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.

New Medical Directive for 2024/25:

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 Ajax

• Critical Care Outreach Team (CCOT) Adult In-Patient Medical Directive (all LHO Critical Care Intensivists, LHB & LHAP Physicians)

All Physicians Providing Service at Lakeridge Health Bowmanville

• Adult Enteral Tube Feeding Medical Directive
• Adult Parenteral Nutrition Medical Directive
• Critical Care Outreach Team (CCOT) Adult In-Patient Medical Directive (all LHO Critical Care Intensivists, LHB & LHAP Physicians)
• Critical Care Response Team (CCRT) Adult In-patient Medical Directive
• Diet Texture Medical Directive
• Emergency Situations Medical Directive
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)

Anesthetists (Lakeridge Health Oshawa Only)

• Administration of Neuromuscular Blocking Agents and Reversal Agents by the Anesthesia Assistant
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Emergency Situations Medical Directive
• Initiation of Peripheral Intravenous in the Operating Room and Endoscopy Suite
• 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
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)

Anesthesiologists (Hospital Wide)

• Administration of Pre-Operative Acetaminophen for Paediatric Day Surgery
• Adult Pre-Operative Testing Grid
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Initiation of Peripheral Intravenous in the Operating Room and Endoscopy Suite
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Ultrasound Guidance for Prescribed Procedures

Cardiologists

• Agitated Sale (Bubble Study) with Transthoracic Echo
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Computed Tomography (CT) Coding
• Contrast Echocardiography
• Initiation of Intravenous or Access Deaccess of Central Venous Access Devices in Diagnostic Imaging
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)

Code Blue First Responders

• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• ALS Medical Directive with Sub-Specialty
• Automated External Defibrillation (AED) Medical Directive
• Emergency Situations Medical Directive
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)

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
• COVID - 19mRNA Vaccine for Adult (12 years of age and older)
• Unregulated Care Providers Pfizer-BioNTech COVID-19 mRNA Vaccine for COVID Immunization Clinic

Diagnostic Imaging Physicians

• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)

• Computed Tomography (CT) Coding

• CT Chest, Ontario Lung Screening Program OLSP
• Emergency Situations Medical Directive
• Hyoscine Butylbromide (Buscopan) Injection for Diagnostic Imaging Procedures
• Initiation of Intravenous or Access Deaccess of Central Venous Access Devices in Diagnostic Imaging
• Interventional Radiology (IR) Protocoling by Medical Radiation Technologists (MRT) - Medical Directive
• Pre-MRI X-ray - Medical Directive
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)

Endocrinologists

• Adult Enteral Tube Feeding Medical Directive
• Adult Parenteral Nutrition Medical Directive
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Diet Texture Medical Directive
• Emergency Situations Medical Directive
• Point of Care Glucose Meter Testing and Treatment for Out-Patients with Suspected Hypoglycemia
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)

ER Physicians (Hospital Wide)

• Adult Intubation by Registered Respiratory Therapist
• Adult Enteral Tube Feeding Medical Directive
• Adult Parenteral Nutrition Medical Directive
• ALS Medical Directive with Sub-Specialty
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Automated External Defibrillation (AED) Medical Directive
• Diet Texture Medical Directive
• Emergency Department - Medical Directives
• Emergency Department Naloxone Distribution Kit
• Emergency Situations Medical Directive
• Medical Directive for Physician Assistants - Emergency Medicine
• Nicotine Replacement Therapy
• Off Site Naloxone Administration (Emergency Department physicians)
• Oral Nutrition Therapy
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)
• Ultrasound Guidance for Prescribed Procedures

ER Physicians (Lakeridge Health Oshawa Only)

• Adult Enteral Tube Feeding Medical Directive
• Adult Parenteral Nutrition Medical Directive
• ALS Medical Directive with Sub-Specialty
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Automated External Defibrillation (AED) Medical Directive
• Diet Texture Medical Directive
• Domestic Violence-Sexual Assault Medical Directive
• Emergency Department - Medical Directives
• Emergency Department Naloxone Kit Distribution
• Emergency Situations Medical Directive
• Erythromycin for Chlamydia Drug Prophylaxis When a Client is Pregnant or Breastfeeding
• Medical Directive for Physician Assistants - Emergency Medicine
• Nicotine Replacement Therapy
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)

Family Medicine Obstetrics

• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Initial Screening and Management of Hypoglycemia in Neonates Greater than 35 weeks Gestation
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Respiratory Syncytial Virus (RSV) Monoclonal Antibody (Nirsevimab) Ordering
• Well Newborn - Family Medicine Obstetrics

