Practice FAQs

I have been asked to provide asthma and COPD education by telephone to patients who live outside of Ontario. Am I permitted to do that?September 2017

Yes, CRTO Members are permitted to provide RT services via telecommunication technology (e.g., telephone, videoconference, email) to patients who reside outside of Ontario provided certain practice parameters are adhered to. These parameters are outlined in the CRTO Professional Practice Guideline entitled Respiratory Therapists Providing Telepractice Services.

My understanding is that nurses can dispense medication. Can an RN or NP delegate dispensing of medication to RTs?Summer 2017

You are correct that nurses can dispense medications. However, neither RPNs, RNs nor NPs are permitted to delegate the controlled act of dispensing of medication.

More information on this can be found on the College of Nurses of Ontario (CNO) website under the section entitled Who can delegate, which acts can be delegated and who can accept delegation?

I am working as an RT, but do not provide direct patient care. Do I still need to have personal liablity insurance?June 2017

The Regulated Health Professions Act, 1991 (Health Professions Procedural Code) requires all practising regulated health professionals to carry professional liability insurance (PLI). Click here to view the CRTO policy on PLI. 

If you are using the title RRT in the course of your work – regardless of whether you provide direct patient care or not – you need to have PLI coverage. This can be either through your employer or purchased privately.

Can an RRT order a chest x-ray?April 2017

RRTs do not have the authority to order tests or procedures. However, an RRT can implement a physician-authorized medical directive for a chest x-ray order – provided respiratory therapists are listed in the directive as an implementer or co-implemeter. A properly constructed medical directive… Read More

Can I accept an order that a physician has authorized using an electronic signature?March 2017

In situations where a physician’s signature is required (e.g., prescriptions, requisition forms), an electronic signature is generally treated by the legislation and the relevant regulatory bodies as equivalent to a handwritten signature…. Read More

I work for a small home care company. If a client asks that we destroy their medical records, can we do so as long as we are no are longer providing them with any respiratory services?February 2017

The commonly accepted standard in both the hospital and community setting is to retain Personal Health Records (PHR) for a minimum of 10 years before disposing of them. The Public Hospitals Act states… Read More

I work for a home care company and have a client who is on a high litre flow and who continues to smoke while wearing his oxygen. He has been warned numerous times, both verbally and in writing, about the dangers to both himself and those around him. However, he refuses to stop. My company says that the oxygen equipment must now be removed, but I am concerned what will happen when we take him off such a high flow. What should I do?December 2016

The needs of the client must be balanced against the potential risk their actions pose to themselves and others… Read More

If my shift is over but the RT taking over for me has not yet arrived, can I leave? I have been told that this would constitute “patient abandonment”. November 2016

Whenever an RT is required to discontinue providing services, such as when their shift ends, then it is the RT’s responsibility to ensure these services continue to be provided. If there is no RT to take over, then the departing RT must arrange for that care to be taken over by another competent healthcare professional… Read More

Are RTs permitted to give subcutaneous injections? If so, what type of medication can we administer via that route? September 2016

The Respiratory Therapy Act (RTA) permits RTs to “administer a substance by injection or inhalation” and subcutaneous (SQ) is one of the possible injection routes of administration. As for what types of medications can be administered subcutaneously, the Scope of Practice statement in the RTA (s.3) requires that any medication administered by an RT be for the “…treatment of cardio-respiratory and associated disorders to maintain or restore ventilation”Read More

I work for a home care company and have a client who is on a high litre flow and continues to smoke while wearing his oxygen. He has been warned (both verbally and in writing) about the dangers to both himself and those around him (he lives in a small apartment building). However, he refuses to stop and if he continues we will need to remove his oxygen equipment. In the meantime, I think we should inform the fire department about the potential risk. Can I share this information without the client’s consent? Summer 2016

