Standards of Practice for Chiropodists and Podiatrists

Administration of Injectable Substances (Including Local Anaesthesia)

The member will always administer any injectable substance using a safe technique.

CRITERIA:

  1. The member shall administer any injectable substances only if they have gained a qualification to do so which is recognized by the College of Chiropodists of Ontario. (see Chiropody Act, 1991 section 5(1)2) and College Local Anaesthesia policy).
  2. The member shall convey appropriate information to the patient and obtain consent before the administration of any injectable substance (see Consent).
  3. The member will be proficient in the procedures that follow in the case of anaphylaxis, or other clinical emergencies which can result from the administration of an injectable substance.
  4. The member will ensure that the needles, syringes and substances to be injected are sterile.
  5. The member will always follow the criteria outlined in the Infection Control standard.
  6. The member will not discharge the patient from the clinic following administration of an injectable substance until the patient and/or the member are convinced that no adverse reactions or complications are likely to occur.
  7. In all cases where any injectable substance is administered the dosage, quantity, site, effectiveness and the presence or absence of adverse reactions, will be charted in detail (see Records).
  8. The disposal of sharps, including needles, syringes and vials should be in accordance with the criteria outlined in the Infection Control and Safety and the Practice Environment standards.
  9. An emergency kit and oxygen supply will be maintained in good order in the suite. Instructions for their use will be in the office manual.
Assessment and Management

The member shall perform an assessment for each patient seen in clinical practice and establish a management plan based on the assessment.

CRITERIA: Assessment

  1. The initial assessment recorded shall include pertinent information gathered from the patient’s history and relevant clinical findings.
  2. A differential diagnosis shall be stated as well as a treatment plan with anticipated prognosis.
  3. Required tests, referrals and/or consultations shall be recorded (See Records).
  4. The patient record shall be reviewed periodically and amended where there is a change in health status.

CRITERIA: Management

  1. Treatment areas should provide privacy, security and comfort.
  2. The condition, treatment plan and prognosis shall be discussed with, and explained to the patient (see Patient Relations; Communication).
  3. No member shall treat or attempt to treat a problem or condition which the member recognizes, or should have recognized, is beyond their experience, scope or competence (see Competency).
  4. No member shall provide treatment which they know, or should have known, would be harmful or which is inappropriate to meet the needs of the patient.
  5. No member shall continue treatment of a patient where such need is no longer indicated or treatment has ceased to be effective.
  6. Consultation with and/or referral to another health professional shall be made when the patient’s condition is beyond the member’s scope of practice, or where the member deems the referral/consultation to be in the best interest of the patient.
  7. The treatment plan shall be reviewed periodically.
Competence

The member shall conduct themselves so that patients receive the member’s most effective personal performance.

CRITERIA:

  1. Each member is responsible for maintaining his or her competence.
  2. Each member is responsible for evaluating his or her own educational needs and meeting those needs through programs of continuing education.
  3. The member shall perform within his or her scope of practice, education and experience.
  4. The member will refer, or assist patients to find the necessary professional help when the condition or status of the patient falls outside his or her scope of practice, education or experience
    ( see Professional Misconduct regulation – pdf )
  5. The member shall not engage in the practice of chiropody/podiatry while his or her ability to do so is impaired.
    ( see Professional Misconduct regulation – pdf )
  6. The member shall ensure that he or she meets the quality assurance requirements outlined in the Quality Assurance regulation and Quality Assurance policy of the College.
  7. The member shall maintain current knowledge of legislation, standards and policies pertaining to the delivery of chiropodial/podiatric care and to the education or general welfare of his or her patients.
Infection Control

Infection control is considered an integral part of patient care. Concerns regarding the possible
spread of blood-borne diseases have prompted practitioners to reassess and update their infection control measures. The College of Chiropodists of Ontario has revised its infection control standards to meet the needs of the profession and to provide the public of Ontario with safe foot care.

