Carry out intradermal injections of botulinum toxin type A to treat cosmetic excessive sweating
Overview
This standard coexists alongside, SKANSC1: Implement and maintain safe, hygienic and effective working practices during elective non-surgical cosmetic procedures and SKANSC2: Consult, assess, plan and prepare for elective non-surgical cosmetic procedures within the working environment, following a consultation and evaluation with a regulated independent prescriber. This standard is for aesthetic practitioners carrying out intradermal injections of botulinum toxin type A to treat cosmetic excessive sweating. The botulinum type A inhibits the release of acetylcholine, a neurotransmitter of the parasympathetic nervous system, preventing the hyper stimulation of eccrine sweat glands that leads to excessive sweating. Botulinum toxin is performed as a course of procedures as the nerves will regenerate over time. You will also be required to do a post procedure evaluation and reflection for continuous improvement. The aesthetic practitioner must have a First Aid at Work qualification or equivalent and be able to carry out the functions within SFHCHS36: Basic life support and have access to life support equipment as identified in the emergency plan. Users of this standard will need to ensure that their practices reflect up-to-date information, policies, procedures and best practice guidance.
The main outcomes are :
- Reduce cosmetic excessive sweating
- To treat diagnosed primary focal axillary hyperhidrosis
Performance criteria
You must be able to:
- acquire and discuss the individual’s consultation outcomes and documentation for the botulinum toxin type A procedure from the regulated independent prescriber, to include:
1.1 individual procedure plan to include areas to be treated
1.2 advice, support and guidance
1.3 emergency plan
1.4 medicine management policy
1.5 pain management strategy
- agree and obtain the botulinum toxin type A prescription from the regulated independent prescriber, in accordance with the botulinum toxin type A procedure protoco*l*, legislative, regulatory requirements, organisational policies and procedures
- carry out a concise and comprehensive consultation face to face with the individual and maintain your responsibilities for health and safety pre, during and post the botulinum toxin type A procedure
- discuss the individual’s objectives, concerns, expectations and desired outcomes to inform the botulinum toxin type A procedure plan, to include:
4.1 alternative treatment options
- establish the botulinum toxin type A procedure plan in accordance with legislative requirements and organisational policies and procedures
- reiterate, confirm and agree with the individual, they have understood the proposed botulinum toxin type A procedure and pain management, to include:
6.1 contra-actions
6.2 adverse reactions
- obtain and record the individual’s informed consent for the botulinum toxin type A procedure and pain management, allowing an adequate time scale for the individual to make an informed choice
- review the informed consent for the botulinum toxin type A procedure and pain management
- collect with the individual’s informed consent, the fulfilled prescription from a pharmacist, to include:
9.1 patient specific direction
9.2 saline reconstitution solutions
9.3 storage instructions
9.4 waste disposal protocol
- select an effective hygiene preparation product to meet the individual’s needs in accordance with the manufacturer instructions
- prepare the individual’s treatment area in accordance with the botulinum toxin type A procedure protocol and associated risk avoidance strategies, to include:
11.1 mark out pre-procedure markings to identify the hyperhidrotic area of each axilla, according to the hair bearing area
11.2 ensuring markings are sufficiently spaced and evenly distributed
- prepare the single use syringe, and single use needle in accordance with the procedure protocol
- inject and deposit the botulinum toxin type A solution subdermally with a sterile, single use needle in accordance with the botulinum toxin type A procedure protocol, to include:
13.1 adaptation of injection techniques, angle and depth
13.2 in accordance with the pre-procedure markings
13.3 in one smooth motion and slow release to reduce trauma to the area
- monitor the individual’s health, wellbeing and skin reaction throughout the botulinum toxin type A procedure, in accordance with legislative requirements and organisational policies and procedures
- in the event of an adverse reaction or incident, the aesthetic practitioner take prompt corrective action, as set out within the emergency plan to include:
15.1 seek and implement immediate medical intervention from the identified healthcare professional trained to deal with complications as set out in the emergency plan when a prescription only medication is required
- conclude the procedure in accordance with the botulinum toxin type A procedure protocol, legislative requirements and organisational policies and procedures, to include:
16.1 removing any pre-procedure markings, if applicable
- take and store consensual visual media of the individual’s treatment area in accordance with insurance requirements, organisational policies and procedures
- complete the individual's non-surgical cosmetic procedure records and store in accordance with data legislation
- use reflective practice to evaluate the botulinum toxin type A procedure and take appropriate action
- provide instructions and advice to the individual, pre and post procedure, to include:
20.1 the regulated independent prescribers contact details
20.2 emergency plan
20.3 contingency plan in the event of absence
- discuss, evaluate and record the outcomes with the regulated independent prescriber and agree further action and future procedures
