Perform muscle relaxing procedures using botulinum toxin type A
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 face to face consultation and evaluation with a regulated independent prescriber. This standard is for aesthetic practitioners using botulinum toxin type A to relax muscles to temporary disguise signs of ageing. 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.
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 protocol, 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 the individual's written 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 written 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 device and needle
9.4 storage instructions
9.5 waste disposal protocol
select an effective hygiene preparation product to meet the individual's needs in accordance with the manufacturer's 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 if applicable
- inject the botulinum toxin type A solution with a sterile, single use needle **in accordance with the botulinum toxin type A procedure protocol to include:
12.1 adaptation of injection techniques, depth and placement
12.2 in accordance with the pre-procedure markings if applicable
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 must take prompt corrective action as set out within the emergency plan to include:
14.1 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:
15.1 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 and obtain confirmation of receipt of the verbal and written instructions and advice given to the individual pre and post procedure to include:
19.1 the regulated independent prescribers contact details
19.2 emergency plan
19.3 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
3. 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
5. 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 physiological effect of botulinum toxin type A solution has on the targeted and surrounding facial muscle structures to include:
7.1 adaptation of injection techniques
7.2 adaptation of depth and placement
- the purpose, use and limitations of botulinum toxin type A procedures in relation to:
8.1* *past and current medical history
8.2 previous non-surgical cosmetic and/or dental procedure history
8.3 relevant lifestyle factors
8.4 contraindicated medication and medical conditions
8.5* *the individual's physical and psychological suitability for the non-surgical cosmetic procedure
8.6 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:
10.1 why and when immediate medical invention is necessary
the risk avoidance strategies
the regulatory and legislative requirements for prescription only medicines to include:
12.1 licensed and off license product use
- the licensed indicated use of prescription only medicines and when and why it can be used off license considering:
13.1 safety
13.2 treatment area
13.3 suitability
13.4 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, legislative and regulatory requirements to include:
18.1 access
18.2 use
18.3 storage
18.4 longevity and expiry
18.5 waste disposal policy
18.6 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 written 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's instructions
the importance to 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
It is expected that the aesthetic practitioner undertaking this standard already has the skills, knowledge and behaviours identified within the aesthetic practitioner's procedure guidance and non-surgical cosmetic National Occupational Standards.
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.
It is expected that this standard is used in conjunction with 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.
Items listed within the scope/range should be evidenced in line with the specific type of non-surgical cosmetic procedure being performed.
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
- instructions and advice
- waste management
- evidence based and reflective practice
Individual's objectives
- muscle relaxant
- cosmetic
Contra-actions
- hyperemia
- micro wounds
- bruising
- oedema
Scope Knowledge
Anatomy and physiology
- the structure and function of the body systems and their interdependence on each other
- skin and systemic pathologies
- severe adverse event pathologies
- basic knowledge of pharmacology and sciences
- effects of medications have on the skin and muscles
- study of the ageing process of the skin and underlying tissues/ effects of bone reabsorption and understanding of complex facial anatomy and venous and arterial blood supply
Adverse reactions
- ptosis
- infection
- nausea
- allergic reaction
- anaphylaxis
- botulism* *
- visual disturbances
- eye injuries
- needlestick injuries
- inability to swallow/ neck paralysis
- necrosis
- headache
- hematoma
- pulmonary embolism
- venous, arterial and nerve injury
- voice changes
- respiratory difficulty
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
- understanding of the pharmacology
- working knowledge of facial and neck anatomy
- waste management
- assessment of the individual's physical and emotional suitability
Visual aids
- Illustrative images
- Illustrative diagrams
- pre-procedure markings
* *
Instructions
- the individual, regulated independent prescriber and aesthetic practitioner's legal rights and responsibilities
- the regulated independent prescriber's contact details
- the regulated independent prescriber's contingency plan in the event of absence
- emergency plan
- post procedure expectations and associated time frames
- post procedure instructions and care
- restrictions and associated risks
- aftercare products and future procedures
- complaints procedure or concerns protocol
Values
Behaviours
Skills
Glossary
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.
Universal precautions and standard precautions
Universal precautions are relevant if the practitioner is exposed to blood and/or some bodily fluid. It is the responsibility of the practitioner to implement infection prevention and control measures to prevent exposure to blood borne pathogens or Other Potentially Infectious Materials (OPIM).
Standard precautions are the basic level of infection control that should be used at all times within the working environment, such as hand hygiene, personal protective equipment, prevention of needlestick and injuries from sharps, risk assessment, respiratory hygiene and cough etiquette, environmental cleaning and waste disposal.
Visual media
Visual media is evidence generated through photography or video.
Working environment
The working environment requirements should comply with Health and Safety legislation and be in accordance within guidelines set out either by your local authority or governing body.
Risk assessments should be undertaken and control methods implemented and documented, updated regularly and/or if changes occur. The working environment should be hygienic and fit for purpose for the non-surgical cosmetic procedures to be conducted safely and effectively using aseptic techniques. Infection prevention and control procedures are required to minimise risk of infection and transmission of microbes. Personal protective equipment must be fit for purpose and available. Equipment and products must be maintained in line with the manufacturer's instructions and legislative requirements.
It is advisable to create a complication management and/or emergency plan for all non-surgical cosmetic procedures in the event of an adverse reaction or incident.
Links To Other NOS
SKANSC1, SKANSC2, SKANSC4, SKANSC5, SKANSC6, SKANSC7,SKANSC8 and SKANSC9