Standards of Practice

 OBLIGATIONS OF A REGULATED HEALTH PROFESSION

CARTA’S Standards of Practice are derived from the following obligations of a regulated health profession, to:

1. Provide professional, safe and quality services to the public.

2. Be accountable for their professional practice.

3. Adhere to the Code of Ethics.

4. Possess a specialist body of knowledge.

5. Demonstrate competent application of professional knowledge.

6. Abide by continuing competence requirements.

1.  Provide Professional, Safe and Quality Services to the Public

The RRT uses a patient-focused approach to provide safe, quality care to patients, inherent with the privilege of self governance. The RRT:

1.1. Uses clinical judgement, including determining any contraindications prior to any intervention, to assess, treat, manage and evaluate the patient’s health care needs, on an ongoing basis

1.2  Consults when necessary with other regulated health care practitioners, and (where appropriate) with regulated health care workers, prior to initiating treatment

1.3  Evaluates the patient’s progress toward the achievement of anticipated clinical outcomes, and maintains, revises or discontinues treatment, in consultation with the patient and other regulated health care professionals

1.4  Communicates effectively with patients, family and the health care team regarding the patient’s respiratory and health status, and profess with respect to the treatment plan.

1.5  Protects and maintains the patients’ rights to privacy, safety, dignity and confidentiality.

1.6  Manages available resources effectively and efficiently in meeting patients needs

1.7  Uses critical thinking skills and competencies to analyze, synthesize and apply information to improve the quality, efficiency and effectiveness of patient care.

1.8 Recognizes their competency limitations, and when necessary seeks assistance, guidance, and expertise from others.

1.9  May refuse to provide professional health services, if in the RRT’s professional opinion, the ordered service or procedure may be detrimental to the patient’s health status, or may otherwise be inappropriate. In these circumstances, the RRT will convey their professional opinion to the practitioner who ordered the service.

Performance Indicators

In clinical, educational, management and research practice settings, the RRT:

• forms relationships with patients and other health professionals based on compassion, mutual respect, trust, and open and honest communication.
• recognizes the value of other health professions and collaborates as appropriate in patient-centered care.
• evaluates the risks and benefits of therapeutic interventions.
• recognizes the limitations of their competencies, and seeks assistance, guidance and intervention from others as appropriate.
• understands the importance of creating a learning environment for students and treats preceptorship of students as a professional responsibility.
• treats students with dignity and respect and continually provides clear, honest and objective feedback.
• reports on unsafe practice or unprofessional conduct to the appropriate authority.
• assists colleagues, students and others to learn about respiratory therapy practice and health care services.
• renders assistance to any person, within the RRT’s level of competence, where an urgent need for health care exists.
• does not falsely or frivolously impugn the reputation of another member or colleague.
• demonstrates a thorough understanding of multi-disciplinary versus interdisciplinary teams in the provision of patient care services.
• provides leadership by facilitating and advocating for patient care needs.
• allocates available resources to promote effective and efficient care.
• evaluates outcomes in relation to respiratory care.
• Obtains an appropriate consent for care, treatment and participation in research

2.  Is Accountable for Their Professional Practice

The RRT is accountable to the College and the public to ensure their practice meets legislative and professional requirements. The RRT takes accountability and intervenes – rather than watching, waiting, documenting or commenting.  The RRT:

2.1  Ensures they are in good standing the CARTA, and where possible and time permits, contributes to the College’s self-governance and related activities

2.2  Assumes accountability and responsibility for their professional competencies, in part through participating in the Continuing Competency Program. This includes developing and maintaining the RRT’s competencies through conducting annual competency assessments, determining their strengths and learning needs, and undertaking measures to meet these learning needs>

2.3 Ensures their professional practice complies with the HPA, Respiratory Therapists Profession Regulation, Bylaws, Standards of Practice, Code of Ethics, College Policies and procedures, and Employer Policies and Procedures.

