Resources:
Controlled Acts Standard

There are seven controlled acts (sometimes referred to as authorized activities) that Ontario PTs can perform. A physiotherapist must roster (complete an online declaration) with the College if they perform any of the following controlled acts.

• Spinal manipulation
• Tracheal suctioning
• Acupuncture (this includes dry needling)
• Treating wounds below the dermis by cleansing, soaking, irrigating, soaking, probing, debriding, packing or dressing
• Inserting a hand, finger, or instrument beyond the labia majora or anal verge for the purposes of assessing or rehabilitating pelvic musculature relating to incontinence or pain
• Administering a substance by inhalation (when the substance has been ordered by an authorized person)

Physiotherapists do not have to roster for communicating a diagnosis identifying a disease, physical disorder, or dysfunction as the cause of a person’s symptoms because this is a fundamental part of PT practice. Learn more about rostering. 

Rostering is the process where physiotherapists add their names to a public list indicating they have the required training, education and experience to safely perform the higher risk activity. Physiotherapists who perform authorized activities must roster for each individual authorized activity they perform. 

The only exception is communicating a diagnosis. This is an authorized activity that does not require rostering as it is considered an essential competency.

PTs must roster for the following activities:

• tracheal suctioning
• spinal manipulation
• acupuncture (including dry needling)
• 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)
• administering a substance by inhalation

Read the Controlled Acts and Restricted Activities Standard to learn more.

Physiotherapists may delegate 3 of the controlled acts they are authorized to perform: tracheal suctioning, wound care and administering a substance by inhalation.

Physiotherapist may NOT delegate: acupuncture, communicating a diagnosis, spinal manipulation, or internal assessment treatment of pelvic musculature

Before delegating to another person, physiotherapists must document that they have:

• Ensured the person they are delegating to has the knowledge, skills, and judgment to carry out the activity safely, competently, and ethically.
• Explained when the person can and cannot perform the controlled act. If the patient’s condition changes or they are high risk for example, it may not be appropriate to delegate a controlled act in this case.
•  Ensured that the person who is carrying out the activity knows how to manage any adverse outcome that can reasonably be foreseen. They must be familiar with the written plan that has been created by the person delegating the activity. 
• Confirmed that the person knows they must not delegate the act to anyone else.

Delegation is a formal transfer of authority and can take place either through a direct order or a medical directive.

Direct orders are when you get the authority to perform a controlled act from another healthcare provider (usually a physician) for a specific client.

A direct order can be written or verbal (although if received verbally, you should document that it was received). A typical direct order would include for example “Patient X to ambulate with 3L O2 maintain SaO2 94+%.”

A medical directive is an order that can be used for several patients when certain conditions exist. For example, a PT may be asked to order x-rays or routine blood work for total hip arthroplasty patients. Medical directives are always written.

Useful Resource for Multi-Disciplinary Teams
An Interprofessional Guide on the Use of Orders, Directives and Delegation for Regulated Health Professionals

Yes, delegation is required in this scenario. The controlled act given to physiotherapists is “administering a substance by inhalation” and requires that there be an order for the substance. Even though the PTA is not adjusting the amount of oxygen delivered, if the PTA is changing the delivery of oxygen from the wall to a portable tank, they will need to set up the portable O2 system, which is the same as administering O2 and delegation is required. 

Yes, delegation is required in this scenario. The controlled act given to physiotherapists is “administering a substance by inhalation” and is not limited to adjusting O2 levels. Oxygen is a prescription. 

If the PTA is changing the delivery of oxygen from the wall to a portable tank, they will need to set up the portable O2 system which is administering O2 and delegation is required.

This activity involves risk. The PTA needs special knowledge to do the activity.

For example, the PTA will need to make sure the tank is turned on and has enough oxygen in it. They will need to be certain that they reconnect the hose to the oxygen and not to the air valve. The PTA should know whether to monitor SpO2  during the activity, meaning they may need to increase the flow rate if the patient desaturates. This activity could be a risk to patients and therefore requires delegation. If the patient requires a face mask for their O2 needs, the PTA will need for example to understand the impact on FiO2 and any humidification requirements.

Yes, any time you want to adjust a patient’s 02 level you need to either be rostered or have the authority (to administer, titrate or adjust) delegated to you by an MD (Dentist, Nurse Practitioner, midwife). An order for 02 and the parameters for administration is also always needed.

Same thing with switching between the wall and portable 02 – you may not be adjusting the levels, but you are changing the system where O2 is delivered. The competencies are needed to set up and adjust 02 levels are the same.

If you are not administering or adjusting or titrating or doing anything with a patient’s 02, then you do not need to be rostered.