Insight

Delegation, Assignment and Pre-Testing

Delegation By Opticians

Delegation is when a regulated health professional transfers their authority to perform a controlled act to a person who is not authorized to perform that act. Delegation can only occur where it complies with relevant standards and/or regulations governing the professional who is delegating the act.

In Ontario, registered opticians who choose to delegate must do so in accordance with the Standards of Practice, and in particular Standard 10: Delegation.

If you choose to delegate to a non-optician, it is important to keep the following in mind:

• You should only delegate where you believe it is in the patient’s best interest to do so. In addition, you should consider the patient’s comfort level, and ensure you have their informed consent. This means ensuring that the patient understands that they are receiving a service from someone who is not an optician, that you are the responsible optician, and that they can decline this service if they want.
• You should only delegate to someone who has the knowledge, training and ability to perform the task properly and competently.
• You can only delegate tasks that are part of your regular practice and that you are competent to perform yourself. For example, if you do not ordinarily fit rigid contact lenses, then you should not delegate this task to a non-optician, even if they are experienced. You also cannot delegate a task that was delegated to you by someone else.
• You must be physically present when the task is being performed, and able to intervene if necessary. This means that delegation cannot take place remotely. You also need to monitor or supervise the person who is performing the task. The amount of monitoring/supervision will depend on factors such as the nature of the task, the training and experience of the person performing it, and the optician-patient relationship.
• You remain responsible for the patient outcome, and for recording the information in the patient file.

Delegation is different from assignment. Opticians may assign tasks that are not considered controlled acts (e.g. data entry, minor repairs such as replacing a screw) to non-opticians. As with delegation, the best interest of the patient should always be the main consideration and the optician remains responsible for all patient outcomes.

Receiving Delegation

Opticians are also eligible to receive delegation from another regulated health professional (e.g. optometrist) to perform a controlled act that is otherwise outside the scope of opticianry.

Receiving delegation is also covered by Standard 10 of the Standards of Practice. It is important to remember that you cannot receive delegation, even from another optician, while your certificate of registration has been suspended, or is subject to a term, condition or limitation that prohibits you from performing the controlled act in question.

When you receive delegation, the delegating health professional will bear ultimate responsibility for the patient outcome. But, as an optician, you always remain responsible for acting competently, ethically and in accordance with the Standards. In particular, when receiving delegation, you remain responsible for ensuring that:

• The delegation is in the best interest of the patient. If you believe it would be better for the patient to receive the service from the responsible health professional directly, it is your responsibility to say so.
• The patient has given their informed consent to receive this service from you under delegation. This means you are responsible for ensuring that the patient understands that this task has been delegated to you by another regulated health professional, and that you are performing it under their supervision.
• You have received appropriate training and possess the knowledge, skill, and judgment to perform the task in question competently and safely.
• The regulated health professional is authorized to delegate to you, is themselves competent and is following their own standards and rules relating to delegation.
• You create and keep your own patient record for any service that you provide under delegation, even if the delegating professional has made their own record.

Pre-Testing

Many opticians work in collaborative practice environments with optometrists and/or ophthalmologists, and may be asked to carry out pre-testing tasks prior to the patient receiving an eye exam or assessment.

In general, most pre-testing tasks are not controlled acts and can be assigned by a prescriber to an optician, rather than delegated. Whether the task is assigned or delegated, though, the optician remains responsible for ensuring they have the requisite knowledge and training to perform it safely and competently, and that the person assigning or delegating the task to them is authorized to do so.

The Choice is Yours Alone

It is important to remember that you are never required to delegate or assign tasks to a non-optician, nor are you ever required to accept delegation or assignment from another regulated health professional. If you choose to give or receive delegation, you take on the responsibilities that come with it.