Standards of Practice

The RRT uses a patient-focused approach to provide safe, quality care to patients, inherent with the privilege of self governance. The RRT:

1.1. Uses clinical judgement, including determining any contraindications prior to any intervention, to assess, treat, manage and evaluate the patient’s health care needs, on an ongoing basis

1.2  Consults when necessary with other regulated health care practitioners, and (where appropriate) with regulated health care workers, prior to initiating treatment

1.3  Evaluates the patient’s progress toward the achievement of anticipated clinical outcomes, and maintains, revises or discontinues treatment, in consultation with the patient and other regulated health care professionals

1.4  Communicates effectively with patients, family and the health care team regarding the patient’s respiratory and health status, and progress with respect to the treatment plan.

1.5  Protects and maintains the patients’ rights to privacy, safety, dignity and confidentiality.

1.6  Manages available resources effectively and efficiently in meeting patients needs

1.7  Uses critical thinking skills and competencies to analyze, synthesize and apply information to improve the quality, efficiency and effectiveness of patient care.

1.8 Recognizes their competency limitations, and when necessary seeks assistance, guidance, and expertise from others.

1.9  May refuse to provide professional health services, if in the RRT’s professional opinion, the ordered service or procedure may be detrimental to the patient’s health status, or may otherwise be inappropriate. In these circumstances, the RRT will convey their professional opinion to the practitioner who ordered the service.

1.10. Does not promote personal beliefs or causes (including business, religious or political nature) to a patient in the context of providing professional services.

Performance Indicators

In clinical, educational, management and research practice settings, the RRT:

• forms relationships with patients and other health professionals based on compassion, mutual respect, trust, and open and honest communication.
• recognizes the value of other health professions and collaborates as appropriate in patient-centered care.
• evaluates the risks and benefits of therapeutic interventions.
• recognizes the limitations of their competencies, and seeks assistance, guidance and intervention from others as appropriate.
• understands the importance of creating a learning environment for students and treats preceptorship of students as a professional responsibility.
• treats students with dignity and respect and continually provides clear, honest and objective feedback.
• reports on unsafe practice or unprofessional conduct to the appropriate authority.
• assists colleagues, students and others to learn about respiratory therapy practice and health care services.
• renders assistance to any person, within the RRT’s level of competence, where an urgent need for health care exists.
• does not falsely or frivolously impugn the reputation of another member or colleague.
• demonstrates a thorough understanding of multi-disciplinary versus interdisciplinary teams in the provision of patient care services.
• provides leadership by facilitating and advocating for patient care needs.
• allocates available resources to promote effective and efficient care.
• evaluates outcomes in relation to respiratory care.
• Obtains an appropriate consent for care, treatment and participation in research

The RRT is accountable to the College and the public to ensure their practice meets legislative and professional requirements. The RRT takes accountability and intervenes – rather than watching, waiting, documenting or commenting.  The RRT:

2.1  Ensures they are in good standing the CARTA, and where possible and time permits, contributes to the College’s self-governance and related activities

2.2  Assumes accountability and responsibility for their professional competencies, in part through participating in the Continuing Competency Program. This includes developing and maintaining the RRT’s competencies through conducting annual competency assessments, determining their strengths and learning needs, and undertaking measures to meet these learning needs.

2.3 Ensures their professional practice complies with the HPA, Respiratory Therapists Profession Regulation, Bylaws, Standards of Practice, Code of Ethics, College Policies and procedures, and Employer Policies and Procedures.

2.4 Appropriately documents, on paper and/or electronic form, all information regarding initial assessments, patient response to therapeutic interventions and follow-up and discharge plans.

The RRT ensures that all documentation is legible, comprehensive, concise and pertinent. The RRT notes the date and time of each chart entry, and affixes their protected title or initials on all documentation. The RRT co-signs entries into the patient/client care record made by students.

