ontario regulation 338/08

made under the

Chiropody act, 1991

Made: May 2, 2008
Approved: September 24, 2008
Filed: September 26, 2008
Published on e-Laws: September 30, 2008
Printed in The Ontario Gazette: October 11, 2008

Amending O. Reg. 203/94

(General)

1. Ontario Regulation 203/94 is amended by adding the following Part:

Part I
injections, prescriptions and standards of practice

1. (1) For the purposes of paragraph 2 of subsection 5 (1) and paragraph 3 of subsection 5 (2) of the Act, a member may administer by injection into the foot a substance set out in Schedule 1 to this Regulation, if the member complies with the standards of practice set out in section 2.

(2) For the purposes of paragraph 3 of subsection 5 (1) of the Act, a chiropody class member holding a general or academic class certificate of registration may prescribe a drug set out in Schedule 2 to this Regulation, if the member complies with the standards of practice set out in sections 3 and 4.

(3) For the purposes of paragraph 4 of subsection 5 (2) of the Act, a podiatry class member holding a general or academic class certificate of registration may prescribe a drug set out in Schedule 3 to this Regulation, if the member complies with the standards of practice set out in sections 3 and 4.

2. (1) Subject to the other provisions of this section, it is a standard of practice of the profession that a member who administers a substance by injection into the foot shall first have successfully completed at least one of the following which has been approved by the Council:

1. A course on administering substances by injection into the foot.

2. A program that includes administering substances by injection into the foot.

3. Relevant training in administering substances by injection into the foot.

(2) A member is deemed to have met the standard of practice referred to in subsection (1) if the member was, on September 26, 2008,

(a) a podiatry class member; or

(b) a chiropody class member who had successfully completed a course listed in Schedule 4, together with meeting any other applicable educational requirements set out in that Schedule.

(3) Despite subsection (1), a member holding an educational class certificate of registration may administer by injection into the foot a substance set out in Schedule 1, if,

(a) the administration by injection is done as part of an educational program which is a specific requirement for the issuance of that educational class certificate of registration; and

(b) the administration by injection is performed under the direct supervision of a member who is authorized under subsection 1 (1) to perform that administration by injection.

(4) Despite subsection (1), a member holding a general or academic class certificate of registration may administer by injection into the foot a substance set out in Schedule 1, if,

(a) the administration by injection is done as part of a course, program or training approved by the Council; and

(b) the administration by injection is performed under the direct supervision of a member who is authorized under subsection 1 (1) to perform that administration by injection.

3. (1) Subject to the other provisions of this section, it is a standard of practice of the profession that a member who prescribes a drug shall first have successfully completed at least one of the following which has been approved by the Council:

1. A pharmacology course.

2. A pharmacology program.

3. Relevant training in pharmacology.

(2) A member is deemed to have met the standard of practice referred to in subsection (1) if the member was, on September 26, 2008,

(a) a podiatry class member; or

(b) a chiropody class member who had successfully completed a course listed in Schedule 4, together with meeting any other applicable educational requirements set out in that Schedule.

4. (1) For the purposes of subsections 1 (2) and (3), and subject to subsection (3), it is a standard of practice of the profession that a member may prescribe a drug set out in the following table for the indicated maximum duration, in the indicated maximum daily dosage:

 

Drug	Maximum duration	Maximum daily dosage
Ketorolac tromethamine	Five days	10mg. every 4-6 hours, as needed for pain, not to exceed 4 doses per day, or 40mg, in total.

(2) For the purposes of subsection 1 (3), and subject to subsection (3), it is a standard of practice of the profession that a podiatry class member may prescribe a drug set out in the following table for a patient, prior to the performance of any act that member is authorized to perform, for a maximum of a single dose only, in the indicated maximum daily dosage:

 

Drug	Maximum daily dosage
Diazepam	10 mg.
Hydroxyzine hydrochloride	25 ml. or 50 mg.
Lorazepam	3 mg.

(3) A member who may prescribe a drug set out in the tables to subsections (1) and (2) may prescribe the drug in a prescription that exceeds the maximum duration or maximum daily dosage or both, if the member first consults with the patient’s physician, and retains records of that consultation. 

2. The Regulation is amended by adding the following Schedules:

Schedule 1
Substances Administered by Injection into the foot

Betamethasone sodium phosphate beta-acetate

Dexamethasone sodium phosphate

Hydrocortisone sodium succinate

Methylprednisolone acetate

Triamcinolone acetonide

Denatured alcohol 4% (ethyl alcohol)

Bupivacaine

Lidocaine hydrochloride (with or without epinephrine)

Mepivacaine hydrochloride

Sterile saline solution

B12- Cyanocobalamin

Schedule 2
drugs that may be prescribed by Chiropody Class Member

Antibiotics for Topical Use

Bacitracin

Framycetin sulfate

Fusidic acid

Gentamicin sulfate

Mupirocin

Silver sulfadiazine

Erythromycin

Bacitracin/neomycin sulphate

Neomycin sulphate/polymyxin B sulphate/bacitracin

Neomycin sulphate/polymyxin B sulphate/gramicidin

Antifungals for Topical Use

Ciclopirox olamine 

Clotrimazole 

Ketoconazole

Miconazole nitrate

Nystatin

Terbinafine HCl

Tolnaftate cream 

Undecylenic acid

Analgesics for Topical Use

Benzocaine

Capsaicin

Diethylamine Salicylate

Lidocaine/prilocaine

Astringents for Topical Use

Aluminum Chloride hexahydrate 

Corticosteroids for Topical Use

Amcinonide

Betamethasone diproprionate

Betamethasone valerate

Clioquinol/hydrocortisone

Desoximetasone

Flumethasone/clioquinol

Fluocinonide

Halcinonide

Hydrocortisone

Hydrocortisone 17 valerate

Mometasone furoate

Triamcinolone acetonide

Caustics for Topical Use

Cantharidin Podophyllin Salicylic acid combination (1% or less Cantharidin with 2% or less Podophyllin with 30% or less Salicylic acid)

