Medical Orders

Front 1

When is an Order Required

Back 1

- The Respiratory Therapy Act
• suctioning beyond the point in the nasal passages where they normally narrow or beyond the larynx; and
• administering a prescribed substance by inhalation (Oxygen)

Front 2

When is an Order Required

Back 2

- If the activity is not a controlled act then it is in the public domain and does not require an order

- The Regulated Health Professions Act (RHPA) provides for exemptions in emergencies.

Front 3

When is an Order Required

Back 3

• The Public Hospitals Act requires an order for every treatment or diagnostic procedure

• The Independent Health Facilities Act requires an order for all examinations, tests, consultations, and treatments

Front 4

When is an Order Required

Back 4

• In other words, the Public Hospitals Act and the Independent Health Facilities Act may require an order for an activity that is not a controlled act

Front 5

What Constitutes a Valid Order

Back 5

- An “order” is only authority to undertake an
intervention if the circumstances are appropriate and, in your professional judgement, it is appropriate to undertake the intervention.

- A medical order does not necessarily make the
intervention appropriate.

Front 6

Valid Order

Back 6

- when the order is given (includes date and time)

- who the order is for (patient identification)

- who the prescriber is

Front 7

Valid Order

Back 7

- the details of the intervention so that is clear what is being ordered

- when the order is to be carried out

-how the order is to be carried out

Front 8

Verbal Order

Back 8

- Verbal orders must be transcribed immediately and meet all of the requirements of a valid order

- Verbal orders must be countersigned by the prescriber or authenticated by another form of signed paperwork

Front 9

Telephone Order

Back 9

- Telephone and verbal orders must be received directly from the prescriber and not their designate unless the designate is another regulated health professional

Front 10

Telephone Order

Back 10

When transcribing a phone or verbal order:
-“p.o. prescriber/your name, designation” or “t.o. prescriber/your name, designation” may be used to indicate that it was a phone or telephone order, and

-“v.o. prescriber/your name, designation” may be used to indicate that it was a verbal order.

Front 11

Verbal Orders: Problems

Back 11

- Verbal orders present more room for error than written or electronic orders

- Communication difficulties:
-different accents, dialects, pronunciations
-background noise, interruptions
-unfamiliar drug names and terminology

Front 12

Verbal Orders: Problems

Back 12

- Adds more steps to prescribing and transcription processes

- Only the sender/prescriber can verify that an order was heard correctly

- students can never take verbal orders

Front 13

Verbal Orders: Problems

Back 13

- Wrong drug: verbal order for ephedrine misheard as epinephrine

- Wrong dose: Ventolin 5 mg misheard as 5 mL

- Wrong lab results: Blood sugar misheard as 257mg/dL when it was actually 157mg/dL, and patient receives too much insulin

Front 14

Prevent Errors

Back 14

- WRITE it down

- READ it back

- get CONFIRMation

Front 15

Who Can RRTs Take Orders From

Back 15

- An order for a controlled act authorized to Respiratory Therapists must be from one of the four regulated health care professionals:
- physician/surgeon/anaesthesiologist

- dentist

- midwife

- nurse practitioner (RN(EC))

Front 16

Types of Orders

Back 16

Direct Order
• A direct order is an order or prescription for care written by an individual prescriber for a particular patient for a specific treatment
• Written, Verbal or Telephone

Front 17

Types of Orders

Back 17

Therapist Driven Protocols

Medical Directive

Front 18

Therapist Driven Protocols

Back 18

• Type of direct order (for a specific patient) to be implemented by a Respiratory Therapist

• A Ventilation-Weaning Protocol is a common example of an RT-driven protocol

Front 19

Therapist Driven Protocols

Back 19

• RT-Driven protocols outline the framework and provide guidance for Respiratory Therapists to deliver care only to the specific patient/client they are ordered for

Front 20

Medical Directive

Back 20

A medical order for a specified range of
patients who meet specific conditions

Front 21

The Essential Elements of a Properly Constructed Medical Directive

Back 21

• The name and description of the procedure, treatment or intervention being ordered;

• Specific patient/client conditions that must be met before the procedure can be implemented;

Front 22

The Essential Elements of a Properly Constructed Medical Directive

Back 22

• Circumstances which must exist before the procedure can be implemented;

• Comprehensive list of contraindications to performing the procedure (patient does not want to be resuscitation);

Front 23

The Essential Elements of a Properly Constructed Medical Directive

Back 23

• A list of health care professionals who may implement or perform the procedure and any
educational requirements required

• The health care provider authorizing the medical directive

Front 24

The Essential Elements of a Properly Constructed Medical Directive

Back 24

• A list of administrative approvals from the facility with dates and signatures.

Front 25

Order for Mechanical Ventilation

Back 25

• The application of mechanical ventilation falls under the act of administering a substance by injection or inhalation

• Specifically, the controlled acts associated with ventilation include the application of pressurized gas and the administration of Oxygen

Front 26

Order for Mechanical Ventilation

Back 26

Minimum requirements consist of:
• prescriber - the signature and name of the regulated health professional along with the appropriate credential also be included so that clear identification can be made;
• date and time;
• direction to initiate mechanical ventilation and oxygen therapy

Front 27

Delegation

Back 27

• Delegation is the transfer of legal authority to perform controlled act to a person not authorized to perform that controlled act

• Delegation often refers to the transfer of authority to perform “procedures” involving controlled acts

Front 28

Delegation

Back 28

• Procedures and/or activities that do not involve controlled acts do not require delegation, however they may still require orders depending on the practice setting

• Delegation is a process.