1.0     POLICY STATEMENT

It is the College of Respiratory Therapists of Ontario’s (CRTO) policy that Members who may be required to perform authorized acts under supervision according to terms, conditions, and limitations (TCLS) applied to their certificate of registration perform their duties as set out in this policy.

2.0     PURPOSE

Respiratory Therapists (RT) may be required to provide supervision to student RT’s (SRT), graduate RT’s (GRT) and Members of the profession that have TCL’s, in the performance of authorized controlled acts as outlined in the Interpretation of Authorized Acts. It is a shared accountability between the supervisor and the supervisee to ensure that the supervision requirement is met (direct or indirect), documentation is accurate, and that the performance of the authorized act is done competently. Safe and effective patient care is the priority in all supervisory situations.

3.0     SCOPE OF POLICY

This policy applies to all individuals who hold an active certificate of registration with the CRTO. Members must understand that there are two types of supervision requirements.

1. 1. Direct: Direct supervision requires the supervisor to be always personally present. It is required if a panel of the Registration Committee imposes the condition that an RT “may only perform a controlled act, authorized to Respiratory Therapy, for the purpose of gaining competence in that procedure if performed under the direct supervision of a regulated health professional who is authorized to perform the controlled act.”

      An example of direct supervision would be a supervising RT, physically observing and guiding the performance of arterial blood gas procurement by a RT with the TCL as outlined in the example above. Documentation (as detailed in Responsibilities below) must reflect that it was performed under direct supervision, with the RT co-signing.

   2. Indirect (General): General supervision requires that a supervisor be available within 10 minutes notice to assist if needed, A Member registered with a Graduate Certificate of Registration (GRT) “may only perform a controlled act that is authorized to the profession if it is performed under the general supervision of a Member of a College within the meaning of the Regulated Health Professions Act, 1991 who, the Member holding the graduate certificate has reasonable grounds to believe, is authorized to perform the controlled act and is competent to do so and who is available to be personally present¹ at the site where the authorized act is performed on ten minutes notice”.

An example of indirect (general) supervision would be a GRT applying CPAP to a new patient/client while the supervising RRT (Registered Respiratory Therapist) is available in person or virtually, within 10 minutes, to assist the procedure.

Although students are not Members of the CRTO, according to an exception in RHPA (section 29), they are permitted to perform authorized acts under the supervision or direction of a Member of the profession while fulfilling the requirements to become a Member of that health profession.

4.0     RESPONSIBILITIES

The degree or type of supervision deemed necessary is in part the professional responsibility and judgment of the Member who is providing the supervision or direction required. As a full Member² of the CRTO the supervisor also assumes some responsibilities as an educator. However, a Member who is practicing Respiratory Therapy (including controlled acts) is accountable for their practice and adhering to the TCLs imposed on their certificate of registration. Students are also accountable for their practice and to their academic program.

When assigning care, the supervising RT must:

• assign only activities that they have the knowledge, skill, and judgement to perform.
• ensure that the supervised person has the knowledge, skill, and judgement to deliver safe and competent care.

5.0     DOCUMENTATION

Where a student or Member is performing procedures under direct supervision, the Member or student must document in the patient/client’s health record that they have performed the procedure(s) under “direct supervision”. It is the responsibility of the Member or student carrying out the procedure(s) to ensure complete documentation of the patient contact in the patient/client record. This includes having the supervisor co-
sign the entry in the patient/client record. Remember that anyone reading the documentation must clearly be able to identify that the requirements of “direct supervision” have been met. Also, keep in mind that the Member/student’s signature and that of the co-signing supervisors verifies the information provided and gives assurance that the record of the activity, assessment, behaviour, or procedure is accurate and complete. Procedures performed under general supervision are not co-signed by the supervisor.

6.0     RELATED DOCUMENTS

Registration and Use of Title PPG (crto.on.ca)
Respiratory Health Professions Act, 1991, S.O. 1991, c. 18 (ontario.ca)
Interpretation of Authorized Acts PPG

7.0     CONTACT INFORMATION

College of Respiratory Therapists of Ontario
180 Dundas Street West,
Suite 2103
Toronto, ON M5G 1Z8

Telephone: 416-591-7800
Toll-Free (in Ontario): 1-800-261-0528
Fax: 416-591-7890
General Email: questions@crto.on.ca

¹ In emergency situations (e.g., pandemics) “personally present” includes by remote/virtual connection.
² Full Member who holds a General Certificate of Registration without any terms, conditions, or limitations.