CPSO has approved targeted updates to the Delegation of Controlled Acts policy, which clarify the process for appropriate delegation. Intended to address patient risk, the updates: 

• require physicians to only delegate in the context of an established or anticipated physician-patient relationship; and
• clarify that an “anticipated” physician-patient relationship requires a physician to perform a clinical assessment within two business days of a new patient’s first encounter with the delegate.

The updates also set out the exceptional circumstances in which delegation can occur without a physician-patient relationship, including when care is provided:

• by paramedics or community paramedics;
• in remote and isolated regions of the province by registered nurses, registered practical nurses or physician assistants;
• under public health programs or in a public health emergency; and
• in a hospital under medical directives or protocols. 

These targeted changes have been made in advance of a full policy review, which is now underway and for which a draft policy has been released for consultation.