A working group of RTs from a variety of settings across the province lent their expertise to help the CRTO ensure the new SOP document provides a comprehensive framework for current RT professional practice.

View the CRTO Standards of Practice Website

These standards of Practice will be reviewed regularly and revised every five years at a minimum, or as required. The CRTO Standards of Practice outline the requirements for meeting and maintaining the CRTOs ethical and legal requirements of professional practice.

Professional Practice Guidelines

Although Professional Practice Guidelines (PPG) are not legislation, they are used by the CRTO to define appropriate professional standards of practice for Respiratory Therapy in Ontario.Respiratory Therapists as Anesthesia Assistants

• Certification Programs for Advanced Prescribed Procedures Below the Dermis
• Community Respiratory Therapy Practice
• Conflict of Interest
• Delegation of Controlled Acts
• Dispensing Medications
• Documentation
• Interpretation of Authorized Acts
• Orders for Medical Care
• Abuse Awareness & Prevention
• Registration and Use of Title
• Respiratory Therapists Providing Education
• Respiratory Therapists Providing Telepractice Services
• Responsibilities Under Consent Legislation

Clinical Best Practice Guidelines (CBPGs)

The Respiratory Therapy Act authorizes Respiratory Therapists to perform five controlled acts; one of which is prescribed procedures below the dermis. To assist its Members in providing safe and competent care when performing these procedures, the CRTO has developed a number of Clinical Best Practice Guidelines (CBPG). These CBPGs contains evidence-based clinical resources to support Respiratory Therapy practice by providing information on such elements as techniques, indications, contraindications, and risk factors, as well as procedure-specific complications and their management. These guidelines also serves to direct infection control practices related to these procedures, in order to minimize the incidence of infectious complications.

• Infection Prevention & Control CBPG
• Oxygen Therapy CBPG

• Bloodborne and Other Infectious Pathogens
• French Language Services
• Handling, Administration and Dispensing of Controlled Substances
• Use of Automated External Defibrillators (AEDs) by Respiratory Therapists
• Zero Tolerance of Sexual and Other Forms of Abuse

Insert Link to Practice FAQs

Diagnostic Ultrasound

The Ontario Ministry of Health and Long-Term Care (MOHLTC) has directed the College of Medical Radiation Technologists of Ontario (CMRTO) to regulate the profession of Medical Sonography. This change has necessitated the amendment of several pieces of legislation, including the Controlled Acts Regulation (O. Reg. 107/96). Up until this point, RRTs have been able to “apply soundwaves for diagnostic ultrasound” under a provision within this regulation [s. 7.1(1)]. However, the pending changes to the Controlled Acts Regulation will permit only Members of the CMRTO and the College of Nurses (CNO) to perform diagnostic ultrasound under this provision. Therefore, as of January 1, 2019, Respiratory Therapists (RTs) who wish to use ultrasound in their practice (e.g., for guided arterial line insertions) will require delegation. Information regarding the delegation can be found in the CRTO Delegation of Controlled Acts Professional Practice Guideline.

If you have any questions about this issue, please contact Carole Hamp RRT, Deputy Registrar at hamp@crto.on.ca.

• Working with Non-Regulated Health Care Professionals (NRHCPs)
• Collaborative Care Principles and Best Practice

This is a significant change that will improve access to care for patients with respiratory disease and has implications for RT practice and for home care companies and providers.

For links to additional information on our website please see relevant links on the right.

Recent Changes Enabling Independent Administration of Oxygen Webinar

During this webinar, we explained this change and associated topics. The webinar may be of interest to RTs working in the community setting, managers, home care companies, and other health care providers in the community.

To view a copy of the PowerPoint presentation, please click here.

RRTs can independently authorize APD-funded home oxygen therapy applications

Please note… If a Members’ employment or membership status has recently changed, they may no longer be eligible to authorize the ADP forms. Member data is sent to ADP twice a year in April and October.

The Assistive Devices Program (ADP) has expanded the role of hospital-based and some community-based RRTs by authorizing them to complete the Application for Funding Home Oxygen (application) in place of the prescriber.  This expanded role recognizes the specialized training and expertise Respiratory Therapists have regarding oxygen administration, as well as the vital part they play in the implementation of home oxygen therapy.  Please follow this link to find important information about this and other recent changes to the ADP-funded home oxygen therapy.

