Medical Directives
Review and Acknowledgment of Medical Directives
Physicians are required by legislation to sign off initially and if there is a significant change on Medical Directives for which they are deemed to be responsible. To meet the requirement, Lakeridge Health uses a process that links authorization of Medical Directives relevant to your practice to your annual reapplication. The following statement has been included to the Declaration Section of the Reapplication Form:
I have reviewed and acknowledge the Medical Directives for which I am an authorizing physician.
New/Changed/Harmonized Medical Directives for 2021/22 are:
- Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
- Critical Care Outreach Team (CCOT) Adult In-Patient Medical Directive (all LHO Critical Care Intensivists, LHB & LHAP Physicians)
- Medic Emergency Situations at Lakeridge Health Medical Directive (all MRPs)
A comprehensive list of all Medical Directives categorized by practice groups is included below. Legacy RVHS Medical Directives can be found on the WAVE.
Going forward, we encourage physician participation in the ongoing revision, and development of both existing and new medical directives. Should you have any recommendations please contact your section chief, program director, or Pharmacy & Therapeutics Committee representative. We strive for Medical Directives to reflect evidence based best practices. Your input is welcomed and appreciated.
Thank you in advance for your cooperation and assistance.
Medical Directives By Practice
All Physicians Providing Service at Lakeridge Health Bowmanville
- Adult Enteral Tube Feeding Medical Directive
- Critical Care Response Team (CCRT) Adult In-patient Medical Directive
- Diet Texture by Speech Language Pathologists (all MRPs)
- Emergency Situations Medical Directives (all MRPs)
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Rapid Response System - Chest Pain
- Rapid Response System - Respiratory Distress
- Rapid Response System - Abdominal Pain
- Rapid Response System - Changes in Central Nervous System Status
- Rapid Response System - Hypotension/Shock
- Rapid Response System - Suspected Anaphylaxis-Like
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
Anesthetists (Lakeridge Health Oshawa Only)
- Emergency Situations Medical Directives (all MRPs)
- Administration of Neuromuscular Blocking Agents and Reversal Agents by the Anesthesia Assistant
- Insertion of Arterial Lines by Anesthesia Assistants
- Management of the Acute Onset of Bradycardia by Anesthesia Assistants
- Management of Hypopnea and/or Apnea in the Sedated Patient by Anesthesia Assistants
- Management of Hypertension by Anesthesia Assistants
- Management of Hypotension by Anesthesia Assistants
- Management of Hypoxemia by Anesthesia Assistants
- Management of Intravenous Fluid Therapy by Anesthesia Assistants
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
Anesthesiologists (Hospital Wide)
- Administration of Pre-Operative Acetaminophen for Paediatric Day Surgery
- Adult Pre-Operative Testing Grid
- Ultrasound Guidance for Prescribed Procedures
Code Blue First Responders
- Emergency Situations Medical Directives (all MRPs)
- Adult Advanced Life Support (ALS) - Code Blue, Emergency & Critical Care Physicians)
- Advanced Life Support Automated External Defibrillation
- Advanced Life Support Intraosseous Cannulation and Infusion
- Automated External Defibrillation (AED) Medical Directive
COVID-19 Associated Clinic Physicians
- Management of Anaphylaxis for Paediatric Patients from 12-16 years of Age for Pfizer-BioNTech COVID-19 mRNA Vaccine
- Management of Anaphylaxis for Pfizer-BioNTech and/or Moderna COVID-19 mRNA Vaccine for COVID-19 following immunization
- Moderna Spikevax COVID-19 mRNA Vaccine for COVID-19 immunization
- Paramedic Pfizer-BioNTech and Moderna Covid-19 mRNA Vaccine
- Pfizer-BioNTech COVID-19 mRNA vaccine for adult (12 years of age and older) COVID-19 immunization
- Unregulated Care Providers Pfizer-BioNTech COVID-19 mRNA Vaccine for COVID Immunization Clinic
Diagnostic Imaging Physicians
- Computed Tomography (CT) Coding
- CT Chest, Ontario Lung Screening Program OLSP
- Emergency Situations Medical Directives (all MRPs)
- Hyoscine Butylbromide (Buscopan) Injection for Diagnostic Imaging Procedures
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
Endocrinologists
- Adult Enteral Tube Feeding Medical Directive
- Diet Texture by Speech Language Pathologists (all MRPs)
- Emergency Situations Medical Directives (all MRPs)
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Point of Care Glucose Meter Testing and Treatment for Out-Patients with Suspected Hypoglycemia
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
ER Physicians (Hospital Wide)
- COPD
- Diet Texture by Speech Language Pathologists (all MRPs)
- Emergency Department - Medical Directives
- Emergency Situations Medical Directives (all MRPs)
- Obstetric Patient in the Emergency Department
- Off Site Naloxone Administration (Emergency Department physicians)
- Emergency Department Naloxone Distribution Kit
- Nicotine Replacement Therapy
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Pediatric Asthma