Yes. The Personal Health Information Protection Act (PHIPA) allows for the sharing of personal health information with persons outside of the patient’s circle of care in circumstances where there is believed to be a risk of harm to the patient or others. Therefore, a patient’s consent is not required to share information “for the purpose of eliminating or reducing a significant risk of serious bodily harm to a person or group of persons”. [PIHIPA. (2004). s.40 (1) – Disclosure Related to Risks]… Read More

I work at the only acute care hospital in our city and we work sole charge at nights. My brother-in-law is now on a ventilator in ICU. Am I permitted to look after him? June 2016

Providing care to a member of one’s own family is never an optimal situation, and should not be undertaken if other options are available. However, the CRTO recognizes that there are times when providing RT services to a family member is unavoidable. If the family member requires the services of a Respiratory Therapists and there is no one else available, then the RRT must act in the best interest of the patient… Read More

I understand that RRTs can now authorizie ADP Home Oxygen applications without a physician’s signature, as long as they do not work for an ADP vendor of record. I work part time at a hospital and casual for a home care company that is an ADP vendor. So I know I can’t sign the ADP applications, but can I still do the assessments necessary to determine if a patient qualifies for home O2 (e.g., ABGs, walk tests)? May 2016

Nothing has changed regarding a Registered Respiratory Therapist (RRT), Graduate Respiratory Therapist (GRT) or Practical (Limited) Respiratory Therapist’s (PRT) ability to conduct home O2 assessments (e.g., ABGs, exertional oximetry) or even to fill out the ADP home oxygen applications. The only thing that has changed is that RRTs* can now independently authorize ADP home oxygen applications… Read More

I currently work part time at one hospital and casual at another. Sometimes I need to leave one place just prior to shift change in order to make it in time for my shift at the other facility. If my employer is okay with me leaving early, it is permissible according to the CRTO? April 2016

There are a number of important factors to take into consideration in the scenario you have presented, and they all relate back to what is in the best interest of the patients you care for. First off – if you leave prior to shift change, how is the relevant information being transferred to the RT coving the next shift? There have been a number of studies identifying the point of “transfer of accoutablity” (shift report, handover report, etc.) as the place where it is most likely that a breakdown in communication will occur… Read More

One of my staff told me that she has received a notice saying that her CRTO license has been suspended because she hadn’t yet paid her registration renewal fees. She intends to send in the money, but needs to wait until her next paycheque. However, she is booked to work this weekend and I am really short staffed. Is it still okay for her to work the shifts? March 2016

The short answer is quite simply “no” – the Member cannot work as an RRT until she completes her renewal and pays both her registration fee and the reinstatement fee… Read More

What happens if an RT simply decides not to participate in the CRTO’s QA Program? February 2016

There are two factors to consider when reflecting on why a Respiratory Therapist (whether they are an RRT, GRT or PRT) should participate in the CRTO’s QA Program. One is the legislative (legal) reason, and the other is the principle upon which the legislation is based… Read More

My understanding is that after January 1, 2016, if I am charged with an offence (but not yet found guilty) I have to report it to the CRTO and it will be posted on the Register. Why is the CRTO doing this? December 2015

It is important to understand that the Ministry of Health and Long-Term Care (MOHLTC) directed all health regulatory colleges to make increased transparency a strategic priority. The reason for this is that the public, the media and government are demanding greater access to information about healthcare professionals; particularly regarding conduct and practice issues… Read More

On my CRTO renewal online form it asks me to “…declare that I am participating in the CRTO Quality Assurance Program by maintaining my professional portfolio on an ongoing basis”. I am a fairly recent grad and have not been able to find a job yet. Therefore, I cannot take part in in services, rounds, etc. Should I answer “no”? November 2015

All Members (General, Graduate, Inactive & Limited) are required to participate in the CRTO’s QA Program by participating in professional development activities and updating the information in their professional portfolios to reflect this; this applies regardless of whether or not you are working as an RT at the time… Read More

What happens if I don’t “pass” the Professional Standards Assessment (PSA) and/or my Portfolio Online for Respiratory Therapists (PORTfolioOM) is not accepted? September 2015

