RTs are authorized to “administer a substance by injection…” via various routes, including subcutaneous, intravascular, Intramuscular and Intradermal. What medications an RT can administer via these routes by injection depends on both professional scope of practice and personal competency…Read More
Yes, RTs are permitted to perform Nasally Pharyngeal (NP) swabs. There are different interpretations at the regulatory level regarding NP swabs, both that it is part of the public domain and that it is a controlled act… Read More
When beginning to perform procedures previously deemed during the pandemic to be “non-essential”, there are two types of guidelines to consider:
- guidelines from governing bodies (e.g., Ontario Ministry of Health, Public Health Ontario)
- clinical guidelines from relevant professional associations (e.g., ERS, ATS, CTS, etc.)… Read More
“The Occupational Health and Safety Act does include some provisions that permit an individual to refuse to work, such as unsafe equipment or work environment. However, the legislation goes on to explain… Read More
“Administering a substance by injection or inhalation” is a controlled act authorized to RTs. This means that RTs are permitted to administer medications by injection that are within the RT scope of practice (e.g., flu vaccines, procedural sedation,etc.). However, medications such as forms of botulinum toxins are outside of the RT scope of practice… Read More
As outlined in the CRTO’s Registration and Use of TitleProfessional Practice Guideline(PPG), documents signed by a Member or used by a Member in a professional capacity (e.g., business card) mustinclude their full professional title (e.g., Registered Respiratory Therapist, Respiratory Therapist) or professional designation (e.g., RRT, RT)… Read More
Quick and cost effective email is the CRTO primary mode of communication with its Members, and the information contained in these emails is important and often time-sensitive. Therefore, it is each Member’s professional responsibility to ensure that they are able to receive and read all email communications from the CRTO… Read More
The newly revised CRTO PORTfolio was designed to reflect the diverse roles that RTs play within the healthcare system… Read More
It is important to understand that Medical Directives and Delegation are two completely different processess. Delegation is that transfer of legal authority (from a healthcare professional who has the authority to perform a particular controlled act to a healthcare professional who does not), whereas a Medical Directive is a type of order… Read More
Yes – as of January 1, 2019, Respiratory Therapists (RTs) who wish to use ultrasound in their practice (e.g., for guided arterial line insertions) will require delegation. Therefore, 2 things are needed to continue using ultrasound in your practice… Read More
In January 2018, the CRTO rolled out its new Professional Development Program, which includes a completely redesigened PORTfolio platform and assessment process. Member’s PORTfolios are now assessed based on 2 clear criteria; that there 12 Professional Development entries in the Member’s Learning Log that are related to their role and/or the profession and that at least one of these entries support the Learning Goal the Member has selected. If it is initially clear… Read More
Graduate Respiratory Therapists (GRTs), Practical (Limited) Respiratory Therapists (PRTs), and Inactive CRTO Members are not eligible to sign the Assistive Devices Program (ADP) Home Oxygen applications, nor are any RRTs with terms, conditions or limitations preventing the independent administration of oxygen. In addition, new CRTO Members… Read More
Yes, in order for an RT to practise in the capacity of an Anesthesia Assistant (AA) in Ontario, they must be registered with the CRTO. It is important to understand that… Read More
From a regulatory perspective – the verification of blood products is not a controlled act and, therefore, resides within the public domain. This means the task can be performed by anyone who is competent to do so. And because verification of blood products falls within the broad definition of “cardiorespiratory” care, it is considered to be within the scope of practice of the profession – provided the RRT has the requisite competencies.
The National Competency Framework – Career Stages document lists “Verifying medication orders for such things as blood, plasma crystalloid substance” under section C3.1 (Determine appropriateness and safety of medication and substances).
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.
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?
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.
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
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
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
The needs of the client must be balanced against the potential risk their actions pose to themselves and others… Read More
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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.
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
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
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
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
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
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
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
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
What does the activity “Oximetry testing for purpose of 5th Act (COMMUNITY)” mean? Read More
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
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
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
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
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
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
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
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
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
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
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
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