- Adult Intubation by Registered Respiratory Therapist
- Adult Enteral Tube Feeding Medical Directive
- Oral Nutrition Therapy
- Adult Advanced Life Support (ALS) - Code Blue, Emergency & Critical Care Physicians)
- Advanced Life Support Automated External Defibrillation
- Advanced Life Support Intraosseous Cannulation and Infusion
- Automated External Defibrillation (AED) Medical Directive
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
- Ultrasound Guidance for Prescribed Procedures
ER Physicians (Lakeridge Health Oshawa Only)
- Adult Enteral Tube Feeding Medical Directive
- Automated External Defibrillation (AED) Medical Directive
- Diet Texture by Speech Language Pathologists (all MRPs)
- Domestic Violence-Sexual Assault Medical Directive
- Emergency Department - Medical Directives
- Emergency Department Naloxone Kit Distribution
- Emergency Situations Medical Directives (all MRPs)
- Erythromycin for Chlamydia Drug Prophylaxis When a Client is Pregnant or Breastfeeding
- Nicotine Replacement Therapy
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
Family Medicine Obstetrics
- Initial Screening and Management of Hypoglycemia in Neonates Greater than 35 weeks Gestation
- Well Newborn - Family Medicine Obstetrics
General Surgeons
- Adult Pre-Operative Testing Grid
- Adult Enteral Tube Feeding Medical Directive
- Diet Texture by Speech Language Pathologists (all MRPs)
- Emergency Situations Medical Directives (all MRPs)
- Initiation of Intravenous in Endoscopy Suite
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Staging Investigations for Colorectal Patients Within the Colorectal Diagnostic Assessment Program
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
- Orthopedic and General Surgery Preoperative Blood Conservation - (Orthopedic And General Surgeons)
Hospitalists
- Adult Enteral Tube Feeding Medical Directive
- Diet Texture by Speech Language Pathologists (all MRPs)
- Emergency Situations Medical Directives (all MRPs)
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Adult Intubation by Registered Respiratory Therapist
- Oral Nutrition Therapy
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
Infectious Diseases Physicians - Positive Care Clinic
- Collection of Acute Respiratory Infection (ARI) for Infection, Prevention, and Control Surveillance and Outbreak Management
- Abbott ID Now COVID Swab and Processing
- Take Home Naloxone Kit (Positive Care Clinic Physicians & RAAM physicians)
- Emergency Situations Medical Directives (all MRPs)
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
Intensivists
- Adult Enteral Tube Feeding Medical Directive
-
Adult Advanced Life Support (ALS) - Code Blue, Emergency & Critical Care Physicians)
- Advanced Life Support Intraosseous Cannulation and Infusion
- Automated External Defibrillation (AED) Medical Directive
- CCOT - Abdominal Pain
- CCOT - Changes in Central Nervous System Status
- CCOT - Chest Pain
- CCOT - Hypotension-Shock
- CCOT - Respiratory Distress
- CCOT - Suspected Anaphlyaxis
- Critical Care Response Team (CCRT) Adult In-patient Medical Directive
- Diet Texture by Speech Language Pathologists (all MRPs)
- Emergency Situations Medical Directives (all MRPs)
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Point of Care Arterial Blood Gas Test in Emergency and Critical Care
- Adult Intubation by Registered Respiratory Therapist
-
Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
- Ultrasound Guidance for Prescribed Procedures
Midwives
- Initial Screening and Management of Hypoglycemia in Neonates Greater than 35 weeks Gestation
- Well Newborn - Midwives
Nephrologists
- Administration of Influenza Vaccination to Out-Patients of the Regional Nephrology Program
- Adult Enteral Tube Feeding Medical Directive
- Diet Texture by Speech Language Pathologists (all MRPs)
- Emergency Situations Medical Directives (all MRPs)
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Treatment of Anaphylaxis within the Regional Nephrology Program
- Adult Intubation by Registered Respiratory Therapist
- Oral Nutrition Therapy
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
Obstetricians
- Adult Enteral Tube Feeding Medical Directive
- Diet Texture by Speech Language Pathologists (all MRPs)
- Emergency Situations Medical Directives (all MRPs)
- Hypertension Screening With Routine Non-Stress Test
- Obstetric Patient in the Emergency Department
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Adult Intubation by Registered Respiratory Therapist
- Oral Nutrition Therapy
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
Occupational Health Physician(s)
- Adult Enteral Tube Feeding Medical Directive
- Antiviral Medication
- BloodTest, Chest X-Ray and Tuberculin Skin Test
- Emergency Situations Medical Directives (all MRPs)
- Influenza Vaccination
- Management of Anaphylaxis
- Management of Anaphylaxis for Pfizer-BioNTech and/or Moderna COVID-19 mRNA Vaccine for COVID-19 following immunization
- Moderna Spikevax COVID-19 mRNA Vaccine for COVID-19 immunization
- Occupational Health Vaccination for Vaccine-Preventable Diseases
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Pfizer-BioNTech COVID-19 mRNA vaccine for adult (12 years of age and older) COVID-19 immunization
