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Care Directives in Aesthetic Medicine

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Professional Standard Regarding Care Directives in Aesthetic Medicine

Definition of a Care Directive

A care directive is an order written by a physician for an intervention or series of interventions to be implemented by a registered nurse (or other health-care provider) for a range of patients with identified health conditions, only when specific circumstances exist. The purpose of a care directive is to provide safe, timely, effective and efficient patient care using the expertise of the physician and the registered nurse (or other health-care provider) who must use discretion and judgment when implementing the care directive. The care directive must outline interventions within the scope of practice of the registered nurse [or other health-care provider].

Adapted from: College of Registered Nurses of Nova Scotia Position Statement: Registered Nurses Role in Cosmetic Procedures: Botox and Dermal Fillers

Professional Standard

Note: For the purposes of this professional standard, “aesthetic medical procedures” are presumed to be services that are not insured by Nova Scotia Medical Services Insurance (MSI).

  1. Physicians who work with non-physicians to undertake aesthetic medical procedures (including but not limited to injections of BOTOX® or dermal fillers) bear ultimate responsibility for these procedures, regardless of the nature of the procedures or the type of facility in which they are performed. The physician must prescribe the aesthetic medical procedure, which may be in the form of a care directive. (See “Definition of a Care Directive” above).
  2. Aesthetic medical procedures may be performed by non-physician health-care providers (such as registered nurses) when these providers are specifically ordered to do so by a responsible physician. This physician is responsible for ensuring that these health-care providers meet the following criteria:
    1. They possess the necessary education, training and experience to perform the procedures.
    2. They are licensed within a regulated health profession.
    3. The procedure is within their professional scope of practice.
    4. They possess appropriate liability coverage.
    5. They are able to meet the standards, guidelines and policies of their professional regulator.
  3. Registered nurses possess the education and legislated authority to administer medications or substances by injection.  However, they do not have the authority to independently order medications or substances (including BOTOX or Dermal Fillers).
  4. A doctor-patient relationship exists in all situations in which an aesthetic medical procedure is ordered by a physician. In such situations, the College expects that the physician will:
    1. interview the patient;
    2. perform an assessment;
    3. make recommendations;
    4. assess contraindications;
    5. determine the injections site(s);
    6. discuss risks;
    7. obtain an informed consent from the patient to proceed; and
    8. be present for the initial injection of BOTOX.
  5. For subsequent BOTOX treatments conducted by a non-physician, the physician must be readily available for consultation, but not necessarily be on site.  However, for subsequent BOTOX treatments that involve new injection sites or different doses, the physician must re-assess the patient.
  6. Notwithstanding section five above, physicians must be on-site during the initial and subsequent administration of dermal fillers.
  7. The name of the physician who has ordered a given aesthetic medical procedure must be explicitly communicated to the patient and the physician’s name must be clearly posted within the facility in which the function takes place.

 

 

Document History

Re-approved with significant amendments by the Council of College of Physicians and Surgeons of Nova Scotia: March 22, 2013

Approximate date of next review: March 2018

Note: This document was formerly titled Policy Regarding Delegated Medical Functions in Aesthetic Medicine