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
  

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
• 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)

• 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

Diagnostic Imaging Physicians

• 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)

• Adult Ashma
• COPD
• Diet Texture by Speech Language Pathologists (all MRPs)
• Emergency Department - Medical Directives
• Emergency Situations Medical Directives (all MRPs)
• Emergency Sepsis Protocol: Early Recognition and Treatment
• 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)

• Acetaminophen Plain for Uncomplicated Pain
• Adult Enteral Tube Feeding Medical Directive
• Automated External Defibrillation (AED) Medical Directive
• Azithromycin for Chlamydia Drug Prophylaxis
• Azithromycin for Gonorrhea Drug Prophylaxis When a Client is Allergic to Penicillin or Cephalosporin
• Cefixime for Gonorrhea Drug Prophylaxis
• Diet Texture by Speech Language Pathologists (all MRPs)
• Dimenhydrinate for Prevention of Nausea Induced by Prophylactic Medication
• Doxycycline for Chlamydia Drug Prophylaxis for a Client with a Macrolide Allergy
• Emergency Contraceptive Pill (ECP) for Pregnancy Drug Prophylaxis
• 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
• Hepatitis B Immune Globulin (HBIG) for Hepatitis B Virus Prophylaxis
• Hepatitis B Vaccine for Hepatitis B Drug Prophylaxis
• HIV Post Exposure Prophylaxis for Sexual Assault Victims
• Nicotine Replacement Therapy
• Parenteral Nutrition (Adult & Paediatric) (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)

 General Surgeons

• 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)
• Term Newborn NOT AT RISK for Hypoglycemia
• Term Newborn at Risk for Hypoglycemia
• Adult Intubation by Registered Respiratory Therapist
• Oral Nutrition Therapy
• Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)

Infectious Diseases Physicians - Positive Care Clinic

• Take Home Naloxone Kit (Postivie 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 Automated External Defibrillation

• 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
• 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

• Oral Nutrition Therapy

• Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)
• Ultrasound Guidance for Prescribed Procedures

 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
• Administration of Influenza Vaccine to Healthcare Workers
• Antiviral Medication
• BloodTest, Chest X-Ray and Tuberculin Skin Test
• Emergency Situations Medical Directives (all MRPs)
• Influenza Vaccination
• Management of Anaphylaxis
• Occupational Health Vaccination for Vaccine-Preventable Diseases
• Parenteral Nutrition (Adult & Paediatric) (all MRPs)

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)
• Patient Tattooing - (Radiation Oncologists) 

Orthopedic Surgeons

• Adult Enteral Tube Feeding Medical Directive
• Diet Texture by Speech Language Pathologists (all MRPs)
• Emergency Situations Medical Directives (all MRPs)
• Orthopedic Patients Referred to Preoperative Blood Conservation Clinic (BCC)
• 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)
• 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 NICU Neonates
• Term Newborn at Risk for Hypoglycemia
• 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)

Pinewood Centre Practitioners

• Emergency Situations Medical Directives (all MRPs)
• Parenteral Nutrition (Adult & Paediatric) (all MRPs)

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
• Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)

Rapid Access Adiction Medicine Clinic Physicians

• Take Home Naloxone Kit (Postivie Care Clinic Physicians & RAAM physicians)

Respirologists

• Malignant Pleural Effusion Clinic Investigations 
• Parenteral Nutrition (Adult & Paediatric) (all MRPs)

SACC Physicians

• Acetaminophen Plain for Uncomplicated Pain
• Azithromycin for Chlamydia Drug Prophylaxis
• Azithromycin for Gonorrhea Drug Prophylaxis When a Client is Allergic to Penicillin or Cephalosporin
• Cefixime for Gonorrhea Drug Prophylaxis
• Dimenhydrinate for Prevention of Nausea Induced by Prophylactic Medication
• Doxycycline for Chlamydia Drug Prophylaxis for a Client with a Macrolide Allergy
• Emergency Contraceptive Pill (ECP) for Pregnancy Drug Prophylaxis
• Emergency Situations Medical Directives (all MRPs)
• Erythromycin for Chlamydia Drug Prophylaxis When a Client is Pregnant or Breastfeeding
• Hepatitis B Immune Globulin (HBIG) for Hepatitis B Virus Prophylaxis
• Hepatitis B Vaccine for Hepatitis B Drug Prophylaxis
• HIV Post Exposure Prophylaxis for Sexual Assault Victims
• Parenteral Nutrition (Adult & Paediatric) (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) - (All MRPs)

Stroke Prevention Clinic Physicians

• Stroke Prevention Clinic Diagnostic

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)