Read the full Infection Control Standard of Practice here – 7 page PDF Document

Inhalation

The College is continuing to finalize this Standard of Practice on Inhalation. It is anticipated that an updated version of the Standard will be on Council’s agenda for the February 24, 2017 meeting. The College, in conjunction with its consultant, will be designing the didactic and clinical educational program for inhalation as well as the examination. Members are reminded that they are not allowed to use inhalation in their practice until they have successfully completed the program and passed the examination, both of which are yet to come.

Nail and Cutaneous Soft Tissue Surgery

The member must make every effort to ensure a satisfactory post-operative result and reduce the risk of complications.

CRITERIA:

  1. The operating environment must be prepared in accordance with the Infection Control standard.
  2. Clean equipment and sterile instruments are to be used (see Infection Control).
  3. An appropriate pre-operative work up is to be done prior to surgery.
  4. Patients must be informed of the purpose and nature of treatment and risks involved, in such a way as to be able to decide whether or not to undergo the recommended surgery (see Patient Relations-Informed Consent).
  5. An informed consent must be obtained from a patient in accordance with the consent standard and legislation, prior to surgery, and before any pre-operative medication has been administered (see Patient Relations-Informed Consent).
  6. All surgical fees shall be discussed, recorded and fully explained to the patient prior to the surgery. Any related services that require an additional fee shall be listed, and any time limit on inclusive post operative visits should be stated (see Records).
  7. The patient shall be given a post-operative instruction sheet which must be reviewed verbally so that any misinterpretation can be avoided.
  8. The member must have the education and experience relative to the procedure being performed (see Competence).
Osseous and Subcutaneous Surgery

The member must make every effort to ensure a satisfactory post operative result and reduce the risk of complications.

CRITERIA:

  1. The operating environment must be prepared in accordance with the Infection Control standard.
  2. Clean equipment and sterile instruments are to be used. (see Infection Control)
  3. Sterile drapes shall be used around the operative site and cover all non-sterile areas within a reasonable distance of the operative site. (see Infection Control)
  4. Prior to osseous surgery the patient’s physician should be consulted to confirm that there are no known medical contraindications to the surgery.
  5. Pre and post-operative X-rays must be taken for osseous surgery.
  6. Patients must be informed of the purpose and nature of treatment and risks involved, in such a way as to be able to decide whether or not to undergo the recommended surgery. (see Patient Relations-Informed Consent)
  7. A signed informed consent must be obtained from a patient in accordance with the consent standard prior to surgery and before any pre-operative medication has been administered. (see Patient Relations-Informed Consent)
  8. All surgical fees shall be discussed, recorded and fully explained to the patient prior to the surgery. Any related services that require an additional fee shall be listed and any time limit on inclusive post operative visits should be stated. (see Records)
  9. The patient shall be given a post-operative instruction sheet which must be reviewed verbally so that any misinterpretation can be avoided.
  10. The member must have the education and experience relative to the procedure being performed. (see Competence)
Patient Relations

Table of Contents

  1. Informed Consent
  2. Communications
  3. Confidentiality
  4. Professional Conduct and Accountability
    • Standard 1
    • Standard 2
  5. Sexual Ethics

INFORMED CONSENT

STANDARD:

The member will provide the patient with the necessary information and obtain a valid informed consent prior to the start of any procedure and /or treatment in accordance with the Healthcare Consent Act, 1996.


COMMUNICATIONS

STANDARD:

The member shall take reasonable steps to ensure patient comprehension of assessment findings, diagnoses, treatment plan and prognoses.

CRITERIA:

  1. The member will provide complete, accurate information concerning the patient’s assessment/diagnosis, treatment and prognosis, in terms the patient can be reasonably expected to understand.
  2. The College recognizes that consent is implied when the patient attends for the purpose of assessment for treatment, and that the nature of any treatment plan must be disclosed to the patient following such assessment prior to the implementation of the treatment plan.
  3. It is recommended that in a situation warranting biomechanical assessment, the nature of the procedure should be disclosed to the patient prior to commencement of physical examination beyond the foot.
  4. In cases where the member is unable to communicate in a language which the patient can understand, every effort should be made to arrange for an interpreter at the next and subsequent visits.

