Reflect on your Practice: Cosmetic Injectables

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 and submit your information to the CRNS for review

RNs in Saskatchewan who will be performing cosmetic injections, whether self-employed, contracted or employed through an agency, are required to complete and submit a Recognition of Practice checklist to the CRNS for approval to confirm that the RN has considered whether the practice meets The Registered Nurses Act, 1988 (the “Act”),section 2k.

Until your practice has been reviewed by the CRNS and you have received written confirmation that it has been approved, you may not:

  • Perform any procedures
  • Include the hours worked performing cosmetic procedures as practice hours
  • Use the title Registered Nurse, Reg. N or RN

2. Obtain the proper authorization

To administer cosmetic products, an RN must work in collaboration with a physician or Nurse Practitioner (NP). Depending on the setting in which a procedure is being performed, an RN needs to ensure there is a client-specific order from a physician or an NP. In addition, policies and procedures must be in place for an RN to provide products using RNSP clinical protocols.

Once the appropriate authorization is in place, the physician or NP has completed the initial assessment and developed the treatment plan, an RN must determine that it is clear, comprehensive and appropriate. If any of these requirements are missing, do not proceed and follow up with the physician or NP.

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 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, ensure an assessment has been completed by the physician or NP at every visit to determine if the treatment plan is appropriate and written orders have been received. The RN should also complete an independent assessment. Ensure 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

Reduce the risk to you, others and your client by appropriately handling, cleaning and disposing of materials and equipment needed for the procedure. Ensure you are adhering to the best practices or the manufacturer’s guidelines for the material and equipment being used.

Clinical infection control practices are continually changing and it is up to you to keep current. Consult national, provincial and local evidence-based resources for current information.

If you would like further information or would like to speak to a CRNS Nursing Practice Advisor, contact 306.359.4227.

References:

College of Nurses of Ontario (March, 2020). Reflect before you inject. Retrieved from: https://www.cno.org/en/learn-about-standards-guidelines/magazines-newsletters/the-standard/March-2020/

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