- discuss the outcomes and agree future procedures with the individual
Knowledge and Understanding
You need to know and understand:
- the importance of collaboration with competent professionals to support effective and safe working practices
- the roles and responsibilities of the independent regulated prescriber
- why you must comply with ethical practice and work within the legislative requirements
- the importance to engage in, and document continuous professional development to include, up-to-date information policies, procedures and best practice guidance
- the anatomy and physiology relevant to this standard
- the types, composition and pharmacological effects of chemical compounds in botulinum toxin solutions, to include:
6.1 how religion and belief can prohibit a botulinum toxin type A procedure
- the importance of receiving evidence based diagnosis of primary focal axillary hyperhidrosis or cosmetic excessive sweating from a general medical practitioner, to include:
7.1 the purpose and outcomes of iodine tests
- the differences between cosmetic excessive sweating, primary and secondary focal axillary hyperhidrosis
- the reasons for not treating secondary focal axillary hyperhidrosis
- how to identify the hyperhidrotic area of each axilla according to the hair bearing area, to include:
10.1 the safe amount of injections to use
10.2 why you must space injection sites out evenly
10.3 the sterile tools used to mark out the intended injection sites pre procedure
- the physiological effect of botulinum toxin type A solution has on the underlying tissues of the body, in relation to:
11.1 the inhibited release of acetylcholine neurotransmitter and the effect it has on the parasympathetic nervous system
11.2 why the effect of subdermal injections of botulinum toxin type A is temporary
11.3 the frequency of treatments required in accordance with the individual’s needs
- the purpose, use and limitations of botulinum toxin type A procedures, in relation to:
12.1 past and current medical history
12.2 previous non-surgical cosmetic procedure history
12.3 relevant lifestyle factors
12.4 medication and medical conditions
12.5 considering the individual's physical and psychological wellbeing for the botulinum toxin procedure
12.6 individual’s expectations
- the adverse reactions associated with a botulinum toxin type A procedure
- how to implement the correct course of action in the event of an adverse reaction or incident, to include:
14.1 why and when immediate medical invention is necessary
14.2 the risk avoidance strategies
- the differentiation between licensed, off label an unlicensed product use, to include:
15.1 the regulatory and legislative requirements
- the licensed indicated use of prescription only medicines and when and why it can be used off label, considering:
16.1 safety
16.2 treatment area
16.3 suitability
16.4 agreement with the regulated independent prescriber
- the types of pain management and associated risks
- the legislative requirements and restrictions for sourcing, storing and using licensed topical anesthetics
- the health and safety responsibilities in line with legislation before, during and after the botulinum toxin type A procedure
- the importance of acquiring and discussing the consultation outcomes with the regulated independent prescriber
- the importance of obtaining and following instructions from the regulated independent prescriber in line with the medicines management policy, manufacturer instructions, legislative and regulatory requirements, to include:
21.1 access
21.2 use
21.3 storage
21.4 longevity and expiry
21.5 waste disposal policy
21.6 audit and accountability
- how the regulated independent prescriber’s consultation outcomes inform the botulinum toxin type A procedure plan
- why it is important to discuss and establish the individual’s objectives, concerns, expectations, desired outcomes and agree the botulinum toxin type A procedure plan
- the importance of using visual aids to inform the individual of the physical effects
- the fee structures and treatment options
- why it is important to allow time for the individual to reflect before confirming and agreeing to receive the elective non-surgical cosmetic procedure
- the importance of obtaining informed consent for the botulinum toxin type A procedure and pain management
- the legislative and indemnity requirements of gaining signed, informed consent for the elective non-surgical cosmetic procedure
- the types of hygiene products for the skin and the importance of following manufacturer instructions
- the importance of adhering to the botulinum toxin type A procedure protocol
- the importance of monitoring the health and wellbeing of the individual during, and post procedure
- the importance of adhering to the emergency plan in the event of an adverse reaction
- the legislative, insurance and organisational requirements for taking and storing visual media of the individual’s treatment area
- the legislative and regulatory requirements of completing and storing the individual’s medical and non-surgical cosmetic procedure records
- the expected outcomes from a botulinum toxin type A procedure
- the importance of discussing, reflecting, evaluating and recording the outcomes with the regulated independent prescriber to inform further action and future procedures
- how to collate, analyse, summarise and record evaluation feedback in a clear and concise way
- the importance to record the outcome and evaluation of the botulinum toxin type A procedure
- the instructions and advice, pre and post the botulinum toxin type A procedure
Scope/range
Additional information
The regulated independent prescriber is expected to have achieved the relevant qualifications that meet legislative and regulatory requirements. Full qualifications must be on display including pin number and regulatory bodies.
