Transforming and Supporting Patient Care - Health Professions ...

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386Chapter 16 - Profession of Respiratory Therapymeasure the levels of oxygen and carbon dioxide in the arterial blood, andto determine the acidity (pH) of the blood. Other professionals rely onadvice from RTs, working with them as part of a team, in assessing changesin the patient and the consequent appropriate adjustment in therapy.Physicians indicated, in meetings with HPRAC, some surprise at thebarriers to optimal care that were created by “static” orders and theinability of RTs to adjust oxygen concentrations without additional andseparate prescriptions or orders. Hospitals indicated that new proceduresmight be needed to provide new authorities for RTs to prescribe oxygen,but that efficiencies could be increased and team-based care would beimpacted positively.Upgrading to ensure Readiness for the New Controlled Act of PrescribingThe CRTO said it would initiate appropriate consultations with other healthprofessions, including the College of Physicians and Surgeons of Ontario,College of Nurses of Ontario and the College of Physiotherapists of Ontario,to discuss how best to assess current members’ competencies andimplement any educational bridging program required. 26The CRTO has agreed to address any needed upgrades to training for RTs toensure that they are ready to accept this new role. Measures would include:• Education and guidance for [RTs] relevant to the responsibilities ofprescribing and for those new members coming from jurisdictionswhere prescribing of oxygen is not part of the scope of practice of theprofession. 27• Provision of additional information of the rights and responsibilitiesaround prescribing/ordering oxygen. The CRTO indicates that in view ofmembers’ existing knowledge and skills, very little additional educationwould be required related to prescribing of oxygen. 28The CRTO said it would develop relevant guidelines and continuingeducation processes to specifically address the prescribing function. 29The Professional Standards Assessment (PSA) portion of the QA programwould be revised to include questions on prescribing and a practiceguideline on prescribing and ordering oxygen would be developed toaddress standards of practice related to prescribing. 30Education on the responsibilities related to prescribing and ordering wouldbe provided both to the students through educational programs and toexisting RTs through the CRTO. 31 According to the CRTO, while practiceguidelines are already in place, additional requirements relating to26CRTO. Submission to HPRAC: Review of Non-Physician Prescribing and Administration of DrugsUnder the Regulated Health Professions Act. November 11, 2008: 12.27Ibid: 7-8.28Ibid.29Ibid.30Ibid.31Ibid.HPRAC Critical Links January 2009
387Chapter 16 - Profession of Respiratory Therapyprescribing oxygen therapy would be developed, consistent with standardsand guidelines regarding ordering, responsibilities, professional standards,patient choice and communicating with physicians and other healthprofessionals. The CRTO intends to review educational programs of otherhealth care providers and develop modules for current members. The CRTOindicates that in keeping with an interprofessional collaborative approach,practice guidelines could be developed with other health professions. 32What Leading Jurisdictions DoIf RTs are granted the authority to prescribe oxygen, Ontario will be the firstjurisdiction to do so. In Canada, respiratory therapy is regulated in Alberta,Manitoba, Ontario, Quebec and Nova Scotia. Alberta, Manitoba and NovaScotia provide authority to RTs to administer oxygen. Quebec providesauthority to RTs to administer and adjust prescribed medications andsubstances.In the U.S., RTs are licenced in 48 states. The only two states that currentlydo not regulate respiratory therapy practice are Alaska and Hawaii. All thelicensed states use the NBRC CRT examination as the state licensureexamination. RTs provide their services either under medical direction orthe medical supervision of a licensed physician. In general, RTs cannotprescribe. They carry out the orders of a physician.The respiratory therapy scope of practice statements for the states allinclude the phrase “administering medications to the cardio pulmonarysystem”, or similar words. Essentially, if the drug (medication) is related tocardio-respiratory practice, and prescribed by a physician, the RT canadminister it. The laws are not specific as to the drugs respiratory therapistscan administer, but it is understood that these would be cardio-respiratorydrugs or medications that are U.S. Food and Drug Administration (FDA)approved. Oxygen, for example, is an FDA approved drug.North Carolina authorizes the “administering and application” of oxygenand substances, while Illinois provides the authority for “administration”,with differing authorities for Respiratory Therapists and Respiratory CarePractitioners. Michigan, Colorado, New York and Oklahoma allow RTs to“administer” the therapies.Managing the Risk of HarmThe CRTO has made the case that granting the controlled act ofprescribing to RTs should improve patient safety both in hospitals and athome. As a result of delays in obtaining an order from a physician foroxygen, patients might not receive optimal treatment in a timely fashion ormight not have an order for the correct saturation level (written ordersfrequently do not anticipate changes that may be required to patients’32Summary Notes from December 2, 2008 meeting between HPRAC & and key intervenors.HPRAC Critical Links January 2009
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186Chapter 8 - Profession of Dental
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