Point of Care Ultrasound Delegation and Medical Directive Resources for RRTs and RRT/AAs
The RTSO’s Leadership Committee Ultrasound Working Group under the leadership of Kelly Hassall RRT, FCSRT, MEd, and building on resources from Mackenzie Health Centre, have assembled resource documents including templates that can be adapted to local practice settings to enable compliance with the amendment to the Ontario Controlled Acts Regulation 107/96. The delegation guide has been reviewed by the College of Respiratory Therapists of Ontario.
The RTSO is advocating for RRTs and RRT/AAs to be included in the next iteration of the amendment to the legislation.
As of January 1st, 2019, the following amendment will be made to section 7.1 of the Ontario Controlled Acts Regulation 107/96:
7.1 (1) A person is exempt from subsection 27 (1) of the Act for the purpose of applying soundwaves for diagnostic ultrasound if the application is ordered by a member with ordering authority, and the soundwaves for diagnostic ultrasound are applied,
Note: On January 1, 2019, subsection 7.1 (1) of the Regulation is amended by striking out “A person” at the beginning and substituting “A member of the College of Medical Radiation Technologists of Ontario or a member of the College of Nurses of Ontario other than a member who is a registered nurse in the extended class”.
(See: O. Reg. 566/17, s. 4 (1))
This amendment excludes Respiratory Therapists and Respiratory Therapist Anaesthesia Assistants from being able to apply point of care soundwaves for diagnostic ultrasound without delegation. In an effort to support the RRTs and RRT/AA’s of Ontario who are currently performing point of care ultrasound at the bedside, the RTSO has worked closely with Mackenzie Health to create this universal delegation template document and sample learning package. The delegation document has been reviewed by the CRTO and deemed to meet the requirements to appropriately delegate the use of diagnostic ultrasound at the bedside from the physician group to the RRT or RRT/AA. As with any procedure, the clinician would still require a medical order to complete the procedure. This order can come in the form of a written or verbal order directly from the physician or in the form of a medical directive. It is possible to merge the medical directive and medical delegation into one document should your facility support this.
Diagnostic Ultrasound Delegation Template Documents
Please note:These documents have been developed by the RTSO with assistance from Mackenzie Health and is intended to serve as a sample of delegation and medical directives. The RTSO and Mackenzie Health are not responsible for any of its content.
- Ultrasound Delegation Document Template
- Authorizer Approval Form Template
- Delegator Approval Form Template
- Delegatee Performance Readiness Form Template
For additional templates (i.e. Medical Directive combined with Delegation), please consult the Federation of Health Regulatory Colleges of Ontario
Additional Educational Resources
In an effort to support the dissemination of information and educational resources, the RTSO has compiled the following learning tools in regards to the use of Point-of-Care Ultrasound:
- Point-of-Care Ultrasound Introduction Package
- New England Journal Of Medicine: Ultrasound-Guided Insertion of a Radial Arterial Catheter video https://www.nejm.org/doi/full/10.1056/NEJMvcm1213181
- Literature Search Results
- CRTO Member Communique – Diagnostic Ultrasound http://www.crto.on.ca/pdf/Communiques/Ultrasound_Communique.pdf
Should you wish to contribute to this learning repository, please contact the RTSO at firstname.lastname@example.org your input is very much appreciated and valued.