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Should nonphysicians inject Botox?

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Injection safety
Should nonphysicians inject Botox?

Bill Gillette
Staff Correspondent

LOS ALAMITOS, CALIF. — The Physicians Coalition for Injectable Safety has taken another step in its mission to educate the public about how to safely access injectable cosmetic treatments — as well as who should be performing them and under what conditions.

The Los Alamitos-based Coalition recently issued an advisory stating that not all nurses and physician assistants are qualified to perform cosmetic-filler injections.

“Patients should not accept treatment from nurses or any other clinician in private homes, hair salons, hotels, bars or any other nonmedical setting,” the advisory warns. “Patients should be aware that the most important factor to any nurse or physician-assistant injector is their relationship with an appropriately trained, supervising physician, and how closely the nurse and physician work together.”

Consumer safety guidelines
The Coalition advisory includes consumer guidelines regarding the only conditions under which a nurse or PA should administer cosmetic injections:

  • Under the supervision of a board-certified plastic surgeon, facial plastic surgeon, ophthalmic plastic surgeon or dermatologist who has prescribed the injectable treatment appropriate for the patient
  • Can demonstrate appropriate medical education, licensure and training specific to the delivery of cosmetic injections
  • Administers the injection in a medical setting supervised by the prescribing physician
  • Follows all of the appropriate steps in performing cosmetic injections, including giving patients informed-consent documents that clearly define the risks and benefits of the procedure

Importantly, patients should know that it’s their right to request that the physician administer the injection, the advisory points out. But whether a physician or appropriately trained nurse or PA does the injecting, patients can minimize risk by getting answers to questions posed in the Coalition’s “Doctor, Brand, Safety” guidelines:

  • Doctor — Is the injectable recommended by a qualified doctor who regularly treats similar conditions in an appropriately licensed and equipped medical facility? Has the doctor examined the prospective patient before recommending treatment?
  • Brand — Is the recommended injectable approved by the FDA (or by equivalent agencies in the country of origin) for cosmetic indications, and is the injectable appropriately labeled and packaged to reflect its authenticity and approval?
  • Safety — Is the care setting a proper, medically equipped office, with safety and sterilization procedures? Has the physician evaluated conditions, recommended treatment, offered alternatives and clearly defined the potential outcomes, including any complications?

Certainty with a certificate
Another way is an eight-hour injector training course that the Coalition has created and now offers to nurses and PAs at various professional conferences around the country.

“Patients should know that it’s their right to request that the physician administer the injection.”
 

“We’re linking the course to employment — in other words, only nurses and PAs who can prove they’re employed by a physician can take the course and earn the certificate,” Dr. Jewell tells Cosmetic Surgery Times. “We want to make sure they know not only how to inject, but about patient assessment, the importance of informed consent, and how to manage adverse effects if they occur.

“In my practice, my nurses are trained by me and have taken the course, and they do very well as injectors,” Dr. Jewell adds. “Sometimes, of course, patients want me to do the injections and there are patients that, for one reason or other, [on whom] I prefer to do the injections.”

According to a Coalition survey, that puts Dr. Jewell in the majority of doctors — and his practice in the minority of practices — in terms of who administers cosmetic injections in medical offices. The 2007 survey reports that while nearly 95 percent of physicians personally perform cosmetic injections, slightly less than 25 percent of Coalition member practices include nurse or PA injectors.

In addition, the survey showed that more than 45 percent of complications occur when unqualified providers administer injections, while more than 35 percent result from injections administered in a nonmedical setting, such as a spa, hair salon or private home. CST

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