CONFIDENTIALITY

STANDARD:

The member shall ensure that patient confidentiality is maintained at all times.

CRITERIA:

  1. Any personal confidences not relating to the management of the patient should not be discussed with others.
  2. Case discussion, consultation, examination and treatment is confidential and should be conducted discreetly.
  3. Those individuals, including students, not directly involved in the patient care must seek permission to be present during assessment or treatment.
  4. When seeking advice or assistance from a colleague, only relevant information should be communicated.
  5. The patient record is regarded as confidential and should be secured appropriately when not in use (see Records).
  6. A member will not allow any person, except as authorized by law, to examine a patient health record, or give any information, copy or thing from the patient health record (see Records regulation).
  7. The assessment and treatment area should provide a confidential atmosphere. The treatment room should be separated from the waiting and reception area by a closable door, suitable partitioning should be available in the area to provide privacy for removing clothing.
  8. Telephone conversations regarding patients should be carried out in privacy.
  9. Discussion of patient details should be limited to professional dealings ie. other health care providers.

PROFESSIONAL CONDUCT AND ACCOUNTABILITY

STANDARD 1:

The member shall meet the ethical and legal requirements of professional practice.

CRITERIA:

1.1)The member shall function in accordance with the Regulated Health Profession Act, 1991, Chiropody Act, 1991, regulations and standards of practice of the College of Chiropodists of Ontario.
1.2)The member is accountable for his or her own actions.
1.3)The member shall practise within their scope of practice, education and experience and in accordance with the requirements outlined in the COMPETENCE standard.
1.4)A member shall not provide treatment which they know, or should have known, would be harmful or which is inappropriate to meet the needs of the patient (see Assessment and Management).
1.5)A member shall not continue treatment of a patient where such need is no longer indicated or treatment has ceased to be effective (see Assessment and Management).
1.6)The member shall inform the College when a physical or mental condition/disease has affected, or is likely to affect, his or her ability to practise safely or competently.
1.7)The member shall recognize that, while he or she has the right respecting choice of patients he or she shall act in a manner consistent with the Human Rights Code.
1.8)A member shall not pass judgement on the qualification or procedures rendered by a fellow member except as may be required in the interest of the patient’s foot health.

STANDARD 2:

The member shall not seek special benefit or advantage from relations with a patient.

CRITERIA:

2.1)The member shall not charge fees that are excessive in relation to the service or devices charged for.
2.2)The member shall not sell a professional account to a third party.
2.3)The member shall not charge fees for services not performed.
2.4)The member shall not use, or attempt to use, information received from or to a patient, to directly or indirectly acquire advantage or material benefits.
2.5)The member shall not persuade or influence a patient to make gifts or contributions to him or her, or to institutions, organizations or charities in which he or she has a direct interest.
2.6)The member shall not accept a gift of more than token value from a patient.
2.7)The member shall not have sexual relations with a patient (see Sexual Ethics).
2.8)The member shall not request to date a patient.
2.9)The member shall not receive or confer a rebate or other benefit by reason of referral or transfer of a patient from or to another person.

Reference: Professional Misconduct and proposed Advertising regulations under the RHPA.


SEXUAL ETHICS

STANDARD:

The member shall not commit sexual abuse of a patient.

CRITERIA:

  1. * The member shall not have sexual intercourse or other forms of physical sexual relations with a patient.
  2. * The member shall not carry out touching, of a sexual nature that includes, but is not limited to:
    • genital to genital, genital to anal, oral to genital, or oral to anal contact,
    • masturbation of the member by, or in the presence of, the patient,
    • masturbation of the patient by the member,
    • encouragement of the patient by the member to masturbate in the presence of the member,
    • oral to breast contact
  3. * The member shall not exhibit behaviour, or utter remarks of a sexual nature to a patient. Behaviour and remarks include, but are not limited to:
    • disrobing or draping practices that reflect a lack of respect for the patient’s privacy.
    • deliberately watching a patient dress or undress.
    • sexual comments about a patient’s underclothing.
    • criticism of the patient’s sexual orientation.
    • discussion of the patient’s sexual performance.
    • conversations regarding the sexual preferences or fantasies of the member or patient.
    • kissing of a sexual nature
  4. * The member has a legal obligation to abide by the mandatory reporting requirements outlined in the Regulated Health Professions Act.

