reason the member is unable to take part, it remains the RT's responsibility to obtain the knowledge necessary to competently and safely perform the activities/ procedures that are required.   The Member should refrain from performing the activities/ procedures until such competence is obtained.

    (CRTO Standards of Practice, November 1996)

  2. Am I authorized by the CRTO to care for patients outside the province of Ontario? Will my liability insurance cover me?  Who can I take orders from outside of Ontario?

    The CRTO governs the profession of respiratory therapy within the province of Ontario.  Once a Member is outside of the province, the CRTO no longer has jurisdiction over his/ her practice and the RT becomes subject to the rules and regulations of the region in which they find themselves.  Such things as what controlled acts are authorized to an RT may differ from one district to the next. It is the RT's responsibility to become familiar with the professional standards in the jurisdiction in which they are providing care.

    Most liability insurance provides coverage throughout Canada. However, coverage is only provided for incidences that occurred while the RT was practicing within their scope of practice. It is important to note is that scope of practice definitions can vary from one jurisdiction to another. Once again, it is incumbent on the member to know the scope of practice of the Respiratory Therapists in the district in which they will be providing care.

    Members of the CRTO are only authorized to take orders from health care professionals who are registered with the following regulatory bodies:

    • The College of Physicians and Surgeons of Ontario;
    • Royal College of Dental Surgeons of Ontario;
    • College of Midwives of Ontario;
    • College of Nurses of Ontario (if the nurse holds a certificate of registration in the Extended Class)

  3. Is it permissible for me to perform procedures that are outside my scope of practice if I have the knowledge and skill to do so? 

    The Regulated Health Professions Act identifies thirteen controlled acts that pose significant risk of harm to the public. The Respiratory Therapy Act (RTA) outlines which of those controlled acts are authorized to RTs (known as "Authorized Acts").  The RTA also provides a definition of the Scope of Practice of a Respiratory Therapists as follows:

    The practice of respiratory therapy is the providing of oxygen therapy, cardio-respiratory equipment monitoring and the assessment and treatment of cardio-respiratory and associated disorders to maintain or restore ventilation. 1991, c. 39, s. 3; 1998, c. 18, Sched. G, s. 44 (2).

    The intent of this scope of practice statement is to provide a reference point for any of the activities/ procedures that an RT may undertake; whether they are authorized acts, through delegation or as part of the public domain. This scope is sufficiently broad so as to allow for some variability and change in clinical practice, while at the same time endeavoring to ensure patient safety. While competency (possessing the requisite knowledge, skills and judgment) is essential, it still must exist within the legislative requirement of scope of practice. Also, as mentioned in a previous section, liability insurance coverage is contingent on the RT practicing within their defined scope of practice.  Therefore, when an activity/ procedure is performed by an RT, ALL of the following conditions must be met:

    1. if it is a controlled act, it must be authorized to RTs under the RTA or properly delegated;
    2. it must be within the scope of practice of an RT, as defined in the RTA;
    3. the RT performing the task must have the competency (requisite knowledge, skills and judgment) to do so;
    4. there needs to be proper authorization (valid order);
    5. the patient must have consented to the procedure/ plan of care; and
    6. the proposed plan of care must be in the patient's best interest.

    (CRTO Professional Practice Guideline on Interpretation of Authorized Acts)

  4. How do I verify that I am competent to do an activity/ procedure?

    Having the authority to perform a procedure does not necessarily mean that it is appropriate to do so. According to the CRTO Standards of Practice document (para 5, Professional Conduct and Accountability), it is up to the individual RT to "recognize his/ her own knowledge, skill and judgment limitations and where necessary seeks the help, guidance and expertise of others". 

    There are times when there are defined requirements for the determination of competency. Some employers may have certification programs for certain procedures (e.g., intubation). The CRTO presently has a requirement that all RTs performing an advanced prescribed procedure below the dermis first undergo an approved certification program. Regardless, the ultimate responsibility for ensuring competence rests with the individual practitioner.