Oncologists
- Adult Enteral Tube Feeding Medical Directive
- Clinical Trials Laboratory Investigations
- Diet Texture by Speech Language Pathologists (all MRPs)
- Emergency Situations Medical Directives (all MRPs)
- EMLA Cream Application for Oncology & Hematology Patients
- Gynecological Diagnostic Assessment Program Investigations
- Alteplase (Cathflo) Instillation for Complete or Partially Occluded Central Venous Access Devices
- Adult Intubation by Registered Respiratory Therapist
- Oral Nutrition Therapy
- Ordering Specific Diagnostic Tests, Images, Scans and Procedures by Nurse Practitioners
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
Orthopedic Surgeons
- Adult Pre-Operative Testing Grid
- Adult Enteral Tube Feeding Medical Directive
- Diet Texture by Speech Language Pathologists (all MRPs)
- Emergency Situations Medical Directives (all MRPs)
- Outpatient Surgical Preoperative Blood Conservation
- Rapid Access Clinic Physiotherapists Ordering of Diagnostic Imaging - Medical Directive
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
- Orthopedic and General Surgery Preoperative Blood Conservation - (Orthopedic And General Surgeons)
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Physician Assistant Lakeridge Health Ajax Pickering Shoulder Centre
- Medical Directives for Physician Assistant - Surgical Program Orthopedic Division
Pediatricians and Neonatologists
- Acetaminophen Administration for Treatment of Fever In Pediatric Patients Admitted to the Pediatric Unit
- Adult Enteral Tube Feeding Medical Directive
- Diet Texture by Speech Language Pathologists (all MRPs)
- Emergency Situations Medical Directives (all MRPs)
- Initial Screening and Management of Hypoglycemia in Neonates Greater than 35 weeks Gestation
- Naloxone (Narcan) Administration in Respiratory Depressed Pediatric Patients Receiving Opioids
- Neonatal/Infant/Pediatric Intubation
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Sucrose 24% Oral Solution for Pain Management in Neonates and Infants
- Well Newborn - Pediatricians and Neonatologists
- Adult Intubation by Registered Respiratory Therapist
- Oral Nutrition Therapy
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
PASS Program Physicians
- Adult Enteral Tube Feeding Medical Directive
- Diet Texture by Speech Language Pathologists (all MRPs)
- Emergency Situations Medical Directives (all MRPs)
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- PASS Implementation of Specific Diagnostic Tests, Images & Scans by NPs
- Adult Intubation by Registered Respiratory Therapist
- Oral Nutrition Therapy
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
- Stroke Prevention Clinic Diagnostic – Medical Directive
Pinewood Centre Practitioners
- Emergency Situations Medical Directives (all MRPs)
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Residential Withdrawal Management Service (RWMS) Admission COVID-19 Point of Care (POC) Testing for Clients
Psychiatrists
- Adult Enteral Tube Feeding Medical Directive
- Diet Texture by Speech Language Pathologists (all MRPs)
- Emergency Situations Medical Directives (all MRPs)
- Urine Drug Screens/Blood Alcohol Levels
- Adult Intubation by Registered Respiratory Therapist
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Oral Nutrition Therapy
- Nicotine Replacement Therapy
- Residential Withdrawal Management Service (RWMS) Admission COVID-19 Point of Care (POC) Testing for Clients
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
Rapid Access Addiction Medicine Clinic Physicians
Respirologists
- Malignant Pleural Effusion Clinic Investigations
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
SACC Physicians
- Domestic Violence-Sexual Assault Medical Directive
- Emergency Situations Medical Directives (all MRPs)
- Erythromycin for Chlamydia Drug Prophylaxis When a Client is Pregnant or Breastfeeding
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
Stroke Prevention Clinic Physicians
Surgeons (Hospital Wide)
- Adult Pre-Operative Testing Grid - Surgeons
- Pre-operative COVID-LHO Rapid Testing for Admitted Surgical Adult Patients Requiring Continuous Positive Airway Pressure (CPAP) Therapy Devices
Thoracic Surgeons
- Adult Pre-Operative Testing Grid - Thoracic Surgeons
- Adult Enteral Tube Feeding Medical Directive
- Diagnostic Testing for Lung Patients Prior to their First Surgical Consult Visit within Thoracic Diagnostic Assessment Program
- Diet Texture by Speech Language Pathologists (all MRPs)
- Emergency Situations Medical Directives (all MRPs)
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Initiation of Intravenous in Endoscopy Suite
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
All Associate, Active, Courtesy Workload and Locum Physicians not listed above
- Adult Intubation by Registered Respiratory Therapist
- Diet Texture by Speech Language Pathologists (all MRPs)
- Emergency Situations Medical Directives (all MRPs)
- Oral Nutrition Therapy
- Parenteral Nutrition (Adult & Paediatric) (all MRPs)
- Adult Enteral Tube Feeding Medical Directive
- Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)