RRTs are permitted to independently administer oxygen under the 5th authorized act (“administrating a prescribed substance”) in the Respiratory Therapy Act and the Prescribed Substances regulation.  These legislative provisions now permit RRTs to complete the application without the requirement of the prescriber’s signature.  Therefore, when a physician or a nurse practitioner prescribes home oxygen therapy, the eligible RRT completes the application by:

• Transcribing the applicant’s diagnosis
• Confirming the applicant has tried other treatment measures without success; and
• Confirming that oxygen is medically indicated, and is reasonable and necessary.

There is no longer a requirement to have the application signed by the prescriber (i.e., physician or nurse practitioner).  Therefore, because the RRT is signing the application under their own authority, the task under carries with it a number of essential professional accountabilities, which are as follows:

• Ensuring there is a valid order for the oxygen from either a physician or nurse practitioner. It is important to understand that in authorizing the application, the RRT is not prescribing the oxygen but is transcribing and verifying an existing order. Additional information on what constitutes a valid orders can be found in the CRTO Orders for Medical Care Professional Practice Guideline;
• Using appropriate professional judgement when confirming that oxygen therapy is medically indicated, and is reasonable and necessary;
• Adhering to all published professional standards of practice, which includes not only the CRTO Standards of Practice but also A Commitment to Ethical Practice, and the Oxygen Therapy Clinical Best Practice Guideline.
• Recognizing and addressing any conflict of interest that might exist in accordance with the CRTO Conflict of Interest regulation and the CRTO Conflict of Interest Professional Practice Guideline.
• Maintaining appropriate communication with the patient, their family, the prescriber (MD or NP) and other care providers, and ensuring complete and accurate documentation, as outline in the CRTO Documentation Professional Practice Guideline.
• Keeping employment information current; particularly when moving to or from employment with an oxygen Vendor of Record. You can update your employment information via the Member Login portion of the CRTO website.

Additional Resources

• Information About Member Eligibility
• O₂ Therapy Clinical Best Practice Guideline

Bill C-14 (an Act to amend the Criminal Code relative to medical assistance in dying) received royal assent on Friday, June 17, 2016 and is now part law in Canada. This federal legislation defines MAID as circumstances where a physician or a nurse practitioner (NP), at the request of a patient/client, will either:

• administer a substance that causes the patient/client’s death; or
• prescribe a substance for the patient/client to self-administer to cause their own death.

The legislation goes on to state that healthcare providers and others who aid a physician or NP in providing medical assistance in dying will not be charged under criminal law provided they follow the rules set out in the Criminal Code, as well as any applicable federal and provincial requirements. As in all aspects of practice, RTs are also expected to adhere to the standards, guidelines, regulations and polices that govern the profession in Ontario.

For more information on MAID, please visit the Government of Canada’s Medical Assistance in Dying website.

See Additional Information

The College of Respiratory Therapists of Ontario is the regulator for the profession of Respiratory Therapy. The CRTO regulates and ensures the ongoing improvement of the practice of Respiratory Therapy, to protect and serve the public interest. This means the CRTO protects patients’ rights to safe, competent and ethical care by supporting Respiratory Therapists to maintain the standards of practice of the profession and by holding them accountable for their conduct and practice.

Self regulation for a profession means two things.

1. Respiratory Therapists are involved in determining the rules that govern the profession (ex. being involved as Council members); and
2. Respiratory Therapists are accountable for their own behaviour (ex. they are accountable to self-regulation) with the CRTO providing assistance and oversight.

The work of the CRTO is directed by a Council (similar to a Board of Directors) whose job it is to represent the interests of the patients/public. The Council is made up of Respiratory Therapists who have been elected by their peers, members of the public who have been appointed by the Lieutenant Governor of Ontario and academic representatives from the colleges in Ontario who provide entry level education programs. It is the Regulated Health Professions Act (RHPA) that gives the CRTO its mandate to regulate the practice of Respiratory Therapy and gives health-care patients and the public a strong voice in the regulation of Respiratory Therapists by requiring an equitable balance of public appointees and elected professionals on the CRTO Council.