Salicylic acid (70% or less)

Silver Nitrate (95% or less)

5-Fluorouracil (5% or less)

Salicylic acid/lactic acid combination (Salicylic acid 16.7% and Lactic acid 16.7% in flexible collodion)

Salicylic acid/lactic acid/formalin combination (Salicylic acid 25%, Lactic acid 10%, Formalin 5%)

Immune Response Modifier for Topical Use

Imiquimod

Wound Healing Agents/Dressings for Topical Use

Becaplermin

Santyl collagenase

Antibiotics for Oral Use

Amoxicillin trihydrate

Amoxicillin trihydrate/clavulanate potassium

Azithromycin dihydrate

Cefadroxil

Cephalexin monohydrate

Ciprofloxacin hydrochloride

Clindamycin hydrochloride

Cloxacillin sodium

Sulfamethoxazole/trimethoprim

Erythromycin

Tetracycline hydrochloride

Non-steroidal Anti-inflammatories for Oral Use

Diclofenac potassium

Diclofenac sodium

Diclofenac sodium/misoprostol

Diflunisal

Ibuprofen

Indomethacin

Meloxicam

Ketorolac tromethamine

Naproxen

Naproxen sodium

Tiaprofenic acid

Schedule 3
drugs that may be prescribed by Podiatry Class Member

Antibiotics for Topical Use

Bacitracin

Framycetin sulfate

Fusidic acid

Gentamicin sulfate

Mupirocin

Silver sulfadiazine

Erythromycin

Bacitracin/neomycin sulphate

Neomycin sulphate/polymyxin B sulphate/bacitracin

Neomycin sulphate/polymyxin B sulphate/gramicidin

Antifungals for Topical Use

Ciclopirox olamine 

Clotrimazole 

Ketoconazole

Miconazole nitrate

Nystatin

Terbinafine HCl

Tolnaftate cream 

Undecylenic acid

Analgesics for Topical Use

Benzocaine

Capsaicin

Diethylamine Salicylate

Lidocaine/prilocaine

Astringents for Topical Use

Aluminum Chloride hexahydrate 

Corticosteroids for Topical Use

Amcinonide

Betamethasone diproprionate

Betamethasone valerate

Clioquinol/hydrocortisone

Desoximetasone

Flumethasone/clioquinol

Fluocinonide

Halcinonide

Hydrocortisone

Hydrocortisone 17 valerate

Mometasone furoate

Triamcinolone acetonide

Caustics for Topical Use

Cantharidin Podophyllin Salicylic acid combination (1% or less Cantharidin with 2% or less Podophyllin with 30% or less Salicylic acid)

Salicylic acid (70% or less)

Silver Nitrate (95% or less)

5-Fluorouracil (5% or less)

Salicylic acid/lactic acid combination (Salicylic acid 16.7% and Lactic acid 16.7% in flexible collodion)

Salicylic acid/lactic acid/formalin combination (Salicylic acid 25%, Lactic acid 10%, Formalin 5%)

Immune Response Modifier for Topical Use

Imiquimod

Wound Healing Agents/Dressings for Topical Use

Becaplermin

Santyl collagenase

Antibiotics for Oral Use

Amoxicillin trihydrate

Amoxicillin trihydrate/clavulanate potassium

Azithromycin dihydrate

Cefadroxil

Cephalexin monohydrate

Ciprofloxacin hydrochloride

Clindamycin hydrochloride

Cloxacillin sodium

Sulfamethoxazole/trimethoprim

Erythromycin

Tetracycline hydrochloride

Non-steroidal Anti-inflammatories for Oral Use

Diclofenac potassium

Diclofenac sodium

Diclofenac sodium/misoprostol

Diflunisal

Ibuprofen

Indomethacin

Meloxicam

Ketorolac tromethamine

Naproxen

Naproxen sodium

Tiaprofenic acid

Anxiolytics for Oral Use

Diazepam

Hydroxyzine hydrochloride

Lorazepam

SCHEDULE 4
courses and education

1. A course in prescribing drugs and administering drugs and other substances by injection into the foot containing both a clinical and didactic component taken at the Michener Institute for Applied Health Sciences as part of a program, the successful completion of which program was a requirement for the issuance of a certificate of registration as a chiropody class member.

2. A course in prescribing drugs and administering drugs and other substances by injection into the foot containing both a clinical and didactic component taken at a program in podiatry in either Canada or the United States of America, which program was, at the time the person took it, accredited by the Council on Podiatric Medical Education or another accreditation body approved by the Council.

3. A course in prescribing drugs and administering drugs and other substances by injection into the foot containing both a clinical and didactic component approved by the Council.

4. A course in prescribing drugs and administering drugs and other substances by injection into the foot containing both a clinical and didactic component taken while a member of the College, which was set or approved by the Council as a course which would adequately train a member to prescribe drugs and administer drugs and other substances by injection into the foot, in accordance with the current standards of practice of the profession.

5. A course or courses in prescribing drugs and administering drugs and other substances by injection into the foot taken while a member of the College, if the Registration Committee is satisfied the course or courses together with the formal education and professional experience of the member has resulted in the member having sufficient knowledge, skill and judgment to prescribe drugs and administer drugs and other substances by injection into the foot, in accordance with the current standards of practice of the profession.

3. This Regulation comes into force on the day it is filed.

Made by:

Council of the College of Chiropodists of Ontario:

John Infanti

President

Felecia Smith

Registrar

Date made: May 2, 2008.