Printer-Friendly Version When are Orders, Directives and Delegation Necessary? Orders - direct and medical directives - and delegation are preconditions required by legislation, practice convention or circumstances to authorize and permit performance of certain procedures prior to performing them. Orders are required by: Legislation. A number of provincial and federal health statutes identify when orders are required by law to perform procedures. Practice Convention or Circumstances. Health care teams in some settings may use orders to coordinate and ensure appropriate care when an order is not required by law. For example, physicians may give orders for vital sign assessments or for post-operative mobilization as part of a medical plan of care. Orders from designated authorizers may also be required to qualify for certain health services and benefits. Medical Directives may be used when an order is required and it is appropriate and in the patient's interest for designated implementers to implement the procedure without the authorizer's direct assessment at the time of implementation. Examples of when an order is necessary and a directive may be appropriate include authorizing dietitians to implement therapeutic diets for designated hospital patients, authorizing medical radiation technologists to administer contrast media to specific patients as part of an x-ray exam, authorizing nurses to administer analgesia to elective post-operative adult patients and authorizing respiratory therapists to adjust ventilators for patients in an ICU in accordance with conditions set out in the respective directives. Delegation under the RHPA is not specifically defined, but it is understood to be required when it is deemed appropriate and in the patient's interest for someone who is not authorized by a health profession Act to perform a controlled act. For example, delegation may be used to authorize occupational therapists to splint fractures or unregulated care providers to change simple dressings in accordance with the conditions set out in the respective delegations. In the interests of patient safety, sub-delegation - delegating a controlled act procedure that someone is authorized to perform by way of delegation to someone else - is not permitted. For example occupational therapists would not sub-delegate splinting and unregulated care providers would not sub-delegate simple dressings. Where performance of an act is restricted for performance under legislation other than the RHPA - for example the application of ionizing radiation is restricted to specific regulated health professionals under the Healing Arts Radiation and Protection Act (HARPA) - delegation is not mentioned, thus the authority to perform the procedure may not be delegated.1 Under the RHPA, there are specified circumstances called exceptions and exemptions when orders and delegation are not required where they otherwise would be. In some circumstances, a number of pieces of legislation may apply and authorization may be required in one but not another. When authorization is required in one piece of applicable legislation but not another, authorization is required. For example, the RHPA does not require respiratory therapists to have an order for tracheal suctioning, however under the Public Hospitals Act, an order is required, thus respiratory therapists require an order when performing tracheal suctioning in a hospital. In addition to legislative preconditions for orders and delegation, there may be setting-specific preconditions that apply as well. For example, the authority to become involved in care and authorize or perform procedures may flow from privileges, appointments, role descriptions, care assignments, care delivery models and policies and procedures within the setting. Colleges may also have relevant guidelines or regulations. Refer to the respective college for information pertaining to a specific profession. 1 While the term delegation in the RHPA refers to authority to perform controlled acts, it is also used in other health legislation where it refers to different matters. For example, under the Schedule of Benefits of the Ontario Health Insurance Plan, 'delegated procedures' are services that physicians may bill for but have someone else perform. Such services may or may not be controlled acts. Where they are controlled acts, the RHPA provisions would also apply. In other examples, under the Public Hospitals Act (PHA) and Laboratory Specimen and Collection Centre Licensing Act (LSCCLA), administrators may 'delegate' designated aspects of their authority and responsibilities which do not include controlled acts. © Copyright 2007 Federation of Health Regulatory Colleges of OntarioSite Map