RTs commonly administer medications via the authority granted to them by the Respiratory Therapy Act – “administering a substance by injection or inhalation” [s.4 (4)]. Dispensing occurs less often and will be explained later in this PPG. RTs are responsible for administering medications within both their personal and professional scope of practice. The safe and competent administration of medication requires the RT to have the competencies (knowledge, skill and abilities) to:


assess the appropriateness of a particular medication for the patient/client, including indications and contraindications;

be aware of the actions, interactions, dose, route, side-effects and adverse effects of the drug;

be able to calculate the correct dosage and prepare the medication correctly, when necessary; and


to monitor the patient/client during and following administration, as well as manage any side-effects or adverse reactions to the drug, intervening when necessary.

*Prior to administering any substance, the Respiratory Therapy Act requires RTs to obtain a valid order (direct order or medical directive) from:

(a) a member of the College of Physicians and Surgeons of Ontario, the College of Midwives of Ontario or the Royal College of Dental Surgeons of Ontario;
(b) a member of the College of Nurses of Ontario who holds an extended certificate of registration under the Nursing Act, 1991; or
(c) a member of a health profession that is prescribed by regulation.

It is important to note that the Members of the regulated professions above must also abide by their own legislation when it comes to delegation. Please see Accepting Delegation to Dispense.

Examples of administering medication:

  • Obtaining, preparing and administering a narcotic for use during conscious sedation of a patient/client
  • Obtaining, preparing and administering a drug from a supervised hospital or departmental “stock” of medications (e.g. sedatives kept in a bronchoscopy suite for use during an outpatient procedure)

The 10 “Rights” of Competent Medication Administration


1. right PATIENT/CLIENT – should be at least two unique identifiers (not room number);


2. right MEDICATION to be given – compare Medication Administration Record (MAR) with order;


3. right ROUTE – includes site (e.g., IV, IM);


4. right TIME/ DAY – includes frequency;


5. right DOSE – check calculation and label;


6. right DOCUMENTATION – i.e. after medication is administered;


7. right FORM – e.g. liquid, tablet, etc.;


8. right REASON or ACTION – to treat the appropriate condition; and


9. right RESPONSE – monitor to ensure that the medication has the desired effect.


10. right REFUSE – respecting the patient’s right of choice


Dispensing can only occur once. After a drug is labelled and dispensed to a patient/client via an automated medication dispensing unit, physically giving the medication to the patient/client is administration, not dispensing.​

Medication Management Systems

Most facilities now use some form of medication management system, which usually includes an automated medication dispensing unit. The purpose of implementing this type of delivery system is to avoid preventable medication errors and improve patient safety. The pharmacy receives the medication order electronically from the physician and dispenses the medication into the unit. The medication can then be accessed by staff to be administered when needed.

Oral and Topical Medication

Administration of a substance orally or topically is not a controlled act under the RHPA and is not considered dispensing unless a supply was given to the patient/client to take at another time. An RT may assist a patient/client in taking their prescribed tablets at the time they are due; however, an RT may not leave extra tablets from a stock at the bedside for the patient/client to take. As with all other medications, to administer oral (e.g., Prednisone) and topical medications (e.g., Lidocaine) the RT needs to know the indications, contraindications, proper dosages and potential side-effects. The prescription and medication container must be checked, along with the patient/client’s identity and any potential allergies/drug sensitivities, as with any other medication. Oral medications in a tablet form should be given to the patient in a disposable container, and liquid preparations should be measured using syringes specifically designed for that purpose. The RT must ensure that the medication was taken by the patient/client as directed, and document accordingly.

Over the Counter (OTC) Medication

OTC refers to medications that can be obtained in the community without a prescription from an authorized regulated health care professional. However, in a hospital setting an order is still required to administer an OTC medication. Many facilities also have policies requiring that any OTC medication brought in from home by a patient/client must be sent to the pharmacy for labelling, and then approved by the most responsible physician before returning it to the patient/client.

If an RT is giving out OTC medication in a community setting (e.g., nicotine replacement therapy (NRT) in an outpatient smoking cessation clinic), they are responsible for ensuring the medication is stored securely and must dispose of any medication that is past its expiry date. For more information, please see the section on Safe Storage and Handling.


In order for me to hand out OTC NRT in our Family Health Team, do I need to get delegation to dispense?

What do you do?

OTC medication does not require an order from a physician in the community and is not “dispensed”. Therefore, RTs do not need delegation to provide OTC NRT to a patient/client to take home. However, if this was an in- hospital PFT clinic, an order would be required for the NRT to be given to the patient.


Administration (of a medication): the direct application of a drug to the body of a specific patient or research subject by injection, inhalation, ingestion, or any other means.

Authority: the right to act, as outlined in the legislation, usually related to terms, conditions or limitations imposed on a certificate of registration.

Controlled act: one of the 13 acts defined in the RHPA [section 27(2)]

Compounding: the act of combining two or more elements to create a distinct pharmaceutical product. Compounding is not authorized to Respiratory Therapists. Delegation is not required when combining elements to prepare a drug for administration. For example: mixing liquid bronchodilators in normal saline for aerosolized therapy.

Competence: having the requisite knowledge, skills and judgement/abilities to perform safely, effectively and ethically; and applying that knowledge, skills and judgement/abilities to ensure safe, effective and ethical outcomes for the patient/client.

Delegation: the transfer of the legal authority to perform a procedure within a controlled act to a person not otherwise authorized to perform the procedure.

Drug: as defined in the Drug and Pharmacies Regulation Act.

Labelling: the process of preparing and affixing a label to any drug container. Any such label shall include all information required by provincial regulations. In this context, labelling does not include the labelling by the manufacturer, packer or distributor of a non-prescription drug or commercially packaged drug or device.

Order: An “order” is the authority to undertake an intervention if the circumstances are appropriate and, in your professional judgement, it is appropriate to undertake the intervention. For more information of what constitutes a valid order, please see the Orders for Medication Care PPG.

Pharmacy: a premise in or in part of which prescriptions are compounded or dispensed for the public.

Prescriber: a person authorized to give a prescription within the scope of his or her practice of a health discipline or profession.

Prescription: an authorization from a prescriber permitting the dispensing of any drug or mixture of drugs for a designated person or animal.

Regulated health care professional — a health care provider who is a member of a CRTO and is regulated by the RHPA (e.g., nurse, physician, dentist, massage therapist, physiotherapist, dietitian, occupational therapist, etc).

Respiratory Therapists: Members of the CRTO (RRT, GRT, PRT).

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