Frequently Asked Questions

Controlled Acts, Daily Living and Nursing Support

Find answers to common questions about controlled acts, acts of daily living, training, delegation and nursing support for developmental service agencies.

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Controlled Acts FAQ

Common Questions About Controlled Acts

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Administrator Resource

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What is a controlled act?

Controlled acts are activities that may cause harm if performed by someone who does not have the necessary knowledge, skill and judgment. Regulated health professionals are authorized to perform controlled acts as outlined in the Regulated Health Professions Act, 1991.

The RHPA identifies 13 controlled acts. The controlled acts authorized to nursing that are commonly encountered in group-home and community settings include:

  • Performing a prescribed procedure below the dermis or below a mucous membrane.
  • Administering a substance by injection or inhalation.
  • Putting an instrument, hand or finger beyond specified body openings or into an artificial opening into the body.

Examples of the third category may include insertion beyond the external ear canal, beyond the point where the nasal passages 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.

What is an exempted act?

The RHPA identifies circumstances in which a person may perform a controlled act without a formal delegation. These exemptions may include:

  • Rendering first aid or temporary assistance in an emergency.
  • Fulfilling requirements to become a member of a health profession.
  • Treating a member of the person’s household.
  • Assisting a person with activities of daily living.

A controlled act performed as an activity of daily living remains a controlled act. The exemption means that formal delegation may not be required when the legal and clinical criteria are met. Appropriate teaching, agency authorization, competency confirmation and monitoring are still required.

What is an act of daily living?

An activity of daily living may involve a controlled act that is part of a well-established routine with predictable outcomes for a specific individual.

When the applicable criteria are met, the activity may be exempt from formal delegation. The person performing the activity must still receive appropriate, individual-specific instruction from a professional who is authorized to perform the controlled act.

Example: a newly prescribed insulin regimen John has type 2 diabetes and has recently been prescribed sliding scale insulin. The procedure is new and the outcome is not yet predictable because his response to the regimen has not been established. The activity would require further clinical assessment and may require performance or delegation by an appropriate regulated health professional until the routine and outcomes are established.
Example: an established inhaler routine Nadia has received the same prescribed inhaler every day for two years. She cooperates with administration, has experienced no adverse effects and her health status is stable. The activity may meet the criteria for an activity of daily living, provided that the individual-specific plan, teaching, competency and monitoring requirements are in place.
What controlled acts are commonly encountered in group homes?

Common examples may include administering inhaled medication, suppositories, enemas, catheterization and injections. The exact requirements depend on the procedure, the individual’s condition, the predictability of the outcome and whether the activity meets the criteria for an activity of daily living.

What is the difference between teaching and delegating?

Delegation is the transfer of authority to perform a controlled act to a person who is not otherwise authorized to perform it. Delegation may be required when a controlled act does not qualify as an activity of daily living. It requires an appropriate relationship with the delegating regulated health professional, as well as assessment, instruction, documentation and ongoing monitoring.

Teaching provides the knowledge and practical instruction required to perform an activity safely. For a controlled act that qualifies as an activity of daily living, individual-specific teaching, agency authorization, competency confirmation and an ongoing monitoring process remain necessary, even when formal delegation is not required.

What should be in place before an unregulated worker performs a controlled act?
  • The procedure must be ordered or established by an appropriate health professional and incorporated into the individual’s care plan.
  • The individual’s health condition must be sufficiently stable, and the expected outcome of the procedure must be predictable when relying on an activity-of-daily-living exemption.
  • The worker must receive procedure-specific and individual-specific instruction.
  • The agency must establish how initial competency will be assessed and documented.
  • A process must be in place to monitor continuing competency and identify when reassessment or retraining is needed.
  • The worker must be competent, current and comfortable performing the procedure and must understand when to stop and seek help.
  • Clear documentation, escalation and emergency-response expectations must be available.
Important: This page provides general educational information and does not replace legal advice, clinical assessment, individual-specific direction, agency policy or consultation with an appropriately authorized regulated health professional.