2.5 Collaborates with others in the delivery of inter-disciplinary team health care services.

Performance Indicators

In clinical, educational, management and research practice settings, the RRT:

• demonstrates competency within the specialist body of knowledge
• maintains privacy and ensures confidentiality relating to health information
• practices within the skills and abilities for the level of knowledge
• is able to function independently and forms interdependent relationships with appropriate members of the health care team
• documents assessment, diagnostic and therapeutic interventions, and forms a care plan
• reports instances of unsafe professional practice, misconduct or patient abuse by a peer or other health care provider to the appropriate authority
• develops curricula that reflect the competencies identified in the national competency profile
• shares their knowledge and expertise with students and colleagues
• identifies competency-based objectives
• demonstrates mutually respectful and trusting relationships with students and preceptors
• ensures job functions are within the identified practice statement (“scope of practice”/”practice statements”)
• provides safe, respectful and patient-centered practice environments
• requires that all practitioners have current practice permits and appropriately use the protected titles
• ensures that protocols and policies are supported by evidence informed practices
• participates in research projects only after appropriate research and ethics approval has been granted
• reports instances of inconsistent or poor outcomes to the appropriate authority
• facilities implementation of research findings to evidence-based practice

The RRT practices within the ethical guidelines of the profession. The RRT:

3.1  Demonstrates, through example and behaviour, adherence to CARTA’s Code of Ethics (noted in the third attachment).

3.2 Supports ethical behaviour in practice, education and research

3.3 Reports unsafe practice and unprofessional conduct by CARTA’s regulated members to CARTA’s “Complaints Director”, particularly in circumstances that may jeopardize patient care and/or bring the professions’ reputation into disrepute.

3.4 Protects the patient’s right to autonomy, respect, confidentiality and access to information, in accordance with applicable federal and provincial legislation.

Performance Indicators

In clinical, educational, management and research practice settings, the RRT:

• upholds the values contained in the Standards of Practice and Code of Ethics.
• develops processes for ethical decision making
• bases their workplace ethics to ensure compliance with CARTA’s expectations
• participates in projects only where formal research and ethics approval has been granted. This includes drug studies, epidemiological studies, first application in humans, multi-center trials, pilot projects, qualitative studies, and technology assessment

Additional items that may be considered are privacy and confidentiality, risks and benefits, patient recruitment procedures, informed consent, conflict of interest, and financial remuneration.

The RRT is knowledgeable about the biological, physiological, medical, social and psychological sciences inherent in respiratory therapy health services. The RRT:

4.1 Develops and maintains their knowledge of the biological, physical, social and psychological arts and sciences, consistent with the national competency profile.

4.2 Possesses knowledge relevant to the role and responsibilities of area of practice.

4.3 Assumes responsibility for their personal and professional development.

4.4 Acts as teacher, advisor and mentor to students, peers and members of the health team and patients.

4.5 Promotes ongoing development and growth of knowledge of the profession by engaging in education and research.

Performance Indicators

In clinical, educational, management and research practice settings, the RRT:

• understands and analyzes the concepts of normal functioning, and acute and chronic dysfunction due to cardio-respiratory status
• demonstrates knowledge of the principles, practices and associated risks of procedures and interventions.
• displays expertise relating to the application of technology and equipment.
• is able to perform, analyze and interpret cardio-respiratory function tests and assessments.
• interprets variations in normal and abnormal results
• formulates care plans and recommendations based on interpretations of results, assessments and available technology
• promotes respiratory health and utilizes disease prevention and management strategies
• is aware of major social and disease trends affecting respiratory health
• designs competency-based objectives to meet the unique and specialized body of knowledge identified under clinical practice indicators
• utilizes an evaluation process to promote learning of the unique and specialized body of knowledge
• supports and assists educational institutions to participate in accreditation processes, in part to continually improve learning techniques associated with the body of knowledge
• promotes the growth of evidence informed practices associated with the body of knowledge
• makes use of performance management that reflect the unique and specialized knowledge base
• develops action plans to address competency deficiencies associated with clinical practice
• understands the underlying principles of research, as they apply to the unique and specialized knowledge required for the practice setting
• is able to interpret the level of research variability and dependability associated with specialized knowledge

The RRT competently applies the body of knowledge to the assessment, treatment and management of patients. The RRT:

5.1 Performs a comprehensive assessment of patient’s status to formulate goals and objectives to meet patient health care needs.

