Authorizing Mechanisms
(Direct Orders and Medical Directives)
Of the five controlled acts authorized to RTs via the RTA, three require additional authorizing mechanisms such as direct orders or medical directive.
Table 4: Authorizing Mechanisms
| Authorized Acts (under the Respiratory Therapy Act) | DIRECT ORDER/MEDICAL DIRECTIVE REQUIRED? |
|---|---|
| #1. Performing a prescribed procedure below the dermis. | Yes |
| #2. Intubation beyond the point in the nasal passages where they normally narrow or beyond the larynx. | Yes |
| #3. Suctioning beyond the point in the nasal passages where they normally narrow or beyond the larynx. | No |
| #4. Administering a substance by injection or inhalation. | Yes |
| #5. Administering a prescribed substance by inhalation. | No |
| Exceptions (under the Controlled Acts Regulation) | |
| #1. Performing a tracheostomy tube change2 | Yes |
| #2. Use of diagnostic ultrasound 3 | Yes |
The RTA s 5(1) states RTs are only permitted to accept a direct order/medical directive from one of the following regulated health care professionals:
a member of the College of Physicians and Surgeons of Ontario, the College of Midwives of Ontario or the Royal College of Dental Surgeons of Ontario;
a member of the College of Nurses of Ontario who holds an extended certificate of registration under the Nursing Act, 1991; or
a member of a health profession that is prescribed by regulation.
Additional information on authorizing mechanisms can be found in the CRTO’s Orders for Medical Care PPG.
*Note: For diagnostic ultrasound, RTs are only permitted to accept an order from Members of the College of Physicians and Surgeons of Ontario, and Members of the College of Nurses (Extended Class)