FAQ

Controlled acts are defined as acts that could cause harm if performed by those who do not have the knowledge, skill and judgment to perform them. Regulated health professionals are authorized to perform controlled acts as outlined in the Regulated Health Professions Act, 1991 (RHPA)

There are 13 controlled acts listed in section 27, subsection 2 of the RHPA. The acts that are authorized to the nursing profession are what we often see in our group homes:

Performing a prescribed procedure below the dermis (skin) or a mucous membrane;

Administering a substance by injection or inhalation;

Putting an instrument, hand or finger:

• beyond the external ear canal
• beyond the point in the nasal passages where they normally narrow;
• beyond the larynx;
• beyond the opening of the urethra;
• beyond the labia majora;
• beyond the anal verge; or into an artificial opening into the body.

The RHPA outlines certain exemptions in section 29. Persons may perform controlled acts if they are delegated or done in the course of:

• Rendering first aid
• Fulfilling the requirements of becoming a member of a health profession
• Treating a member of one's household
• Assisting a person with his or her activities of daily living

It is important to note that an activity of daily living is still a controlled act. The Act of Daily Living title only releases the controlled act from the need to be delegated, instead it must be taught by a professional that is authorized to perform the act such as a nurse.

Acts of daily living (ADL) are controlled acts that are performed as part of a well-established routine with predictable outcomes. The Act of Daily Living title only releases the controlled act from the need to be delegated, instead it must be taught by a professional that is authorized to perform the controlled act.

Examples:

John has diabetes type II. His physician has recently prescribed sliding scale insulin to better manage his disease.

This is new procedure that has not yet been well established. There is also no predictable outcome as we do not know how John's body will react to this new regiment. For these reasons, this controlled act cannot be exempted from delegation, and will have to be done by a regulated health professional (RN, or RPN) until it can be exempted.

Nadia has asthma. She has been receiving a puffer for the last 2 years, every day at the same time. She cooperates well when staff administer her puffer, and has never had any adverse effects. Her health is stable with no recent changes.

This controlled act is part of a well established routine and has predictable outcomes. For these reasons, it can be exempted from delegation as it is considered an act of daily living. That said, the act still needs to be taught through appropriate training from a regulated professional.

The most common controlled acts encountered in group homes are suppositories, enemas and inhalers. We also see catheterizations and injections.

• Delegation is a transfer of authority to perform the act. The nurse that delegates holds liability for the actions of the unregulated worker. For example, cleansing and dressing an open wound. Delegation is only required when a controlled act cannot be considered an act of daily living. Delegation requires a close working relationship with a nurse and a nurse must monitor your staff for ongoing competency. The majority of acts being performed in group homes do not require delegation.
• Teaching is required for controlled acts that are acts of daily living (ADL). Liability is transferred to the person performing the act and the employing agency. A monitoring program must be in place for ADL but the monitoring may be done in house by agency staff if the proper criteria are in place.
• What do you need to know before performing a controlled act?
• Procedure must be routine and set out by a health professional
• Client must be stable and outcomes of the procedure predictable. This is determined by looking at the individual’s history and health records. Things taken into consideration are the number of hospitalizations in the past year and past outcomes to the procedure. The potential for severe adverse reactions to the procedure is also considered.
• The unregulated worker must receive instruction on the act that is client specific (may be written).
• The agency must determine competency.
• A process for monitoring continuing competency must be in place.
• The worker must be competent, current and comfortable with the act and have the necessary background knowledge.

• Procedure must be routine and set out by a health professional
• Client must be stable and outcomes of the procedure predictable. This is determined by looking at the individual’s history and health records. Things taken into consideration are the number of hospitalizations in the past year and past outcomes to the procedure. The potential for severe adverse reactions to the procedure is also considered.
• The unregulated worker must receive instruction on the act that is client specific (may be written).
• The agency must determine competency.
• A process for monitoring continuing competency must be in place.
• The worker must be competent, current and comfortable with the act and have the necessary background knowledge.