Both the PSA and the PORTfolio have standards that must be met for successful completion. For the PSA, Members are required to obtain a score that meets or exceeds the benchmark, which is 70% or above the 6th percentile for the given year. Each PORTfolio is assessed using established assessment criteria, and submissions that receive a “NO” on one or more highly or moderately weighted criteria are considered to be incomplete… Read More

The other day one of the RTs in my department admitted that they completely forgot to do a blood gas. However, when I looked at the patient’s chart I saw she had written that the patient had “…refused the procedure”. I suspect that she lied in the chart to cover up her mistake. I am not sure if I should follow up with this or not. July 2015

As outlined in the recently revised Documentation Professional Practice Guideline (PPG), it is considered to be professional misconduct if an RT is found: “falsifying a record relating to the member’s practice” (s.16 Professional Misconduct, O.Reg. 753/93). The purpose of documentation is to provide a clear and precise record of what took place regarding a patient’s care… Read More

I have received an email stating that my certificate of registration has been suspended for failure to renew my membership. I am booked to work this weekend. What should I do? May 2015

The suspensions are effective immediately as of the date the notice is sent out. Therefore, you will unfortunately not be able to work this weekend, and will not be able to practise as an RRT in Ontario until you have renewed your Membership, paid your Membership fees and paid the additional suspension fee. In addition… Read More

Can RRTs, GRTs and SRTs document for each other? April 2015

As outlined in the Documentation Professional Practice Guideline (p. 7), it’s essential that anyone reading the documentation must be able to clearly identify the individual performing the activity. Therefore, RTs must not document for someone else… Read More

Can I hire student RTs to work during the summer months in our pulmonary function lab? March 2015

Yes, it is permissible to hire a Student Respiratory Therapist (SRT) while they are on their summer vacation. However, it is important to understand that SRTs are not Members of the College of Respiratory Therapy of Ontario (CRTO) and do not practise under the authority of the Respiratory Therapy Act (RTA), or any of its regulations. Instead… Read More

I work for a Community Care Access Centre (CCAC) and they want me to start doing capacity assessments for individuals who are being admitted to a long-term care facility. When I was reading through the Health Care Consent Act, I saw that professionals who may act as evaluators are “a member of a category of persons prescribed by the regulations as evaluators”. Does that include RTs? February 2015

The Health Care Consent Act (HCCA) addresses two key issues. 1. Capacity to consent to treatment; and 2. Capacity to consent to admission to a long-term care facility…. Read More

Can we change any of our usual practices during a disease outbreak like Ebola? For example, would it be acceptable if we changed the frequency of our ventilator checks from Q2 to Q4? December 2014

Practice standards must always be evidence-based and created from the perspective having the best interest of our patients in mind. Therefore, any decision to depart from these standards should also be founded in the current best-practices that offer optimal patient care. In the example of ventilator checks… Read More

In a situation where patients have very dangerous diseases (like Ebola), do I have the right to refuse to come to work or refuse to care for these individuals? October 2014

Providing patient care during a disease outbreak often raises a number of ethical issues, including Duty to Care, which is noted in the Commitment to Ethical Practice document (p. 14). The CRTO’s expectation for an RT providing care… Read More

Our hospital is in the process of reviewing the code pink policy and procedure. I know that the Respiratory Therapy Act (RTA) states that RTs require an intubation order from a physician or midwife. Assuming that the RT is competent to intubate a neonate, are there any exceptions to this rule (e.g., unexpected meconium delivery)? September 2014

Yes, there is an exception to this rule. RTs have the legislative authority to intubate, but that authority is usually conditional on receiving a valid order from a health care professional specified in the RTA (such as physicians and midwives). There is an exception… Read More

Delegation of Trach Tube Changes July 2014

I have been asked to delegate trach tube changes to the Personal Support Workers (PSWs) who are employed at the long-term care facility where I work. I understand that the Prescribed Procedures below the Dermis regulation has recently changed. Am I still permitted to delegate this controlled act? Since the regulation change… Read More

