Frequently Asked Questions > Different Professions - Overlapping Scopes of Practice


QUESTION — DIFFERENT PROFESSIONS - OVERLAPPING SCOPES OF PRACTICE

 

  1. How do I know who is authorized to undertake specific acts like to diagnose or to communicate a diagnosis, or to prescribe or make orders? 
  2. What is a controlled act and are there special considerations that must be taken into account for these acts?
RESPONSE
  1. How do I know who is authorized to undertake specific acts like to diagnose or to communicate a diagnosis, or to prescribe or make orders?

    As a member of an interprofessional team, a goal should be to advocate for the distribution of the tasks associated with the patient (or patient population) care or needs in the way that best serves the patient’s best interests.  This might take into account:  clinical appropriateness (which individual(s) has the appropriate knowledge, skills and judgement to perform each activity?), safety (how best to ensure seamless transition and communication between the members of the team) and efficiency (which person is best positioned to perform the activity immediately and without undue expense).

     Ask yourself… 

    • Who can? (consider scoped and controlled acts) 
    • Who could? (consider authorizing mechanisms e.g. medical directives and delegation) 
    • Who should? (given resources and best person to provide best care in the  best interest of patients)
    • Who will? (this is your team’s plan)                                                                       

    A secondary consideration will be the best interests of the health care system:  given that resources are constrained, how best can you maximize productivity of each team without increasing costs or sacrificing safety and quality?

    Understanding who is capable and authorized to perform which aspects of treatment is the starting point for role clarity in a team.

    In Ontario, the scope of practice of each health care profession (or, in other words, who can perform what aspects of health care) is determined by a combination of legislation and regulation.  Most of this framework is found in the Regulated Health Profession Act1991 (RHPA), the specific health profession Acts (e.g. Audiology and Speech Language Pathology Act, 1991; Medicine Act, 1991; Traditional Chinese Medicine Act, 2006) and other statutes (e.g. the Public Hospitals Act, Laboratory Specimen and Collection Centre Licensing Act, Healing Arts Radiation and Protection Act, Health Protection and Promotion Act, Home Care and Community Services Act http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_94l26_e.htm )

    So, how do you know who is authorized to diagnose, prescribe, make orders or provide treatments?  To answer this question or any other related to scope of practice, you may:

    • ask a member of the profession, initiating a conversation about scopes and roles
    • refer to the Scopes of Practice portion of this eTool
    • refer to information available directly from health regulatory colleges, or contact a practice consultant
    • refer to the RHPA and the health profession Acts directly
  2. What is a controlled act and are there special considerations that must be taken into account for these acts?

    The RHPA identifies a number of "controlled acts" which may only be performed by certain regulated health professionals. No regulated health professional is authorized to perform all of them.

    Delegation under the RHPA is not specifically defined, but it is understood to be a process by which a regulated health professional who is authorized to perform a controlled act under an individual health profession Act confirms that authority to someone - regulated or unregulated - who is not authorized by an Act to do so. Delegation may be conferred and established in one of two ways:

    • By an order - a direct order or a directive - from an authorizer with legislative ordering authority, or
    • By designation - given by an authorizer who does not have legislative ordering authority. Performance of procedures delegated by non-ordering authorizers is subject to any requirements for order that may apply.

    Other aspects of this topic, are explained in detail in FHRCO’s Interprofessional Guide on Orders, Medical Directives and Delegation.

LINKS

Regulated Health Professions Act, 1991, S.O. 1991, c. 18

FHRCO Interprofessional Guide on the Use of Orders, Medical Directives, and Delegation

Public Hospitals Act, RSO 1990 Chapter P.40

COLLEGE LINKS
Acupuncturists
Audiologists
Chiropodists
Chiropractors
Dental Hygienists
Dental Technologists
Dentists
Denturists
Dietitians
Homeopaths
Kinesiologists
Massage Therapists
Medical Laboratory Technologists

CMLTO Delegation Guidelines for MLTs

MLT Scope of Practice – Medical Laboratory Technology Act, 1991

 

Medical Radiation Technologists

CMRTO Standards of Practice 

Midwives
Naturopaths
Nurses

Nursing Act

Decisions about Procedures and Authority

Authorizing Mechanisms

Nurse Practitioner

NP Diagnostic and Prescriptive Authority

Occupational Therapists

COTO: Use of Title

COTO: Controlled Acts

Opticians

Delegation Policy 

Optometrists

OPR 4.3  Delegation and Assignment Policy

 

Pharmacists

Model Standards of Practice for Canadian Pharmacists

Medical Directives and the Delegation of Controlled Acts

Pharmacy Technicians

Model Standards of Practice for Canadian Pharmacy Technicians

Physicians and Surgeons

CPSO Policy Statement #8-10: Delegation of Controlled Acts

Physiotherapists

Standard for Professional Practice - Performance of Authorized Activities

Podiatrists
Psychologists
Psychotherapists
Respiratory Therapists

CRTO Standards of Practice

CRTO Professional Practice Guideline: Interpretation of Authorized Acts 

CRTO Professional Practice Guideline: Orders for Medical Care (verbal orders) 

CRTO Professional Practice Guideline: Delegation 

CRTO Position Statement: Medical Directives and the Ordering of Controlled Acts  

Speech-Language Pathologists
Traditional Chinese Medicine and Acupuncturists