    Whatever the activity/procedure, it is advantageous to keep a written record of all the steps taken to ensuring competency (e.g., articles read, colleagues consulted).  This information can be outlined in your Professional Portfolio and can serve to provide a verification of competency, should ever be called into question.

    (CRTO Standards of Practice & Professional Portfolio)

  5. As an RT, how does the use of Automatic External Defibrillators (AED's) differ in the hospital as compared to when it is used in a community setting?

    When using an AED in a community setting an RT is covered under the same authority as any lay person; that is the Good Samaritan Act, 2001.  However, when an RT are required to use an AED as part of his/ her job responsibilities  the procedure  falls under the Regulated Health Professions Act, controlled act number 7 "…the application of a form of an energy" which is not a controlled act authorized to Respiratory Therapists.  Therefore, delegation is required from a healthcare professional authorized to perform the procedure, such as a physician.  A properly constructed medical directive is a good authorizing mechanism in this circumstance as it can provide the necessary delegation and fulfill the requirement for an order.           

  6. What should I do if I disagree with a physicians order? Do I have the right not to do what is asked of me?

    As a healthcare professional you should always consider the best interest of the patients first and foremost.  If you, in your professional opinion, believe that a physician's order is not in the patient's best interest it is incumbent on you to discuss your concerns with the physician.  You may not be in possession of all the facts of the patient's condition and an open discussion with the ordering physician will perhaps help you to understand how the plan of care may benefit the patient. If after discussing your concerns with the physician you are still convinced that the order is not in the patient's best interest, then you have a professional obligation not to proceed (See PPG Orders for Medical Care).  However, if you elect not to follow the order, you should inform the ordering physician and the patient's bedside nurse and if at all possible, the nursing supervisor for the area and your own supervisor.  Also, it is essential that you immediately document the entire scenario as objectively and accurately as possibly, as there is a chance that you may be called on to defend the position that you took.


    There are no controlled acts exclusively authorized to Respiratory Therapists, therefore another healthcare professional could complete the task, according to the standards of their respective profession.  It is not considered to be an abandonment of the patient for you to refuse  to carry out an order, however, open and honest discussion can help resolve many problems and should always be the first step.  So in a situation where you disagree with a patient's plan of care, remember the acronym "DID" - Discuss, Inform and Document.

  7. We now have Physician's Assistants (PA's) at our hospital.  The hospital says that the plan is to have the physicians delegate ordering of procedures to the PA's via a Medical Directive.  That way, the PA's can then order the RT's to perform the procedures, such as ABG's. Can I accept an order from a PA?

    According to the Respiratory Therapy Act, 1991, RT's can only accept orders from one of the following: a physician, a dentist, a midwife and an RN (EC).   (The Public Hospital Act stipulates that RN's in the Extended Class however, can only write orders for hospital out-patients.  An example of this setting would be in an Emergency Dept.)  Therefore, RT's cannot accept orders from Physician's Assistants.

    What the physicians will do is delegate the controlled acts to the Physician's Assistant.  Delegation is the transfer of legal authority to perform a controlled act from a regulated health professional who has the authority, according to their discipline specific act, to another health care professional who does not have the authority under their act.  Delegation is for procedures only and the act of ordering cannot be delegated.  For more information see the Professional Practice Guidelines (PPGs). 

    A properly constructed medical directive that is developed and based on templates provided by the Federation of Health Regulatory Colleges of Ontario (FHRCO), could provide the basis for the delivery of care by PA's and RT's. PA's and RT's could be listed as co-implementers, which would enable a collaborative approach.  For more information regarding the FHRCO's medical directive templates please see http://www.regulatedhealthprofessions.on.ca/index.html.

    Physician's Assistants are relatively new in the Ontario healthcare system, and there are a number of hospitals that are trialing the utilization of these personnel in the emergency department as well as other settings.  At present, they are not regulated under the Regulated Health Professions Act.  Because PA's are not regulated they have no controlled acts authorized to them therefore they cannot delegate or order. 

