Before you administer cosmetic injectables such as neuromodulators (i.e., Botox, Dysport) or dermal fillers (i.e., hyaluronic acid), ask yourself this question: Do I consider this practice to be a high-risk procedure?

The answer should be yes. Administering these products for cosmetic purposes carries risks for your clients. If they are not administered correctly, it may result in infections, unnecessary pain, adverse reactions and in cases where the adverse reactions are not managed, can even be fatal.

Adverse events may occur for several reasons including but not limited to:

• improper infection prevention and control measures;
• lack of provider’s knowledge, skill and judgement to administer the injection;
• not recognizing or appropriately treating adverse reactions;
• lack of an appropriate authorizing mechanism in place;
• inadequate assessment of the client; and/or,
• inadequate resources, including the ability to consult with or refer the client to a more experienced provider.

How to keep you and your clients safe.

To keep your clients safe and prevent avoidable harm:

1. Complete the Confirming Nursing Practice (CNP) process

RNs in Saskatchewan who will be performing cosmetic injections, whether self-employed, contracted or employed through an agency, are required to complete the Confirming Nursing Practice process to confirm that their individual practice and setting meets The Registered Nurses Act, 1988 (the “Act”), section 2, along with all relevant legislative and regulatory requirements.

RNs must complete the CNP process to:

• include the RN or NP practice hours worked in the role towards licensure;
• use the title Registered Nurse, Reg. N, RN, Nurse Practitioner or NP; and,
• have liability protection through the Canadian Nurses Protective Society (CNPS) while providing those nursing services.

To complete the CNP process:

• review the CRNS Legislated Scope of Practice Self-Assessment Tool;
• watch the CNP educational video; and,
• log into your Alinity account to submit the CNP form on your dashboard.

2. Obtain the proper authorization

To administer bioactive agents (i.e., cosmetic injectables), an RN must obtain authorization from a physician or Nurse Practitioner (NP). RNs obtain authorization through a directive (i.e., client-specific or population), as described in the Registered Nurse Specialty Practice Guideline.

3. Reflect on your practice

Before you administer any cosmetic product, ask yourself if you have the knowledge, skill and judgement to safely and competently perform the procedure to prevent and/or manage any unintended consequences. Reflect on the limits of your knowledge, skill and judgement, ask questions and consistently collaborate with colleagues, maintain an updated practice and safely progress from novice to expert through evidence-informed practice and ongoing professional development.

Remember that working together to promote client well-being is one of the nursing values and ethical responsibilities contained in the current CRNS RN Practice Standards, RN Entry-Level Competencies and Code of Ethics for Registered Nurses.

You must also ask yourself if you have the knowledge, skill and judgement to competently manage potential adverse reactions to the product. The following documents will assist you to determine whether this procedure falls within your scope of practice to administer a product and/or to proceed with the injection:

Legislated Scope of Practice

Medication Management Guideline

4. Assess your client

Before administering a cosmetic product to a client, an assessment must be completed to determine if the treatment plan is appropriate and if further consultation with the ordering practitioner is required. Always ensure written orders have been received and that the client understands the procedure and is aware of any potential side effects. Verify they have given written signed consent to have the procedure performed.

5. Assess the environment

You should only perform procedures in practice settings that prioritize client safety. Before proceeding, ask yourself the following questions:

• Does the physical environment, including access to equipment, support the safe performance of the procedure?
• Do you have the resources, both human and material, to monitor and intervene in case of an adverse reaction?

Additional resources to review to ensure your practice meets the Act include:

Registered Nurse Practice Standards

Self-employed Practice Guideline

Registered Nurse Speciality Practice Guidelines

6. Follow best practices for infection prevention and control