As an RT, why can I do a methacholine challenge test but not an allergy skin prick test or an oral allergen challenge? June 2014

Respiratory Therapists (RTs) are not currently authorized to perform procedures under the 13th controlled act in the Regulated Health Professions Act (RHPA): “Allergy challenge testing of a kind in which a positive result of the test is a significant allergic response” (e.g., allergy skin prick testing). However, RTs routinely perform methacholine challenges under the authority of the fifth controlled act (authorized act #4 in the Respiratory Therapy Act) “administering a substance by injection or inhalation”. The rationale… Read More

Can a pharmacist accept a telephone order for medication from an RT? May 2014

For an RT to communicate an order to a pharmacist there must be a medical directive that outlines which physician (or group of physicians) is ordering the medication, and indicates that an RT (or group of RTs) will be the implementers of the directive. A pharmacist should then be able to accept that prescription over the telephone, because ultimately the physician(s) authorized the order.

There is a group of health care providers at my workplace using the title “RT” but they are not Respiratory Therapists. Am I wrong in thinking that RT is a title reserved
only for Respiratory Therapists?
April 2014

You are correct. Respiratory Therapist is the professional title and RRT or RT is the abbreviated professional designation; both of which are protected in legislation. The following excerpt from the Respiratory Therapy Act, 1991 spells that out quite clearly… Read More

We usually give a verbal report at shift change in my department. However, when a staff member is late for their shift, some of our staff will just leave a written report and go home. Is this an acceptable method for handover at shift change? March 2014

It is essential that the information passed from one RT to another during shift report (also referred to as handover, transfer of accountability (TOA) or bedside reporting) is always clear, complete and accurate. “According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO 2003), almost 70% of all sentinel events are caused by breakdown in communication1.”… Read More

We have a Physician’s Assistant (PA) working in our Emergency Room. She recently started giving the RTs orders to perform arterial blood gas (ABG) samples on her patients. Can we accept her orders? February 2014

Physician’s Assistants (PAs) are a non-regulated healthcare provider in Ontario and have no controlled acts authorized to them. Their authority to perform controlled acts comes either through delegation from a regulated healthcare professional (e.g., a physician) or through one of the exceptions in the Regulated Health Professions Act (RHPA)1. In addition, they may also perform procedures that are in the public domain and do not fall under a controlled act as defined by the RHPA (e.g., administration or oral medication). There are two important principles to remember… Read More

I have a question regarding renewal for this year. I’m currently on maternity leave and will continue to be on this leave until December 2014. Do I have to pay the full amount of the renewal fee or could I possibly just pay a portion to be registered? February 2014

If you are not practising as a Respiratory Therapist in Ontario, you may consider changing your CRTO membership to Inactive. You may apply for the Inactive Certificate online as part of your 2014 registration renewal (CRTO website “Member Login” section). The Inactive Renewal fee is $50.00. … Read More

Can I rely on implied consent when sending patient’s PFT results to the Respirologist for interpretation, or do I need to obtain written consent? For the most part, the Respirologist is not the physician looking after these patients and I don’t know if they are considered to be part of the patient’s “Circle of Care”? December 2013

The Personal Health Information Protection Act, 2004 (PHIPA) sets out the rules for the collection, use and disclosure of personal health information, and provides the following definitions… Read More

Disclosure of Information November 2013

An adult patient was brought into our emergency department by police and subsequently required intubation. During the intubation, the police officers overheard me say to one of the nurses that the patient smelled of alcohol. The officer approached me later to ask if I thought the patient had been drinking. What information am I able to disclose about a patient to a police officer?