* See Regulated Health Professions Act.

Prescription Custom Foot Orthoses

Prescription custom foot orthoses are an integral part of patient care in the management of pedal pathologies and are used to improve gait and to alleviate pain and discomfort from abnormal foot function or structure.

This Standard of Practice reflects what should be performed by Chiropodists and Podiatrists with respect to the manufacturing and dispensing of orthotic devices.  [For purposes of this Standard of Practice “dispensing” includes fitting the prescription custom foot orthoses and educating the patient on their proper use to maximize their effectiveness.]  However, this treatment therapy is dependent on many variables including each patient’s medical history, footwear, activities, and work environment. As a result of the personalized treatment plan and this multi-factorial and complex process, deviations from this Standard of Practice may be called for in certain circumstances. In these situations, the patient chart should clearly document the revised treatment process and the justification.

The College of Chiropodists of Ontario has developed its prescription custom foot orthoses standard to ensure that the public of Ontario has access to safe and effective foot care, including safe and effective foot prescription custom foot orthoses. The College defines an orthotic prescription (the “prescription”) to be the set of instructions intended for the orthotic laboratory that very specifically outlines the parameters of design, composition and fabrication of the orthotic intended for the treatment of an underlying medical condition or postural imbalance of the patient.

Read the full Prescription Custom Foot Orthoses Standard here.

Prescription Footwear

Prescription footwear is an integral part of patient care for the management of lower extremity pathology and to alleviate pain and dysfunction caused by foot deformities.

The College of Chiropodists of Ontario has developed its Prescription Footwear Standard to meet the needs of the profession and to provide the public of Ontario with safe and effective foot care.

Read the full Prescription Footwear Standardshere.

Records

The member shall ensure that documentation is clear and accurate, satisfying optimum patient care and legal requirements.

Read the fullRecords Standards here.

Safety and the Manufacturing of Orthotic Devices

The member shall make certain that safe orthotic device manufacturing practices are developed and maintained at all times and that procedures for same are in place to ensure the safety of member, patient and staff.

CRITERIA:

  1. The procedures for orthotic device manufacturing and the site (room or lab) of manufacturing must be in current compliance with the following legislation or guidelines:
    1. Occupational Health and Safety Act and Regulations for Industrial Establishments.
    2. Workplace Hazardous Materials Information System (WHMIS regulation).
    3. Workers Compensation Act
    4. Ontario Fire Code.
    5. Ventilation for Acceptable Indoor Air Quality 1
    6. Canadian Electrical Code
    7. Regulation made under the Occupational Health and Safety Act for Health Care and Residential Facilities.
    8. Canadian Standards Association 2
    9. American National Standard for Emergency Eyewash and Shower Protection 3
  2. The member shall maintain the orthotic device manufacturing site/lab with a door, separate and away from the patient treatment room.
  3. The member shall manufacture orthotic devices under the following controlled conditions:

A. General ventilation

  • The orthotic device lab or site shall be adequately supplied with intake air to replace the air taken away by the exhaust.

B. Local ventilation

  • All gluing, heating and drying of orthotic materials shall be carried out by the member within a fumehood4 which has a capture velocity of no less than 500 cubic ft/min. (Note: a “range” type hood is not acceptable.)
  • The contaminated air should be drawn away from the member and not through the breathing zone of the member.
  • If grinding is performed a fumehood which has a capture velocity of no less than 1200 cubic feet/min is recommended. The fumehood should have a filter to capture the dust.

