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Delegation and medical directives

Delegation and medical directives are often discussed together because they are both tools used to facilitate interprofessional care. But delegation and medical directives are quite distinct and understanding the distinction, and which is required in each situation, is critical. MLTs could be asked to implement medical directives, such as for reflex testing, or be delegated the authority to perform a controlled act, such as releasing test results to a patient. MLTs could also potentially delegate the controlled act of phlebotomy, which is authorized to them.

Medical directives are a form of order whereby a health professional that is authorized to order a test or procedure enables another health professional to decide to order that test or procedure under specific conditions.

Delegation refers to the delegation of controlled acts in accordance with the provisions of the Regulated Health Professions Act, 1991 (RHPA). While delegation is not specifically defined in the RHPA, it is understood to be a process whereby a regulated health professional who is authorized to perform a controlled act procedure, confers authority to someone else. 

Both medical directives and delegation can address evolving healthcare needs by extending authority to perform procedures within the existing legislative framework but they are each used in different situations. 

CMLTO's MLT scope of practice - FAQ
2014 Medical Laboratory Technologist Scope of Practice Survey - Report (PDF)
CMLTO Delegation Guidelines (2023)Directives de délégation (2023) 

Learning resources for MLTs

 The Federation of Health Regulatory Colleges of Ontario (FHRCO) developed a guide to address questions, variances and confusion regarding the use of ordersdirect orders and medical directives—and delegation across all professions and practice settings in Ontario to facilitate interprofessional care in accordance with regulatory and legislative requirements. It is designed to complement and assist with fulfilling guidelines, standards and regulations developed by health profession Colleges. The guide is based on a framework of the fundamental cornerstones of health professional practice: public protection and patient safety achieved through regulated health professions practising independently and interdependently, in accordance with expectations of professional practice. 

To access the guide and templates, please go to "A Guide to Medical Directives and Delegation" at: http://www.regulatedhealthprofessions.on.ca/practitioners/medical.asp.