Respiratory Therapists (RTs) typically work within a diverse interprofessional health care team. While many health practitioners in Ontario are regulated under the Regulated Health Professions Act (RHPA), there are also a significant number of care providers who are “non-regulated” (referred to here as Non-Regulated Health Care Providers or NRHCP). It is essential that RTs be able to work effectively alongside both regulated and non-regulated professionals in order to provide the best possible care to their patients/clients.
Examples of NRHCPs
- Physician’s Assistants (PA)
- Personal Support Workers (PSW)
- Other paid and unpaid care providers (e.g., customer service technicians)
How NRHCPs are Authorized* to Provide Care
- Delegation – the process of transferring the authority* to perform a controlled act.
- Exceptions in the RHPA – enables the performance of certain controlled acts in specific circumstances without delegation. These acts are:
- Treating a member of his/her household; or
- Assisting a person with routine activities of daily living.
- Public Domain – is not a controlled act and therefore does not require authority to perform (e.g., spirometry).
* “Authorized/Authority” refers to the ability to perform certain controlled acts granted through a profession-specific act (e.g., the Respiratory Therapy Act). This is not to be confused with an “order” to perform a procedure. An order (either a direct order or via a medical directive) is required for both regulated and non-regulated care providers to perform most controlled acts and must come from a professional who is permitted to order (e.g., a physician).
The RHPA recognizes that it is sometimes in a patient’s/client’s interest for someone who is not authorized by a health profession Act to perform a specific controlled act. In these circumstances, a health care professional that has the legislative authority to perform a procedure can transfer authority to a care provider who does not have the authority (e.g., an RT can transfer the authority to suction to a PSW who works in his/her hospital).
Controlled Acts Authorized to RTs in the Respiratory Therapy Act
- 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.
- Administering a prescribed substance by inhalation.
2. Exceptions in the RHPA
(d) treating a member of the person’s household when performing controlled act # 1, 5 or 6;
(e) assisting a person with his or her routine activities of living and the act is controlled act # 5 or 6.
Controlled Acts that Fall Under the Exceptions
# 1 – Communicating a diagnosis.
# 2 – Administering a substance by injection or inhalation.
# 6 – Putting an instrument, hand or finger,
i. beyond the external ear canal,
ii. beyond the point in the nasal passages where they normally narrow,
iii. beyond the larynx,
iv. beyond the opening of the urethra,
v. beyond the labia majora,
3. Public Domain
If a procedure is not a controlled act, then it is considered to be in the public domain and may be performed by anyone, whether regulated or not (e.g., administering oral medications). The expectations for anyone performing a procedure or task within the public domain are that they are competent and act in the best interest of the patient/client.
Please note that whether performing a procedure under delegation, via an exception or within the public domain, care providers must consider other relevant legislation, such as the Public Hospitals Act.
RTs and NRHCPs as Partners in Providing Safe, Competent & Ethical Care
The ability to provide “the right care, at the right time and in the right place1” requires a range of care providers and skills. Competency is the essential element for providing safe and ethical care – regardless of who performs a task and how they are authorized to perform it. RTs play an important role assisting the NRHCPs to obtain and maintain these competencies, whether an RT teaches for the purpose of delegation or simply teaching.
Teaching involves providing instruction and determining that the NRHCP is competent to perform a procedure. This is required when NRHCPs are providing care under an Exception in the RHPA or performing a task in the Public Domain.
Teaching and Delegating is a process that involves the transfer of legislative authority to the NRHCPs that includes teaching. This is required when a NRHCP must perform a controlled act that neither falls under an exception, nor is in the public domain [e.g., when an RT delegates the ability to apply CPAP (which falls under the controlled act “administering a substance by injection or inhalation”) to a customer service technician working for their home care company]. When delegating to NRHCPs, the RT is accountable for either directly evaluating the initial and continuing competence of the care provider, or ensuring that a mechanism exists for competency assessment.
For more information on teaching and delegating, please see the CRTO Responsibilities of Members as Educators PPG.
A patient/client-centred system that improves health outcomes and is sustainable requires collaborative interaction between both regulated health care professionals and NRHCPs. For more information, the Federation of Health Regulatory Colleges of Ontario have developed an Interprofessional Collaboration (IPC) eTool providing valuable information on health care professionals’ scope of practice and controlled acts, as well as guidelines and templates for medical directive and delegation processes.
1 Excellent Care for all Act