General Surgeons

• Adult Pre-Operative Testing Grid
• Adult Enteral Tube Feeding Medical Directive
• Adult Parenteral Nutrition Medical Directive
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Diet Texture Medical Directive
• Emergency Situations Medical Directive
• Initiation of Peripheral Intravenous in the Operating Room and Endoscopy Suite
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)

Gastroenterologists

• Initiation of Peripheral Intravenous in the Operating Room and Endoscopy Suite

Hospitalists

• Adult Enteral Tube Feeding Medical Directive
• Adult Intubation by Registered Respiratory Therapist
• Adult Parenteral Nutrition Medical Directive
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Diet Texture Medical Directive
• Emergency Situations Medical Directive
• Oral Nutrition Therapy
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)

Infectious Diseases Physicians - Positive Care Clinic

• Abbott ID Now COVID Swab and Processing 
• Adult Parenteral Nutrition Medical Directive
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Collection of Acute Respiratory Infection (ARI) for Infection, Prevention, and Control Surveillance and Outbreak Management
• Emergency Situations Medical Directive
• Nurse-Drawn Standardized Investigations for Positive Care Clinic Patients
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)
• Take Home Naloxone Kit (Positive Care Clinic Physicians & RAAM physicians)

Intensivists

• Adult Enteral Tube Feeding Medical Directive Adult Parenteral Nutrition Medical Directive
• ALS Medical Directive with Sub-Specialty
• Adult Intubation by Registered Respiratory Therapist
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Automated External Defibrillation (AED) Medical Directive
• Critical Care Response Team (CCRT) Adult In-patient Medical Directive
• Critical Care Outreach Team (CCOT) Adult In-Patient Medical Directive (all LHO Critical Care Intensivists, LHB & LHAP Physicians)
• Diet Texture Medical Directive
• Emergency Situations Medical Directive

• Oral Nutrition Therapy

• Point of Care Arterial Blood Gas Test in Emergency and Critical Care
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)
• Ultrasound Guidance for Prescribed Procedures

Midwives

• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Initial Screening and Management of Hypoglycemia in Neonates Greater than 35 weeks Gestation
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Respiratory Syncytial Virus (RSV) Monoclonal Antibody (Nirsevimab) Ordering
• Well Newborn - Midwives

Nephrologists

• Administration of Influenza Vaccination to Out-Patients of the Regional Nephrology Program
• Adult Enteral Tube Feeding Medical Directive
• Adult Intubation by Registered Respiratory Therapist
• Adult Parenteral Nutrition Medical Directive
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Diet Texture Medical Directive
• Emergency Situations Medical Directive
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)
• Treatment of Anaphylaxis within the Regional Nephrology Program
• Oral Nutrition Therapy

Obstetricians

• Adult Enteral Tube Feeding Medical Directive
• Adult Intubation by Registered Respiratory Therapist
• Adult Parenteral Nutrition Medical Directive
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Diet Texture Medical Directive
• Emergency Situations Medical Directive
• Hypertension Screening With Routine Non-Stress Test
• Oral Nutrition Therapy
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)

Occupational Health Physician(s)

• Adult Enteral Tube Feeding Medical Directive
• Adult Parenteral Nutrition Medical Directive
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Antiviral Medication
• BloodTest, Chest X-Ray and Tuberculin Skin Test
• COVID - 19mRNA Vaccine for Adult (12 years of age and older)
• Emergency Situations Medical Directive
• Influenza Vaccination
• Management of Anaphylaxis for Occupational Health Nurses
• 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
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)

Oncologists

• Adult Enteral Tube Feeding Medical Directive
• Adult Intubation by Registered Respiratory Therapist
• Adult Parenteral Nutrition Medical Directive
• Advanced Practice Radiation Therapist (APRT) for Radiation Oncology - Medical Directive
• Alteplase (Cathflo) Instillation for Complete or Partially Occluded Central Venous Access Devices
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Clinical Trials Laboratory Investigations
• Diet Texture Medical Directive
• Emergency Situations Medical Directive
• EMLA Cream Application for Oncology & Hematology Patients
• Gynecological Diagnostic Assessment Program Investigations
• Oral Nutrition Therapy
• Ordering Specific Diagnostic Tests, Images, Scans and Procedures by Nurse Practitioners
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)

