Transforming and Supporting Patient Care - Health Professions ...

390Chapter 16 - Profession of Respiratory TherapyHPRAC reviewed the Quebec alternative, which provides authority for RTsto administer and adjust prescribed medications and substances; however,in the Ontario framework, an adjustment of medication is considered aprescription; alternatively, the initial prescription would need to specificallyreference the performance of both procedures. Given the tendency byprescribers to write static orders, HPRAC does not consider the latter arealistic probability.Under the Public Hospitals Act, Regulation 965 would need to be modified inorder to authorize an RT to order a treatment. With that authority, HPRAChas concluded that a reporting relation must exist between RTs and thepatient’s most responsible physician. Requirements must also be in placefor any treatment orders to be recorded in the patient’s health record.HPRAC has also reviewed the CRTO QA program and has concluded thatadditional rigour is required to accommodate new prescribing authorities.HPRAC notes that the CRTO has indicated that it is eager to proceed in acollaborative approach with other health professions to expand itscontinuing quality improvement and assurance programs.It is HPRAC’s view that CRTO should engage in discussions with the OntarioHospital Association and the Council of Academic Hospitals of Ontario toensure that adequate protocols are in place for the implementation of a newauthority to make orders in the hospital setting. In the community, HPRACexpects that referral protocols and extensive sharing of patient careinformation between the RT and the patient’s primary health careprofessional would be a necessary part of the prescribing authority.This would be part of a collaborative development of standards of practice.RTs do not see themselves as separate and distinct from other healthprofessionals who provide care to a patient, but rather as part of a team thatcoordinates and communicates with other members of the patient’s healthteam. Nonetheless, with additional authority for RTs to prescribe oxygen, itis important that there be clear understandings about how the initiation ofor adjustments to oxygen therapy affect other aspects of patient care andwhat information must be communicated to other health professionals.HPRAC has concluded that RTs, with independent prescribing authority,will be well positioned to effect efficient, timely and competent patient carewithin interprofessional care teams, both in the hospital and thecommunity.Recommendations1: That RTs be authorized to prescribe oxygen.2: That complementary amendments be made to section 24 (1) ofregulation 965 of the Public Hospitals Act to authorize RTs to makeorders for oxygen therapy in hospitals.3: That RTs be required to advise the attending physician of the orderor prescription in a hospital, or the attending health professional inthe community, and cause the order or prescription to be recordedin the patient health record.HPRAC Critical Links January 2009