March 2020

Reflect before you inject

Do you consider administering cosmetic injectables to be a high-risk activity? You should.

Every year, CNO receives reports of patients who have been harmed during a cosmetic procedure. These incidents occurred for a number of different reasons. For instance, the nurse may not have followed proper infection prevention and control measures. Or, the nurse did not have the knowledge, skill and judgment to administer the injection or to manage an adverse outcome. As well, the nurse could have neglected to perform the procedure in an environment that supported safe care.

Administering substances such as botulinum toxin (Botox) or platelet-rich plasma (PRP) for cosmetic purposes carries the same risk for patients as administering those substances for medical reasons. If they are not performed properly, these procedures can result in infection, unnecessary pain, adverse reactions, and in cases where the adverse reactions are not managed, even death.

To keep your patients safe and prevent avoidable harm, you must:

1. Obtain the proper authorization
To administer Botox or PRP, an RN or RPN must perform the controlled act of administering a substance by injection. Therefore, RNs and RPNs who administer cosmetic injectables need to work in collaboration with a prescriber, such as a doctor or NP, and obtain the proper authorization, such as a direct order or directive.

Once the order is in place, you must determine that it is clear, complete and appropriate. If any one of those requirements is missing, do not proceed. Follow up with the prescriber.

2. Reflect on your practice
Before administering, ask yourself if you have the knowledge, skill and judgment to perform the procedure. Reflect on the limits of your knowledge, skill and judgment, asking questions and consulting with your colleagues as needed. Remember that working together to promote patient well-being is one of the six principles of the nursing Code of Conduct.

You must also ask yourself if you have the knowledge, skill and judgment to manage potential negative reactions to the medication. The Medication and Decisions About Procedures and Authority practice standards include decision trees that can help you decide whether to administer a medication and perform a procedure.

3. Assess your patient
Before administering a substance to a patient, complete an assessment and determine if it is appropriate for them. Make sure the patient understands the procedure and is aware of its risks and possible side effects. Then, verify that they consent to having the procedure performed.

4. Assess the environment
You should only perform procedures in practice settings that prioritize patient safety. Ask yourself if the physical environment, including access to equipment, supports the safe performance of the procedure. Then, ask yourself if you have the resources, both human and material, to monitor and intervene in case of adverse reaction.

5. Follow best practices for infection prevention and control
Reduce risk to yourself and others by appropriately handling, cleaning and disposing of the materials and equipment needed for any procedure. Ensure you are adhering to best practices or the manufacturer’s guidelines for the materials and equipment you use.

Since clinical infection control practices are continually changing, it’s up to you to keep current. Make sure you consult appropriate, evidence-based resources for this information.

If you have questions about your accountabilities related to administering cosmetic injectables, write to us. Our Practice Support team can help guide your decision-making.


You asked us: Can nurses in independent practice administer Botox?

Read CNO’s case scenario about syringe use and cosmetic injections.

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