Orthopedic Surgeons

• Adult Pre-Operative Testing Grid
• Adult Enteral Tube Feeding Medical Directive
• Adult Parenteral Nutrition Medical Directive
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Diet Texture Medical Directive
• Emergency Situations Medical Directive
• Medical Directives for Physician Assistant - Surgical Program Orthopedic Division
• Outpatient Surgical Preoperative Blood Conservation
• Physician Assistant Lakeridge Health Ajax Pickering Shoulder Centre
• Rapid Access Clinic Physiotherapists Ordering of Diagnostic Imaging - Medical Directive
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)

Pediatricians and Neonatologists

• Acetaminophen Administration for Treatment of Fever In Pediatric Patients Admitted to the Pediatric Unit
• Adult Enteral Tube Feeding Medical Directive
• Adult Parenteral Nutrition Medical Directive
• Adult Intubation by Registered Respiratory Therapist
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Emergency Situations Medical Directive
• 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
• Oral Nutrition Therapy
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Respiratory Syncytial Virus (RSV) Monoclonal Antibody (Nirsevimab) Ordering
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)
• Sucrose 24% Oral Solution for Pain Management in Neonates and Infants
• Well Newborn - Pediatricians and Neonatologists

PASS Program Physicians

• Adult Enteral Tube Feeding Medical Directive
• Adult Parenteral Nutrition Medical Directive
• Adult Intubation by Registered Respiratory Therapist
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Diet Texture Medical Directive
• Emergency Situations Medical Directive
• Oral Nutrition Therapy
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)
• Stroke Prevention Clinic Diagnostic – Medical Directive

Pinewood Centre Practitioners

• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Adult Parenteral Nutrition Medical Directive
• Emergency Situations Medical Directive
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Residential Withdrawal Management Service (RWMS) Admission COVID-19 Point of Care (POC) Testing for Clients

Psychiatrists

• Adult Enteral Tube Feeding Medical Directive
• Adult Intubation by Registered Respiratory Therapist
• Adult Parenteral Nutrition Medical Directive
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Diet Texture Medical Directive
• Emergency Situations Medical Directive
• Oral Nutrition Therapy
• Nicotine Replacement Therapy
• Residential Withdrawal Management Service (RWMS) Admission COVID-19 Point of Care (POC) Testing for Clients
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)

Rapid Access Addiction Medicine Clinic Physicians

• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Take Home Naloxone Kit (Postivie Care Clinic Physicians & RAAM physicians)

Respirologists

• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Adult Parenteral Nutrition Medical Directive
• Initiation of Peripheral Intravenous in the Operating Room and Endoscopy Suite
• Malignant Pleural Effusion Clinic Investigations 
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)

SACC Physicians

• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Adult Parenteral Nutrition Medical Directive
• Domestic Violence-Sexual Assault Medical Directive
• Emergency Situations Medical Directive
• Erythromycin for Chlamydia Drug Prophylaxis When a Client is Pregnant or Breastfeeding
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)

Stroke Prevention Clinic Physicians

• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Stroke Prevention Clinic Diagnostic – Medical Directive

Surgeons (Hospital Wide)

• Adult Pre-Operative Testing Grid - Surgeons
• Adult Parenteral Nutrition Medical Directive
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Diet Texture Medical Directive
• Initiation of Peripheral Intravenous in the Operating Room and Endoscopy Suite
• Outpatient Surgical Preoperative Blood Conservation
• Pre-operative COVID-LHO Rapid Testing for Admitted Surgical Adult Patients Requiring Continuous Positive Airway Pressure (CPAP) Therapy Devices
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)

Thoracic Surgeons

• Adult Pre-Operative Testing Grid - Thoracic Surgeons
• Adult Enteral Tube Feeding Medical Directive
• Adult Parenteral Nutrition Medical Directive
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Diet Texture Medical Directive
• Emergency Situations Medical Directive
• Initiation of Intravenous in Endoscopy Suite
• Initiation of Peripheral Intravenous in the Operating Room and Endoscopy Suite
• Outpatient Surgical Preoperative Blood Conservation
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)
• Thoracic Diagnostic Assessment Program Investigations Medical Directive

All Associate, Active, Courtesy Workload and Locum Physicians not listed above

• Adult Enteral Tube Feeding Medical Directive
• Adult Intubation by Registered Respiratory Therapist
• Adult Parenteral Nutrition Medical Directive
• Ambulatory Rehabilitation Centre Referral - Medical Directive (all MRPs)
• Diet Texture Medical Directive
• Emergency Situations Medical Directive
• Oral Nutrition Therapy
• Respiratory Distress - Respiratory Therapy Medical Directive (all MRPs)
• Specimen Collection for Antibiotic Resistant Organisms (AROs) – Medical Directive (all MRPs)