Standard
The physiotherapist only performs controlled acts that they are competent and authorized to perform and ensures that all controlled acts performed within the context of physiotherapy practice are safe, within the scope of physiotherapy, and compliant with regulatory and legislative requirements.
Expected outcome
Patients can expect that the physiotherapist performs controlled acts safely, competently, and with the required legal authority and training, and keeps them informed about all aspects of their care involving those acts.
Performance expectations
Related to the Performance of All Controlled Acts
The physiotherapist:
- Is authorized to perform a controlled act based on legislation or delegation.
- Ensures they are listed on the College roster for the controlled act being performed, except if:
- Performing the controlled act of communicating a diagnosis, or
- Performing an activity that is delegated by another health professional, in which case, they can agree to perform it under the conditions outlined in this Standard.
- Is able to demonstrate that they have successfully completed training for the controlled acts they perform, which may include formal education or training delivered on the job, and that they have met the following requirements as part of their training:
- Learned the indications, contraindications, adverse events, and risks associated with performing the controlled act, as well as the management of those risks and adverse events.Practiced the controlled act under the supervision of a person who is authorized to perform it.Was evaluated on the knowledge, judgement, and practical skills needed to perform the controlled act.
- Demonstrated an ability to safely and competently perform the controlled act.
- Demonstrates currency of knowledge, judgement, and practical skills for each controlled act they are rostered for or perform through delegation.
- Is accountable both for deciding to carry out the controlled act, and for performing it.
- Ensures the controlled act is within the scope of practice of physiotherapy, as defined under section 3 of the Physiotherapy Act, 1991, unless being delegated a controlled act that is outside of scope, in which case the Physiotherapist title must not be used.
- Obtains informed consent prior to performing the controlled act, including by communicating its risks and benefits, and documents consent.
- Maintains and follows a written plan for managing any reasonably foreseeable adverse events arising from the controlled act, and knows what to do should an adverse event occur.
- Documents any patient safety incidents or near misses related to the controlled act.
- Communicates in a timely manner with other healthcare providers when performing controlled acts that may impact the care patients receive from those providers.
Related to Receiving Delegation of Controlled Acts
When agreeing to perform a delegated controlled act, the physiotherapist:
- Must possess the currency of knowledge, judgement, and practical skills necessary to accept the delegation.
- Is satisfied that the delegation is provided by a legally authorized source.
- Can reasonably assume that the delegating health professional has the knowledge, skills, and judgement to perform the controlled act safely, competently, and ethically.
- Ensures that they fully understand the circumstances under which they are authorized to perform the controlled act, including which patients they may treat and any other limitations, as communicated by the delegating professional.
- Explains to patients the source and scope of their authority to perform the controlled act.
- Does not delegate the controlled act to anyone else, including a Physiotherapist Assistant (PTA) or physiotherapy student.
Related to the Delegation of Controlled Acts to Another Person
When delegating a controlled act, the physiotherapist:
- Understands that they are responsible for deciding to delegate the controlled act.
- Must not delegate the following:
- Acupuncture,
- Communicating a diagnosis,
- Spinal manipulation,
- Internal assessment or internal rehabilitation of pelvic musculature.
- Must have the knowledge, skills, and judgement to perform the controlled act safely, competently, and ethically before delegating the act.
- Ensures that the person who will be performing the controlled act has the knowledge, skills, and judgement to do so safely, competently, and ethically.
- Reviews with the person how to manage adverse events that can reasonably be foreseen and provides them with a written protocol for adverse event management.
- Explains to the person that they must not delegate the controlled act to anyone else.
- Explains to patients the circumstances in which the person can perform the controlled act, including any limitations.
- Must document that each of the above requirements has been fulfilled.
Definitions
- Adverse Event
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An adverse event is an event that results in unintended harm to a patient that is related to the physiotherapy services received, rather than the patient’s underlying condition. In the context of controlled acts, this may include unexpected harm, clinical deterioration, or complications arising during or after assessment or treatment.
- Controlled acts
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Controlled acts are acts which may be performed only by authorized regulated health professionals under section 27 of the Regulated Health Professions Act, 1991 (RHPA). Controlled acts are considered particularly harmful if performed by someone who does not have the required knowledge, skill and judgement. There are 14 controlled acts in total.
In accordance with Section 4: Authorized Acts of the Physiotherapy Act, 1991, physiotherapists can perform the following controlled acts when providing services to patients:
- communicating a diagnosis,
- spinal manipulation,
- tracheal suctioning,
- treating a wound below the dermis,
- pelvic internal exams (this includes putting an instrument, hand or finger, beyond the labia majora, or beyond the anal verge), and
- administering a substance by inhalation.
For the purposes of this Standard, this also includes acupuncture, which is a component of the controlled act of performing a procedure on tissue below the dermis. Under O.Reg 107/96: Controlled Acts, physiotherapists are exempted from the restriction on the performance of acupuncture, provided it is within the scope of practice of physiotherapy.
- Currency
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Currency refers to a physiotherapist’s ongoing and up-to-date competence in performing controlled acts. It means that the physiotherapist maintains the necessary skills, knowledge, and judgement, such as through regular training, education, and practice, to safely and effectively carry out these higher-risk activities.
- Delegation
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Delegation is the process by which one or more regulated health professionals grant someone the authority to perform a controlled act that they are authorized to perform, that the recipient is not normally permitted to carry out on their own. Delegation may be provided through direct orders (for an individual patient) or medical directives (pre-authorized instructions for designated professionals to carry out specified procedures under defined conditions).
According to sections 8 and 9 of the Professional Misconduct Regulation, it is professional misconduct to delegate or perform a delegated controlled act without the knowledge, skills, and judgement to do so safely.
Physiotherapy students who perform controlled acts as part of their clinical education are not normally considered recipients of delegation. Instead, section 29(b) of the Regulated Health Professions Act, 1991 (RHPA) explicitly authorizes students to carry out controlled acts under supervision while fulfilling the requirements to become a member of a regulated health profession, as long as that act is within their professional scope.
- Rostering
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Rostering for a controlled act is a process where physiotherapists add their names to the College’s list indicating they have the necessary training, education, and competence to safely perform the act. By rostering with the College, physiotherapists confirm that they are currently competent and will maintain their skills for as long as they remain on the roster. Rostering information appears on a physiotherapist’s profile on the Public Register.
Physiotherapists who perform the following activities under their own authority must roster for each of these activities with the College:
- tracheal suctioning
- spinal manipulation
- acupuncture (including dry needling)
- treating a wound below the dermis
- pelvic internal exams
- administering a substance by inhalation