Frequently Asked Questions > Accountability


QUESTION — ACCOUNTABILITY
  1. Do I remain individually accountable when I am a member of a team?
  2. If I make a referral/order/directive to a regulated team member, am I accountable for ensuring the team member is capable to implement the referral/order/directive?
  3. If I provide a “hallway consultation” am I accountable for the advice I provide as if I were interacting directly with the patient/client?
  4. What if the team member I’ve referred to, or who implements an order I’ve made makes an error? What if it has been delegated? 
  5. What about unregulated team members? What’s their accountability, and mine?
RESPONSE
  1. Do I remain individually accountable when I am a member of a team?

    Yes, your professional accountability is the same in all patient/client situation.

    In team care, as in individual care, each team member is individually accountable to demonstrate professional competence.   For those team members who are regulated, this accountability is both to the patient/client and the regulator (for most health care providers, the health professional college).

    Being accountable also means refraining from providing care if you do not feel that you have the necessary knowledge, skills, and judgment. If this is the case, then you must  take the appropriate alternative action to address patient/client best interests.

    Being accountable also means that, as a team member, you inform yourself of the scopes of practice, roles, and competencies of the other team members.

  2. If I make a referral/order/directive to a regulated team member, am I accountable for ensuring the team member is capable to implement the referral/order/directive? 

    As a regulated professional, you may assume that their registration is testament to their competence within their professional scope unless they declare, or you have reasonable grounds to believe, otherwise. 

  3. If I provide a “hallway consultation” am I accountable for the advice I provide as if I were interacting directly with the patient/client?

    While these FAQs cannot provide advice about civil liability, you need to keep your professional accountability in mind. Generally, if you provide information to another member of the team about a patient/client who is not in your care, that person will be entitled to rely on your advice. You should be careful to provide advice only within your scope of practice and commensurate with the information that you are given. If you need to see the patient/client in order to answer the question, you should say so.

    Ultimately, the decision to act on the advice lies with the treating health care provider. Informal consultations can be valuable sources of treatment advice. If they are acted upon, they should be documented in the patient/client chart.

     

  4. What if the team member I’ve referred to, or who implements an order I’ve made makes an error? What if it has been delegated?

    You must always act in the best interests of the patient/client. The authorizer should ensure that the referral or order is received and understood, seeking clarification if necessary. Likewise, the implementer is accountable to ensure that he/she has received valid orders/referrals, that are in the best interest of the patient/client, and if they are unsure, to verify. You are not accountable for the decisions or actions of another care provider if there is no way of knowing about them.

    If you have any concerns about the quality of the care that the patient/client will receive if you make the referral or order, you should not make that referral or order. However, if you had reasonable grounds to rely on the competence of another team member, and their mistake was not reasonably foreseeable by you, could defend your position that you would not be professionally responsible to your College for the other practitioner’s mistake. There are some exceptions. For example, a practitioner delegating a controlled act may be professionally responsible for the performance of the controlled act. The delegator of a controlled act is responsible for its performance. That is the difference between a controlled act done under the legislatively required order of another practitioner (e.g., a respiratory therapist administering a substance or drug) and a controlled act done under delegation.

  5. What about unregulated team members? What’s their accountability, and mine?

    While these FAQs cannot provide advice about civil liability, you need to keep your professional accountability in mind. Generally, your relationship with unregulated health care providers is not materially different from those who are regulated except that, in the absence of regulatory oversight, the competencies of the individual or the members of his or her particular group of health care practitioners may not have been consistently assessed. Accordingly, before you rely on that person to provide care or undertake an activity, in addition to following the informed consent rules, you must take steps to ensure their competency.

    You should refer to your College’s requirements regarding working with unregulated providers.

    Some regulatory Colleges hold members accountable in certain circumstances if unregulated persons perform controlled acts they shouldn’t have, including students and interns, not solely based on competency. Check with Colleges for more information.

     

LINKS

FHRCO’s Interprofessional Guide on Orders, Medical Directives and Delegation

 

COLLEGE LINKS
Acupuncturists
Audiologists

Position Statement on the Acceptance of Delegation of a Controlled Act

Position Statement on the Delegation of the Controlled Act of Prescribing a Hearing Aid For a Hearing Impaired Person

Position Statement on the Use of Support Personnel for Audiologists

 

Chiropodists
Chiropractors
Dental Hygienists
Dental Technologists
Dentists
Denturists
Dietitians

The jurisprudence handbook for Dietitians in Ontario 

Assessing Capacity for Admission to Long Term Care Homes 

Communicating a Diagnosis 

Dysphagia Policy 

Insulin adjustment 

Medical Directives 

Medical Directives - Blood Work

Medical Directives - Skin Pricking

Swallowing Assessment 

Therapeutic Diet Orders 

Vitamins and Minerals 

More on Vitamins and Minerals

 

Homeopaths
Kinesiologists
Massage Therapists
Medical Laboratory Technologists

CMLTO Delegation Guidelines for MLTs

CMLTO Standards of Practice

CMLTO - Delegation

 

Medical Radiation Technologists

CMRTO Standards of Practice 

Midwives
Naturopaths
Nurses

Professional Standards

Professional Standards Learning Module

Conflict Prevention and Management

Occupational Therapists

COTO Standards - Supervision of Personnel

COTO ELearning Module 

 

Opticians

Supervision of Students and Interns Policy 

Delegation Policy 

Optometrists

College of Optometrists of Ontario’s Delegation and Assignment Policy is found in our Optometric Practice Reference (OPR) section 4.3

Pharmacists
Pharmacy Technicians
Physicians and Surgeons

CPSO Policy Statement #5-05: Medical Records

Physiotherapists

Support Personnel

Practice Tool - Risks in Physiotherapy Practice

Standard for Professional Practice - Physiotherapists Working with Physiotherapist Support Personnel

Guide to the Standard for Professional Practice - Physiotherapists Working with Physiotherapist Support Personnel

Standard for Professional Practice - Managing Challenging Interpersonal Situations when Providing Patient Care

Guide to the Standard for Professional Practice - Managing Challenging Interpersonal Situations When Providing Patient Care

 

Podiatrists
Psychologists
Psychotherapists
Respiratory Therapists

CRTO Standards of Practice: Accountability and  Therapeutic and Professional Relationships 

CRTO Positions Statement:   Scope of Practice and Maintenance of Competency 

Speech-Language Pathologists

Position Statement on the Acceptance of Delegation of a Controlled Act

Position Statement on the Use of Support Personnel for Speech-Language Pathologists

Traditional Chinese Medicine and Acupuncturists