The CRTO Professional Misconduct Regulation states that it may be considered to be an act of professional misconduct for a Member to be: Giving information about a patient or client to a person other than the patient or client or his or her authorized representative except with the consent of the patient or client or his or her authorized representative or as required by law.
“Required by law” refers to situations that fall under relevant statutes… Read More

Conflict of Interest October 2013

Although it is often difficult to determine if a conflict of interest exists, it can be helpful if you ask yourself two questions:
1. Does the situation influence, or could it potentially influence, how I treat this particular patient? (actual), or
2. Might a reasonable person think that a situation influences how I treat this particular patient? (perceived).

A conflict of interest can exist in both of the above circumstances. Read More

I remember reading about specific requirements regarding what needs to appear on ID badges for RT’s however, I can’t find that information anymore on the CRTO website. July 2013

While the College no longer has specific requirements for ID badges, it is essential that patients/clients know who is providing their care, and that the Respiratory Therapist (RT) be recognized as an important part of the healthcare team. Therefore, the CRTO encourages its Members to identify themselves to all patients/clients using their name and full professional title e.g., Registered Respiratory Therapist or Respiratory Therapist, whenever it is appropriate to do so. Please take the time to review the College’s updated PPG Registration and Use of Title (September 2012) for more information. Read More

There are many new Respiratory Therapy activities listed on the renewal form this year! I have a few questions… February 2013

What does the activity “Oximetry testing for purpose of 5th Act (COMMUNITY)” mean? Read More

At the hospital where I work, Midwives have been granted privileges to practice. If I attend a delivery at the request of a Midwife, may I accept orders to administer oxygen, CPAP and/or intubate and ventilate newborns? December 2012

Under the Respiratory Therapy Act, RTs may accept orders from Midwives who are Members of the College of Midwives of Ontario. It is likely that you have been asked to attend the delivery because of your scope of practice and role on the interprofessional team as determined by the place where you work. Please refer to the Professional Practice Guideline (PPG) Interpretation of Authorized Acts regarding from whom you may take orders from and what to do when your employers policies are more or less strict than the College’s standards. Read More

Can Respiratory Therapists (RTs) administer radioactive substances by injection for the purpose of nuclear stress testing? November 2012

A very “cautious” yes. Here is the step by step rationale:

1. Under the Respiratory Therapy Act, RTs are authorized to perform the controlled act of “administering a substance by injection or inhalation” and RTs require an order to perform this authorized act. The CRTO does not “list” or restrict the substances which may be administered. (see PPG Interpretation of Authorized Acts). Read More

Can RRT-AAs provide conscious sedation to patients/clients in an eye surgery clinic? October 2012

The CRTO considers the practice of RT-AAs administering conscious sedation within the scope of respiratory therapy practice in Ontario. Please review the following Position Statements Respiratory Therapists as AAs and Scope of Practice and Maintenance of Competency. Read More

I work for a home care company and have been asked to provide general education about oxygen therapy to a variety of health care providers (regulated and non-regulated) at long term care facility in our area. Can I do this? August 2012

RTs may provide education as long as they are competent (have the knowledge, skills and judgement) and accountable. Please review the (PPG)- Responsibilities of Members as Educators specifically, the scenarios to see which best matches your practice. Read More

Do I need an order to teach an inpatient how to use their puffers? August 2012

Providing education/training does not require an order, however RT’s do require an order to “administer a substance by inhalation” if they are administering the puffers as part of the education. Read More

The RTs have been asked to teach suctioning to the PSWs that will be caring for our complex continuing care patients who have tracheostomy tubes in place. Am teaching or delegating? August 2012

I would like to refer you to our Professional Practice Guideline (PPG) Responsibilities of Members as Educators specifically, the description on p. 8 and the table on p.9. I think these references may closely resemble the situation you are describing!

In brief, and from the CRTO’s perspective, suctioning is a controlled act that requires delegation to a paid, non – regulated health care provider (e.g., a PSW) in a health care setting. RTs may be involved in teaching and delegating this controlled act.

