Victoria Cyr – Understanding the Roles and Responsibilities of the Medical Director

Webinar Highlights

A topic that so many of the students have asked from us is regulations of medical directives from the physician and nurse’s point of view and how to manage the situations.

This webinar is about what you need to know with regards to medical directives.

CPSO’s point of view in terms of delegation of controlled acts will be discussed. Controlled acts may only be performed by authorized health professionals. Delegation is a mechanism that allows a physician who is authorized to perform a controlled act to confer that authority to another person (whether regulated or unregulated) who is not independently authorized to perform the act.

Direct order and medical directive will be talked about too.

There are some policy to all physicians who delegate controlled acts.

In every instance of delegation, the primary consideration must be the best interests of the patient.

In most situations where a physician delegates the performance of controlled acts, he or she should have current knowledge of a patient’s clinical status.

A physician must not delegate the performance of an act that he or she is not competent to perform personally.

There are more policies like Quality assurance, Consent.

CNO has very similar definitions for directive and direct orders with regards to delegations.

When an order is required for a nurse, what information a directive needs to include for a nurse and more questions like these will be answered.


List of Controlled Acts, based on Regulated Health Professional Act (RHPA).

A “controlled act” is any one of the following done with respect to an individual:

1. Communicating to the individual or his or her personal representative a diagnosis identifying a disease or disorder as the cause of symptoms of the individual in circumstances in which it is reasonably foreseeable that the individual or his or her personal representative will rely on the diagnosis.

2. Performing a procedure on tissue below the dermis, below the surface of a mucous membrane, in or below the surface of the cornea, or in or below the surfaces of the teeth, including the scaling of teeth.

3. Setting or casting a fracture of a bone or a dislocation of a joint.

4. Moving the joints of the spine beyond the individual’s usual physiological range of motion using a fast, low amplitude thrust.

5. Administering a substance by injection or inhalation.

6. Putting an instrument, hand or finger,

i. beyond the external ear canal,

ii. beyond the point in the nasal passages where they normally narrow,

iii. beyond the larynx,

iv. beyond the opening of the urethra,

v. beyond the labia majora,

vi. beyond the anal verge, or

vii. into an artificial opening into the body.

7. Applying or ordering the application of a form of energy prescribed by the regulations under this Act.

8. Prescribing, dispensing, selling or compounding a drug as defined in the Drug and Pharmacies Regulation Act, or supervising the part of a pharmacy where such drugs are kept.

9. Prescribing or dispensing, for vision or eye problems, subnormal vision devices, contact lenses or eye glasses other than simple magnifiers.

10. Prescribing a hearing aid for a hearing impaired person.

11. Fitting or dispensing a dental prosthesis, orthodontic or periodontal appliance or a device used inside the mouth to protect teeth from abnormal functioning.

12. Managing labour or conducting the delivery of a baby.

13. Allergy challenge testing of a kind in which a positive result of the test is a significant allergic response.

14. Treating, by means of psychotherapy technique, delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgement, insight, behaviour, communication or social functioning. 1991, c. 18, s. 27 (2); 2007, c. 10, Sched. L, s. 32; 2007, c. 10, Sched. R, s. 19 (1).

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