The aesthetic practitioner is expected to already be able to demonstrate competency in determining the relative (restrictive) and absolute (preventative) contraindications for the non-surgical cosmetic procedures. In addition, the aesthetic practitioner should be able to identify adverse reactions or incidents and take prompt corrective action as agreed within the regulated independent prescriber's emergency plan.
Scope Performance
Botulinum toxin type A procedure protocol
- working environment
- health and safety
- risk management plan
- infection prevention and control
- consultation outcomes from the regulated independent prescriber
- emergency plan
- medicine management
- procedure plan
- informed consent
- appropriate professionals
- data management
- audit and accountability
- manufacturer instructions
- instructions and advice
- sustainability
- waste management
- evidence-based practice
- reflective practice
Contra-actions
- hyperemia
- micro wounds
- bruising
- oedema
- arm pain
- muscle weakness
- muscle pain
- itching in the armpit
Scope Knowledge
Anatomy and physiology
- the structure and function of all body systems and their interdependence on each other
- skin and systemic pathologies
- severe adverse event pathologies
- basic knowledge of pharmacology and sciences
- effects of botulinum toxin type A have on the skin and underlying skin structures and muscles
Adverse reactions
- ptosis/ecotrophine
- infection
- nausea
- allergic reaction
- anaphylaxis
- botulism* *
- needlestick injuries
- necrosis
- hematoma
- pulmonary embolism
- venous, arterial and nerve injury
Risk avoidance strategies
- emergency plan
- risk assessment(s)
- acquired medical history
- procedure plan(s)
- restrictive treatment areas
- pre and post instructions and advice
- avoidance of off license use
- inoculations
- first aid at work qualification and basic life support or equivalent
- general health and safety working practices
- infection prevention and control
- working environment
- consultation with the healthcare professional/regulated independent prescriber
- legislative prescription protocol
- medicine management
- informed consent
- collaboration with appropriate personnel professionals
- data management
- audit and accountability
- prescription protocol
- basic understanding of the pharmacology
- working knowledge the axillary anatomy
- waste management
- consideration of the individual's physical and emotional wellbeing
Visual aids
- diagrams
- pre-procedure markings
Values
Behaviours
Skills
Glossary
Competent professionals
Professionals outside your area of competence who you may refer or seek advice.
Adverse reactions
Adverse reactions are also known as adverse incidents or associated risks. An Adverse reaction is an unexpected physical or physiological reaction from a procedure carried out.
Contra-action
Contra action is an expected temporary reaction from a procedure.
Contraindicated
A specific situation in which a drug, procedure, or surgery should not be used because it may be harmful to the person.
Emergency plan
The emergency plan is the responsibility of the regulated independent prescriber. The emergency plan includes the appropriate onsite response, healthcare referral process and access to an emergency kit suitable to deal with adverse reactions or incidents. The regulated independent prescriber has a duty of care to their patients to follow regulatory guidelines set by their Professional, Statutory and Regulated Body.
Patient specific direction
Prescription specific to the individual and procedure to be carried out.
Pre-procedure markings
Pre-procedure markings should be carried out using a sterile single use surgical pen. Pre-procedure markings are used to create guidelines to identify injection sites as set out in the non-surgical cosmetic procedure plan.
Regulated independent prescriber
Regulated independent prescribers are regulated by Professional Statutory Regulatory Bodies. Regulated independent prescribers will hold the relevant qualifications to receive their registration and pin. Regulated independent prescribers who collaborate with other personnel to carry out botulinum toxin type A procedures are responsible to check the aesthetic practitioner is adequately trained and experienced to administer prescription only medicines.
Visual media
Visual media is evidence generated through photography or video.
Links To Other NOS
SKANSC11, SKANSC12, SKANSC13, SKANSC1.2, SKANSC2.2