RTs are encouraged to clarify their role and standards of practice related to teaching and delegation with their employer and the interprofessional health care team. The CRTO also has a PPG Delegation of Controlled Acts to support RTs who delegate their authorized acts. Read More

CRTO Approved Certification Packages for Advanced Prescribed Procedures Below the Dermis…What you need to know. June 2012

The Professional Practice Guideline Certification Programs for Advanced Prescribed Procedures Below the Dermis, describes the process and content necessary to obtain a CRTO approved certification program for advanced prescribed procedures below the dermis. There are also checklists that accompany this guideline click here. If your organization decides to use one of the CRTO’s Clinical Best Practice Guidelines as the basis for your learning package, you may follow the process and fill out Checklist B.

It is important to note that the legislation and regulations that govern the practice of Respiratory Therapists in Ontario may be different from that of other professions e.g., Nurses. Read More

If I was called to assist at the delivery of a baby presenting with severe meconium aspiration syndrome and I knew that the best course of action would be for me to intubate and suction the baby, could I go ahead and intubate even if I had not completed my hospital’s certification process yet? May 2012

The scenario that you outlined certainly poses an ethical dilemma, because there is an expectation that you meet your employer’s requirements that is, the 3 supervised intubations you describe. However, if you have not yet been certified by the hospital and are faced with a situation such as you described (severe meconium aspiration), AND you are of the professional opinion that the infant requires intubation as a life-saving measure, AND you are competent to do so, then it would be appropriate to take such action. Should you choose to not intubate for fear of repercussion and the infant dies as a result, your professional judgement would likely be questioned. Alternatively, if you decided to intubate and the infant died regardless of your life-saving efforts and a complaint/investigation occurred, your defence would be that:
1) it was your professional opinion that intubation was necessary (that the baby would likely die without it), and
2) that you were competent to perform intubation. Read More

Documentation means charting in the patient/client’s medical record or chart. April 2012

In fact, the term ‘documentation’ not only refers to what is recorded in a medical or health record (e.g., the patient’s chart) but also in the equipment maintenance records, shift or transfer of accountability reports, worksheets, the kardex and incident reports (PPG Documentation, 2011, p.3). Read More

What can the College do about non-regulated people applying CPAP to clients in the community? I think this is a patient safety issue. March 2012

As you know the CRTO only regulates the practice of its Members, registered Respiratory Therapists. The mission of the CRTO is as follows:

The College of Respiratory Therapists of Ontario, through its administration of the Regulated Health Professions Act and the Respiratory Therapy Act is dedicated to ensuring that respiratory care services provided to the public by its members are delivered in a safe and ethical manner.

The CRTO has continually asserted its position on the administration of positive pressure as a procedure that falls under the controlled act authorized to RTs of administering a substance by inhalation. This has been our Interpretation of Authorized Acts as long as the College has been around! Read More

Interprofessional Collaboration (IPC) seems to be a really popular phrase these days. What does it really mean? March 2012

From the Canadian Interprofessional Health Collaborative (CIHC) National Interprofessional Competency Framework (NICF):

Interprofessional collaboration is the process of developing and maintaining effective interprofessional working relationships with learners, practitioners, patients/clients/families and communities to enable optimal health outcomes.

Elements of collaboration include respect, trust, shared decision making, and partnerships. For interprofessional teams of learners and practitioners to work collaboratively, the integration of role clarification, team functioning, collaborative leadership, and a patient/client/family/community-centred focus to care/services is supported through interprofessional communication. Read More

Interpretation of Authorized Acts February 2012

The Professional Practice Guideline Interpretation of Authorized Acts was recently revised (December, 2010). Why was Intraosseous (IO) cannulation not added as an option for a cannula site? The Intensivists at our facility have delegated IO cannulation to the Respiratory Therapists (RTs) at our hospital but the nurses don’t require delegation. It seems like an extra step that the RTs need to go through even though IO cannulation is far less invasive than femoral vein or femoral artery cannulation. IO cannulation is also an indicated procedure in the revised ACLS guidelines (2010). RTs should be able to perform procedures that are identified as best practice in ACLS and PALS. Could this please be re-evaluated and revised accordingly? Read More