C. Personal protective equipment

  • The member shall wear a National Institute for Occupational Safety and Health (NIOSH) approved personal respirator when manufacturing orthotics, grinding or gluing orthotic materials and when mixing plaster. (Note:a respirator is optional if a fumehood is used as described above).
  • The member shall wear NIOSH approved goggles when grinding orthotic materials.
  • The member shall wear protective clothing that is not worn for the treatment of patients ie. lab coat or apron).
  • Rubber gloves shall be worn by the member when handling adhesives, thinners and plaster.

D. Handling of orthotic materials

  • The member must have a bonafide material safety data sheet (MSDS) and shall comply with all sections of same for all materials used in the manufacturing of orthotics.
  • All orthotic device manufacturing sites shall have a facility for the member to wash hands and face after the fabrication of orthoses.
  • The member shall review and revise handling instructions for all orthotic materials annually. MSDS are to be kept in the member’s WHIMIS binder (see SAFETY AND THE PRACTICE ENVIRONMENT)
  • The member shall store a minimal amount of hazardous material on site.
  • Flammable materials will be stored separate from other orthotic materials in an approved flammable storage cabinet.

E. Emergency equipment.

  • All orthotic device manufacturing sites shall have the appropriate extinguishing media for all orthotic materials used and as required by the Ontario Fire Code (see MSDS for each material used in orthotic device lab.) (see SAFETY AND THE PRACTICE ENVIRONMENT).
  • All orthotic device manufacturing sites shall have and eyewash station (see section 1, IX).
  • All orthotic device manufacturing sites shall have a first aid kit.

1 American Society of Heating, Refrigerating, Air Conditioning Engineers, Inc. (ASHRAE) 62 – 1989, 1791 Tullie Circle NE, Atlanta, Ga., 30329-2305 Phone 404-636-8400, FAX 404-321-5478

2 Canadian Standards Association, Z316.5 Fumehoods and Exhaust Systems. (This document is available in draft form only at this time and is expected to be published by December 1993)

3 In the absence of a Canadian standard the ANSI Z358.1, 1981 is used.

4 A fume hood is defined by CSA as follows:

“An enclosed space ventilated by an induced flow through the face opening intended to capture and contain vapours, dusts, mists and fumes generated within the enclosure. These airborne contaminants are then exhausted from the cabinet and either filtered or exhausted to a remote location. The fumehood consists of a side, top and back enclosure, panels, a work surface and face opening.”

Safety and the Practice Environment

It shall be the responsibility of each member to ensure that the practice site be equipped and maintained, and that procedures are in place, to assure health and safety for both patients and staff.

CRITERIA:

  1. The premises must be in current compliance with any provincial and municipal requirements including:
    1. The Occupational Health and Safety Act and any regulations applicable to the practice environment
    2. The Healing Arts Radiation Protection Act
  2. Potentially hazardous equipment used for examination and treatment is to be serviced and inspected by a qualified technician for safety, efficacy and where applicable, calibrated for accuracy as specified by manufacturer, government guidelines, or every five years.

  1. An equipment service record shall be kept that sets out the servicing for every potentially hazardous piece of equipment used to examine, treat or render any service to patients.
  2. Deficiencies in equipment are to be brought up to standard. Hazards should be corrected immediately and other deficiencies corrected within 21 days.
  3. Policy statements, procedure and equipment manuals, are to be kept on site in office manuals, and must be available at all times.
  4. The member will be certified/recertified in C.P.R. at least every three years and support staff should be encouraged to seek certification.
  5. Hazardous materials are to be stored in a specific, safe, controlled area.
  6. Hazardous materials are to be labelled, and detailed current handling instructions must be reviewed, initialled annually and kept in the office manual. WHMIS guidelines are recommended additions.
  7. Written “sharps” policy and procedures are to be kept in the office manual.
  8. Pharmaceutical and clinical supplies will be inspected for expiry dates and disposed of appropriately where necessary.