O. Reg. 268/13: GENERAL

Link to law: http://www.ontario.ca/laws/regulation/r13268
Published: 2013-09-27

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ONTARIO REGULATION 268/13

made under the

NURSING ACT, 1991

Made: May 7, 2013
Approved: September 25, 2013
Filed: September 27, 2013
Published on e-Laws: September 27, 2013
Printed in The Ontario Gazette: October 12, 2013


Amending O. Reg. 275/94

(GENERAL)

1. Ontario Regulation 275/94 is amended by adding the following Part:

PART V
DELEGATION

32. In this Part,

“controlled act” means a controlled act set out in subsection 27 (2) of the Regulated Health Professions Act, 1991;

“delegatee” means a person to whom a controlled act is delegated;

“delegator” means a person who delegates a controlled act.

33. A member shall not, except in accordance with this Regulation, delegate a controlled act or perform a controlled act that was delegated to him or her.

34. (1) A member who delegates a controlled act is responsible for the decision to delegate the controlled act.

(2) A member who performs a controlled act that is delegated to him or her is responsible for the decision to carry out the controlled act and for its performance.

35. Subject to this Part, and to the terms, conditions and limitations placed on his or her certificate of registration, a registered nurse in the General or Emergency Assignment class or registered practical nurse in the General or Emergency Assignment class who is authorized to perform a controlled act set out in section 4 of the Act may delegate that controlled act.

36. (1) Subject to this Part, and to the terms, conditions and limitations placed on his or her certificate of registration, a registered nurse in the extended class who is authorized to perform a controlled act set out in section 5.1 of the Act may delegate that controlled act.

(2) Despite subsection (1), a member mentioned in that subsection may not delegate the controlled acts of prescribing, dispensing, compounding or selling a drug.

(3) Despite subsection (1), a member mentioned in that subsection may not delegate the controlled act of ordering the application of a form of energy prescribed by the regulations under the Regulated Health Professions Act, 1991.

(4) Despite subsection (1), a member mentioned in that subsection may not delegate the controlled act of setting a fracture of a bone or dislocation of a joint.

37. (1) A member shall ensure, before delegating any controlled act, that he or she,

(a) has the authority under the Act and its regulations to perform the controlled act himself or herself;

(b) has the knowledge, skill and judgment to perform the controlled act safely and ethically;

(c) has a nurse-patient relationship with the patient for whom the controlled act will be performed;

(d) has considered whether delegation of the controlled act is appropriate, bearing in mind the best interests and needs of the patient;

(e) after taking reasonable steps, is satisfied that sufficient safeguards and resources are available to the delegatee so that the controlled act may be performed safely and ethically;

(f) has considered whether delegation of the controlled act should be subject to any conditions to ensure that it is performed safely and ethically and has made the delegation subject to conditions, if applicable;

(g) after taking reasonable steps, is satisfied that the delegatee is a person who is permitted to accept the delegation;

(h) after taking reasonable steps, is satisfied that the delegatee is,

(i) a member of the College who has a nurse-patient relationship with the patient,

(ii) a health care provider who has a professional relationship with the patient,

(iii) a person in the patient’s household, or

(iv) a person who routinely provides assistance or treatment for the patient; and

(i) after taking reasonable steps, is satisfied,

(i) that the delegatee has the knowledge, skill and judgment to perform the controlled act safely and ethically, where the delegatee is a member of the College or member of a health profession other than the profession of nursing, or

(ii) that the delegation is appropriate for the patient and that the delegatee has the knowledge, skill and judgment to perform the controlled act safely and ethically, where the delegatee is not a member of the College or a member of another health profession.

(2) A member shall not delegate a controlled act that was delegated to him or her to perform.

(3) A member who delegated a controlled act but has reasonable grounds to believe that the delegatee no longer has the ability to perform the controlled act safely and ethically shall immediately cease to delegate the controlled act to that delegatee.