5.2  Develops action and treatment plans based upon patients’ conditions.

5.3 When possible, continually and formally evaluates their provision of health care services through peer reviews and debriefings, management reviews and other quality assurance mechanisms. The intent of continuous evaluation is to improve patient safety and quality of care.

The concept of evaluation is consistent with performance management, which implies benchmarking, research, evaluation and a “systems level” of thinking.

5.4 Applies knowledge gained from evidence informed practices, experience, clinical judgement and research findings.

Performance Indicators

In clinical, educational, management and research practice settings, the RRT:

• performs assessments, evaluates test results and performs interventions in consultation with patients and other members of the health care team. This includes mechanically augmented ventilation, medication administration, medical gas administration, cardiopulmonary resuscitation and airway care. A more comprehensive listing of interventions is contained in the national competency profile
• evaluates, documents and modifies interventions based on patient outcomes
• performs cardiopulmonary diagnostics including the broad headings of pulmonary function testing, cardiac testing, metabolic studies, vascular testing and sleep diagnostics. A more comprehensive list of diagnostic testing is contained in the national competency profile
• promotes safety and manages risk by using routine precautions for infection control, using protective devices, additional precautions for infection control, risk management strategies and reduction and elimination of biohazards and environmental hazards
• promotes respiratory health and independence through pulmonary rehabilitation strategies, home environment analysis, education, coaching and counseling.
• develops curricula to achieve competence for students as noted under the clinical practice indicators.
• utilizes an evaluation process to promote competent application of knowledge, skills, attitude, judgment and experience.
• supports an accreditation process to continuously improve the competent application of knowledge, skills and attitudes
• performs a cost-benefit analysis of therapeutic modalities
• measures workloads and analyzes the types of interventions, activities, geography, functions and productivity
• assesses patient satisfaction
• conducts safety audits
• performs risk management strategies
• evaluates literature pertaining to clinical practice areas and incorporates this into evidence-based practice
• utilizes available meta-analysis for determining evidence associated with clinical interventions and application of technology
• utilizes their experience in consultation with patients to determine the care plan and associated outcomes
• participates in research to advance evidence-based practice

The RRT demonstrates commitment to life long learning and “currency in practice”, inherent in the privilege of being a self-governing profession. The RRT:

6.1 Strives for professional excellence by participating in and promoting self-assessment and feedback from others to review and implement changes in practice

6.2 Invests the time, effort and resources needed to maintain and/or improve the competencies required in the area of practice

6.3 Uses an organized and focused approach in assessing their level of competence based on evidence informed practices, determining the competency requirements identifying their learning needs, and then developing a strategy to address those learning requirements

6.4 Develops and maintains their competence through conducting annual competency assessments, determining their strengths and learning needs, and undertaking measures to meet their learning needs, based on evidence informed practices.

7.1. Regulated members must maintain professional boundaries in all      interactions with patients including but not limited to:

7.1.1.1. Obtaining informed consent for sensitive examinations such as chest auscultation or obtaining femoral arterial blood samples;

7.1.1.2. Using appropriate examination techniques when touching          sensitive or personal areas of the body, including but not limited to breasts, anus etc.;

7.1.2. Providing privacy while the patient is undressing or dressing or;

7.1.3. Where applicable provide adequate draping.

7.2. A regulated member must consider and minimize any potential conflict  of interest or risk of coercion when engaging with a patient in a non-cinical context (i.e., in a personal, social, financial or business relationship).

