Decision-Making Guide

1 Is it appropriate to begin to consider having an MRT accept delegation or perform the service or procedure? Issues to consider What is the exact nature of the service? Is it a controlled act? Who is to perform it? Upon whom? Where? What are the necessary competencies in providing the service? Is performance of the procedure warranted and in the patient's best interests? Do not perform procedure Consult with CMRTO

2 Is it possible for an MRT to accept delegation of perform the service or procedure given scope of practice and legal requirements under the RHPA, HARP Act, HCCA, PHA, LSCCLA, IHFA, and any other relevant legislation? Issues to consider Does the procedure fall within the parameters of the MRT scope of practice statement or is it related enough to consider having an MRT perform the procedure? Is the procedure being performed in the course of engaging in the practice of the profession? If the procedure falls within a controlled act not authorized to MRTs, is it possible to establish a proper delegation program that corresponds to the CMRTO's practice guidelines? Can or has the MRT completed such a program and received written authorization to accept delegation of the procedure? Is performance of the procedure consistent with the provisions of HARP, HCCA, PHA, LSCCLA, IHFA? If the procedure does not fall within a controlled act but could cause serious physical harm, is the procedure within the parameters of the MRT scope of practice? If not consider the "risk of harm clause" of RHPA Do not perform procedure Consult with CMRTO

3 Is accepting delegation or performing the service or procedure within an MRT's competencies and legal requirements given: How known and predictable the patient's condition, needs, and outcome are? The circumstances in the situation including: the degree of independence when performing the procedure; the resources and safeguards available; the opportunities to maintain competence; the structures, processes and authorizing mechanisms in place enabling an MRT to meet legal and practice requirements? Any other factors specific to the situation? Issues to consider How known and predictable are the patient's condition, needs and the outcomes: How effectively controlled is the patient's condition? How well can the type and timing of changes be predicted? To what degree are needs known and established? How accurately can outcomes be predicted when the procedure is performed competently? What are the risks in performing the procedure? Can they be minimized? What actions are necessary to deal with them? What are the benefits of performing the procedure? What knowledge, skills and judgement are necessary to perform the procedure and manage the outcomes safely, effectively, and ethically? If more than one type of care provider can provide care, will the outcome of care be the same if the MRT provides it? (Outcome of care must be the same regardless of who provides it). What are the circumstances in the situation: To what extent is the MRT expected to perform the procedure independently? Are policies in place to guide practice? To what degree is the MRT expected to use judgement in implementing or adjusting the policies? How much independent judgement is necessary in deciding when to consult or seek out assistance? Can this be clearly outlined? What are the resources and safeguards in the situation or what is the availability of back-up? How available is a qualified person to intervene? Are there qualified people available to teach and establish policies to guide practice? Is the appropriate equipment available? Will there be enough opportunity in practice to maintain competence? If not, can alternative mechanisms be provided? Do these make sense from an organizational and fiscal perspective? Can the MRT ensure that legal and practice requirements are complied with: e.g. is an order in place; if supervision or delegation is necessary can these be carried out appropriately; can the MRT assume appropriate responsibility for performance of the procedure; can informed consent be obtained? Are there mechanisms in place for quality monitoring, for the MRT to communicate and collaborate with other members of the team and for the MRT to advocate effectively for safe, effective, and ethical care? Are there any other factors specific to the situation that need to be considered? Given the responses to the above questions, does an MRT have the knowledge, skill and judgement, or have the foundation of knowledge, skill and judgement to reasonably acquire the competencies to accept delegation or perform the service or procedure safely, effectively and ethically? Do not perform procedure Consult with CMRTO

4 Does having an MRT accept delegation or perform the service or procedure make sense? Issues to consider What is the extent of need? Does it make sense from a patient satisfaction perspective, a provision of care perspective, rationalization of services perspective, fiscal perspective, organizational perspective (e.g. is it reasonable to expect a newly hired person to perform the procedure with similar training)? If MRTs perform the procedure, will this detract from their ability to appropriately provide services needed by patients that only MRTs can provide? Do not perform procedure Consult with CMRTO