Dialogue Volume 10 Issue 2 2014 | Page 23

POLICY MATTERS Particular set of circumstances necessary for delegation of controlled acts T he College reminds physicians that they must comply with the CPSO’s Delegation of Controlled Acts policy when delegating acts to others, in order to ensure quality patient care is provided. Under Ontario law, certain acts, referred to as “controlled acts,” may only be performed by authorized health-care professionals. However, under a particular set of circumstances, these acts may be delegated to others. Delegation is a mechanism that allows a physician who is authorized to perform a controlled act to confer that authority to another person who is not independently authorized to perform the act. Acts can be delegated to those who are regulated (i.e., nurses) or unregulated (i.e., physician assistants). It is recognized that delegation can result in more timely delivery of health care, and can promote optimal use of health-care resources and personnel. Delegation must never be done for convenience or financial reasons. “The ability to delegate controlled acts is meant to improve patient access to necessary care while ensuring safety and clear accountability. The only justification for delegation is because it is in the patient’s best interests,” said Dr. Marc Gabel, College President. Physicians who are unsure of expectations should turn to the Delegation of Controlled Acts policy for guidance. For example, its requirements will not be met where: •  ere are not sufficient medical directives or orders in Th place to authorize the range of care and the circumstances under which care is provided by the delegate; •  e delegating physician has not appropriately evaluTh ated the patient safety implications of delegating the care; •  ppropriate quality assurance measures and superviA sion are not in place; •  e physician delegates acts that are outside the scope Th of his or her own practice; •  e patient does not provide informed consent to the Th act being provided by a delegate and/or is left with the impression that the delegate is a physician. Physicians who delegate care should also be mindful of other relevant College policies, including those that pertain to record-keeping, consent, confidentiality, and prescribing.1 For example, they should keep appropriate records documenting the care provided and the directives/orders related to the delegation that has taken place. Delegation that is improperly carried out may also raise concerns in relation to billing practices, and physicians should pay close attention to OHIP restrictions, for example with respect to services for which they must be present. Physicians who delegate the provision of care may also wish to speak to the CMPA to inquire about liability-related issues. 1. Medical Records policy; Consent to Medical Treatment policy; Confidentiality of Personal Health Information policy; and Prescribing Drugs policy. DIALOGUE • Issue 2, 2014 23