  8. When I am taking medication out of an automated medication dispensing unit, am I then "dispensing" medication?

    Dispensing is an act that can only occur once.  Physicians, dentists and pharmacists are the only healthcare professionals who are authorized to dispense medication without requiring delegation.   In most hospital settings, the Pharmacy Department is the one responsible for preparing the medication and filling the dispensing units.  In this case then, dispensing has already taken place by virtue of the fact that the medication(s) has been assigned to the patient in the computer systems of the dispensing unit.  The Respiratory Therapist is, in then simply administering the medication or "repackaging" it for administration.  Administration of a substance by injection or inhalation is a controlled act that is authorized to Respiratory Therapists and therefore does not require delegation.  As always, it is essential that the RT has the requisite knowledge, skills and judgment to carry out the task. 

    If, for some reason, the Pharmacy Department does not manage the automatic dispensing units in your facility, then delegation and possibly medical directives may be required. For more information, please see the CRTO Professional Practice Guideline (PPG) on Dispensing Medication.

  9. We are proposing to start providing Rapid Sequence Induction (RSI) for neonate at my hospital. Is there a prescribed list of medications that an RT can give?

    Respiratory Therapists have the authority to administer substances by injection or inhalation (Authorized act # 4 - Respiratory Therapy Act (RTA), 1991). There is no prescribed list of which medications or by which route an RT's can administer.  In order to guide your decision as to which medications are appropriate to administer, you should consider four important factors:

    1. Does the medication that is to be given fall within the Scope of Practice of Respiratory Therapy?   The RTA defines our Scope of Practice as being the following:
      The practice of Respiratory Therapy is the providing of oxygen therapy, cardio-respiratory equipment monitoring and the assessment and treatment of cardio-respiratory and associated disorders to maintain or restore ventilation.
    2. Do you have the requisite knowledge, skills and judgment to administer the medication?  Having the legislative authority to perform a controlled act does not necessarily suggest it is appropriate to do so. One way to answer this question is to compare your competency (i.e. knowledge, skills and judgment) surrounding the medication in question to your knowledge of a medication such as Salbutamol. Do you know the indications, contraindications, dosage, side effects etc of the medication? If you answer no to any of these questions, you should not be administering it to a patient.
    3. Is there a valid order for the administration of the medication, either via a direct order or a properly constructed medical directive?
    4. Last but certainly not least, you need to consider what is in the best interest of the patient.

    For more information, please see the CRTO PPG on "Interpretation of Authorized Acts".

  10. I am an RT functioning as an Anaesthesia Assistant (AA) in my hospital and I am presently enrolled in the Michener AA program.  The physicians in the OR want us me sign our flow sheets "AA".  Is that a proper designation?

    RRT is a legally protected designation for our profession; AA is not.  Successful completion of the Anesthesia Assistant programs at the Michener Institute or Algonquin College does not confer the AA designation.  As it stands right now, Anaesthesia Assistant (AA) is a job title that some RT's work under at their hospital. (This is somewhat different than the Certified Asthma Educator (CAE) or Certified Respiratory Educator (CRE) designations which can be used by someone who has successfully completed a Canadian Network for Asthma Care (CNAC) approved program and the CNAC exam.) Either way, it is important to note that in both of these scenarios; CRTO members who are practicing Respiratory Therapists must identify themselves as such and must use the designation RRT. Members are free to use additional designations awarded by other organizations (such as CNAC) or by their employer (e.g. AA), provided they continue to use the mandatory and legal designation/title for Respiratory Therapists.

    For more information on this issue, please refer to the CRTO PPG Registration and Use of Title.

    It is essential that it be clear to all who reads the patient/client health record,  "who did what and to whom".  Most patient records include a signature-sheet that provides space for the health care professional to write their full name, professional designation and initials. Provided that this is included with the patient's health record, the RT would be able to use their initials, along with RRT to verify the performance of any duties on the OR flowsheet.  If the RT is functioning at that time in an Anesthesia Assistant role, they may attach AA after RRT (e.g.) RRT-AA.

    To reference the recommended components of proper documentation, regardless of the practice setting; please see the  CRTO PPG on Documentations.