2.4 Appropriately documents, on paper and/or electronic form, all information regarding initial assessments, patient response to therapeutic interventions and follow-up and discharge plans.

The RRT ensures that all documentation is legible, comprehensive, concise and pertinent. The RRT notes the date and time of each chart entry, and affixes their protected title or initials on all documentation. The RRT co-signs entries into the patient/client care record made by students.

2.5 Collaborates with others in the delivery of inter-disciplinary team health care services.

Performance Indicators

In clinical, educational, management and research practice settings, the RRT:

• demonstrates competency within the specialist body of knowledge
• maintains privacy and ensures confidentiality relating to health information
• practices within the skills and abilities for the level of knowledge
• is able to function independently and forms interdependent relationships with appropriate members of the health care team
• documents assessment, diagnostic and therapeutic interventions, and forms a care plan
• reports instances of unsafe professional practice, misconduct or patient abuse by a peer or other health care provider to the appropriate authority
• develops curricula that reflect the competencies identified in the national competency profile
• shares their knowledge and expertise with students and colleagues
• identifies competency-based objectives
• demonstrates mutually respectful and trusting relationships with students and preceptors
• ensures job functions are within the identified practice statement (“scope of practice”/”practice statements”)
• provides safe, respectful and patient-centered practice environments
• requires that all practitioners have current practice permits and appropriately use the protected titles
• ensures that protocols and policies are supported by evidence informed practices
• participates in research projects only after appropriate research and ethics approval has been granted
• reports instances of inconsistent or poor outcomes to the appropriate authority
• facilities implementation of research findings to evidence-based practice

3.  Adheres to the Code of Ethics

The RRT practices within the ethical guidelines of the profession. The RRT:

3.1  Demonstrates, through example and behaviour, adherence to CARTA’s Code of Ethics (noted in the third attachment).

3.2 Supports ethical behaviour in practice, education and research

3.3 Reports unsafe practice and unprofessional conduct by CARTA’s regulated members to CARTA’s “Complaints Director”, particularly in circumstances that may jeopardize patient care and/or bring the professions’ reputation into disrepute.

3.4 Protects the patient’s right to autonomy, respect, confidentiality and access to information, in accordance with applicable federal and provincial legislation.

Performance Indicators

In clinical, educational, management and research practice settings, the RRT:

• upholds the values contained in the Standards of Practice and Code of Ethics.
• develops processes for ethical decision making
• bases their workplace ethics to ensure compliance with CARTA’s expectations
• participates in projects only where formal research and ethics approval has been granted. This includes drug studies, epidemiological studies, first application in humans, multi-center trials, pilot projects, qualitative studies, and technology assessment

Additional items that may be considered are privacy and confidentiality, risks and benefits, patient recruitment procedures, informed consent, conflict of interest, and financial remuneration.

4.  Possesses a Specialist Body of Knowledge

The RRT is knowledgeable about the biological, physiological, medical, social and psychological sciences inherent in respiratory therapy health services. The RRT:

4.1  Develops and maintains their knowledge of the biological, physical, social and psychological arts and sciences, consistent with the national competency profile.

4.2  Possesses knowledge relevant to the role and responsibilities of area of practice.

4.3  Assumes responsibility for their personal and professional development.

4.4 Acts as teacher, advisor and mentor to students, peers and members of the health team and patients.

4.5 Promotes ongoing development and growth of knowledge of the profession by engaging in education and research.

Performance Indicators

In clinical, educational, management and research practice settings, the RRT:

• understands and analyzes the concepts of normal functioning, and acute and chronic dysfunction due to cardio-respiratory status
• demonstrates knowledge of the principles, practices and associated risks of procedures and interventions.
• displays expertise relating to the application of technology and equipment.
• is able to perform, analyze and interpret cardio-respiratory function tests and assessments.
• interprets variations in normal and abnormal results
• formulates care plans and recommendations based on interpretations of results, assessments and available technology
• promotes respiratory health and utilizes disease prevention and management strategies
• is aware of major social and disease trends affecting respiratory health
• designs competency-based objectives to meet the unique and specialized body of knowledge identified under clinical practice indicators
• utilizes an evaluation process to promote learning of the unique and specialized body of knowledge
• supports and assists educational institutions to participate in accreditation processes, in part to continually improve learning techniques associated with the body of knowledge
• promotes the growth of evidence informed practices associated with the body of knowledge
• makes use of performance management that reflect the unique and specialized knowledge base
• develops action plans to address competency deficiencies associated with clinical practice
• understands the underlying principles of research, as they apply to the unique and specialized knowledge required for the practice setting
• is able to interpret the level of research variability and dependability associated with specialized knowledge

5.  Demonstrates the Competent Application of Professional Knowledge

The RRT competently applies the body of knowledge to the assessment, treatment and management of patients. The RRT:

5.1 Performs a comprehensive assessment of patient’s status to formulate goals and objectives to meet patient health care needs.

5.2  Develops action and treatment plans based upon patients’ conditions.

5.3 When possible, continually and formally evaluates their provision of health care services through peer reviews and debriefings, management reviews and other quality assurance mechanisms. The intent of continuous evaluation is to improve patient safety and quality of care.

The concept of evaluation is consistent with performance management, which implies benchmarking, research, evaluation and a “systems level” of thinking.

5.4 Applies knowledge gained from evidence informed practices, experience, clinical judgement and research findings.

Performance Indicators

In clinical, educational, management and research practice settings, the RRT:

• performs assessments, evaluates test results and performs interventions in consultation with patients and other members of the health care team. This includes mechanically augmented ventilation, medication administration, medical gas administration, cardiopulmonary resuscitation and airway care. A more comprehensive listing of interventions is contained in the national competency profile
• evaluates, documents and modifies interventions based on patient outcomes
• performs cardiopulmonary diagnostics including the broad headings of pulmonary function testing, cardiac testing, metabolic studies, vascular testing and sleep diagnostics. A more comprehensive list of diagnostic testing is contained in the national competency profile
• promotes safety and manages risk by using routine precautions for infection control, using protective devices, additional precautions for infection control, risk management strategies and reduction and elimination of biohazards and environmental hazards
• promotes respiratory health and independence through pulmonary rehabilitation strategies, home environment analysis, education, coaching and counseling.
• develops curricula to achieve competence for students as noted under the clinical practice indicators.
• utilizes an evaluation process to promote competent application of knowledge, skills, attitude, judgment and experience.
• supports an accreditation process to continuously improve the competent application of knowledge, skills and attitudes
• performs a cost-benefit analysis of therapeutic modalities
• measures workloads and analyzes the types of interventions, activities, geography, functions and productivity
• assesses patient satisfaction
• conducts safety audits
• performs risk management strategies
• evaluates literature pertaining to clinical practice areas and incorporates this into evidence-based practice
• utilizes available meta-analysis for determining evidence associated with clinical interventions and application of technology
• utilizes their experience in consultation with patients to determine the care plan and associated outcomes
• participates in research to advance evidence-based practice

6.  Abides by Continuing Competence Requirements

The RRT demonstrates commitment to life long learning and “currency in practice”, inherent in the privilege of being a self-governing profession. The RRT:

6.1 Strives for professional excellence by participating in and promoting self-assessment and feedback from others to review and implement changes in practice

6.2 Invests the time, effort and resources needed to maintain and/or improve the competencies required in the area of practice

6.3 Uses an organized and focused approach in assessing their level of competence based on evidence informed practices, determining the competency requirements identifying their learning needs, and then developing a strategy to address those learning requirements

6.4 Develops and maintains their competence through conducting annual competency assessments, determining their strengths and learning needs, and undertaking measures to meet their learning needs, based on evidence informed practices.