38. The delegation of a controlled act may be made orally or in writing.

39. A member who delegates a controlled act shall,

(a) ensure that a written record of the particulars of the delegation is available in the place where the controlled act is to be performed before it is performed;

(b) ensure that a written record of the particulars of the delegation, or a copy of the record, is placed in the patient record at the time the delegation takes place or within a reasonable period of time afterwards; or

(c) record particulars of the delegation in the patient record either at the time the delegation takes place or within a reasonable period of time afterwards.

40. Subject to this Part, and to the terms, conditions and limitations placed on their certificate of registration, the following members may, in the course of engaging in the practice of nursing, perform controlled acts that are delegated to them:

1. A registered nurse in the General class or registered practical nurse in the General class.

2. A registered nurse in the extended class.

3. A registered nurse in the Emergency Assignment or Special Assignment class or registered practical nurse in the Emergency Assignment or Special Assignment class.

41. (1) A member shall not accept the delegation of a controlled act unless the person delegating the controlled act was, at the time of the delegation, a member of the College or a member of another College authorized to perform that controlled act by a health profession Act governing his or her profession.

(2) A member shall not perform a controlled act that was delegated to him or her by a person to whom the controlled act was delegated.

(3) A member shall only perform a controlled act delegated to him or her if, before performing the controlled act, the member ensures that he or she,

(a) has the knowledge, skill and judgment to perform the controlled act safely and ethically;

(b) has a nurse-patient relationship with the patient for whom the controlled act is to be performed;

(c) has considered whether performing the controlled act is appropriate, bearing in mind the best interests and needs of the patient;

(d) after taking reasonable steps, is satisfied that there are sufficient safeguards and resources available to ensure that the controlled act can be performed safely and ethically;

(e) has no reason to believe that the delegator is not permitted to delegate that controlled act; and

(f) if the delegation is subject to any conditions, has ensured that any conditions have been met.

(4) A member who performs a controlled act that was delegated to him or her shall record particulars of the delegation in the patient record, unless,

(a) a written record of the particulars of the delegation is available in the place where the controlled act is to be performed;

(b) a written record of the particulars of the delegation, or a copy of the record, is present in the patient record; or

(c) the particulars of the delegation have already been recorded in the patient record.

42. Any record of the particulars of a delegation must include,

(a) the date of the delegation;

(b) the delegator’s name, if the controlled act was delegated to the member;

(c) the delegatee’s name, if the controlled act was delegated by the member; and

(d) the conditions, if any, applicable to the delegation.

2. (1) Section 35 of the Regulation, as made by section 1, is amended by adding the following subsection:

(2) Despite subsection (1), a member mentioned in that subsection may not delegate the controlled act of 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 judgment, insight, behaviour, communication or social functioning.

(2) Section 35 of the Regulation, as made by section 1, is amended by adding the following subsection:

(3) Despite subsection (1), a member mentioned in that subsection may not delegate the controlled act of dispensing a drug.

3. Section 36 of the Regulation, as made by section 1, is amended by adding the following subsection:

(5) Despite subsection (1), a member mentioned in that subsection may not delegate the controlled act of 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 judgment, insight, behaviour, communication or social functioning.

Commencement

4. (1) Subject to subsections (2), (3) and (4), this Regulation comes into force on the day it is filed.

(2) Subsection 2 (1) comes into force on the later of the day section 16 of Schedule R to the Health System Improvements Act, 2007 comes into force and the day this Regulation is filed.

(3) Subsection 2 (2) comes into force on the later of the day subsection 18 (2) of the Regulated Health Professions Statute Law Amendment Act, 2009 comes into force and the day this Regulation is filed.

(4) Section 3 comes into force on the later of the day subsection 18 (4) of the Regulated Health Professions Statute Law Amendment Act, 2009 comes into force and the day this Regulation is filed.

Made by:

Council of the College of Nurses of Ontario:

Anne L. Coghlan

Executive Director & CEO

Kris L. Voycey

President

Date made: May 7, 2013.