7.3. Regulated members must not:

7.3.1. Make sexual comments or gestures toward a patient or their family    members;

7.3.2. Enter into a close personal or sexual relationship with a patient or      any person with whom a patient has a significant interdependent relationship (e.g. parent, guardian, child or significant other);

7.3.3. Request details of a patient’s sexual or personal history unless    related to the patient’scare;

7.3.4. Socialize or communicate with a patient for the purpose of         pursuing a close personal or sexual relationship; or

7.3.5. Terminate a patient-registered respiratory therapist relationship for  the purpose of pursuing a close personal or sexual relationship unless done with the consent of the patient and suitable arrangements have been made in advance for the transfer of care to another registered respiratory therapist and the circumstances are fully disclosed to that registered respiratory therapist;

7.4. Notwithstanding section 7.3.5 a regulated member must not enter into  a close personal or sexual relationship with a patient unless 1 year has passed since the last professional service was provided. Factors that must be considered when determining if it is appropriate to enter into a sexual relationship with a former patient may include:

7.4.1 The number of times that the regulated member and the patient        had a professional interaction;

7.4.2 The duration of the professional relationship;

7.4.3 The nature of the professional interaction;

7.4.4 Whether sufficient time has passed since the last professional       interaction occurred;

7.4.5 Whether the patient has confided personal information to the       regulated member beyond that which was necessary for the               purposes of receiving professional services;

7.4.6 Whether the patient was emotionally dependent on the regulated  member; and/or;

7.4.7 Whether the patient is particularly vulnerable as a result of factors      such as: age, gender identity, socioeconomic status, or as a result of a mental, intellectual or physical disability.

7.5 Regulated members and former regulated members MUST NOT     sexually abuse or engage in sexual misconduct with a learner.

7.5.1 Make comments or gestures of a sexual nature toward any learner;

7.5.2 Enter into a close personal or sexual relationship with a learner    while directly or indirectly responsible for precepting, mentoring,        teaching, supervising or evaluating that learner;

7.5.3 A regulated member who has a close personal or sexual relationship with a learner or a subordinate registered respiratory therapist, or has had such a relationship within the past 3 years,must:

7.5.3.1 Notify applicable clinical and academic leaders of the relationship with the learner;

7.5.3.2 Not be involved in any role teaching or evaluating the learner and;

7.5.3.3 Not be involved in any discussion of the performance of the learner.

8. A regulated member may provide professional services to a spouse or an adult interdependent partner in urgent circumstances where no other care provider is available.

For the purpose of the standards of practice:

A patient will be defined as a person who is receiving, is likely to receive, or has received any professional service directly from a regulated member or former member regardless of whether or not the professional service has been requested by the person, prescribed or ordered by any other party.

For the purposes of the standards of practice a spouse in relation to a regulated member or former member means a person who is the regulated member's or former member's spouse or a person who has lived with the regulated member or former member in a conjugal relationship continuously for a period of not less than 3 years.

A former patient will be defined as a person who has NOT received any professional service from a regulated or former member for a period of 1 year or longer.

Regulated member means any person who is on any register identified in sections 3,6 or 7 of the Respiratory Therapists Profession Regulation.

A former regulated member is a person who has been on any register identified in sections 3,6 or 7 of the Respiratory Therapists Profession Regulation in the previous 2 years.

A learner includes but is not limited to any student enrolled in an education program or other health professional learner.

Sexual Abuse is defined in section 1(1)(nn.1) of the Health Professions Act for the purpose of addressing a complaint, and means the threatened, attempted or actual conduct of a regulated member towards a patient that is of a sexual nature and includes any of the following conduct:

    i. Sexual intercourse between a regulated member and a patient of that           regulated member;
    ii. Genital to genital, genital to anal, oral to genital, or oral to anal                   contact between a regulated member and a patient of that regulated           member;
   iii. Masturbation of a regulated member by, or in the presence of, a                 patient of that regulated member;
   iv. Masturbation of a regulated member’s patient by that regulated                   member;
   v. Encouraging a regulated member’s patient to masturbate in the                   presence of that regulated member;
   vi. Touching of a sexual nature of a patient’s genitals, anus, breasts, or             buttocks by a regulated member.

Sexual Misconduct is defined in section 1(1)(nn.2) means any incident or repeated incidents of objectionable or unwelcome conduct, behaviour or remarks of a sexual nature by a regulated member towards a patient that the regulated member knows or ought reasonably to know will or would cause offence or humiliation to the patient or adversely affect the patient’s health and well-being but does not include sexual abuse.

Sexual nature does not include any conduct, behaviour or remarks that are appropriate to the service provided.