Introduction to Clinical Practice

1. Introduction to Clinical Practice Unit 1.1 Dermal Science Theory Lecture 1

2. Lecture Overview • Who’s who is cosmetic medicine? • Insurance and Liability Issues • Risk Assessment and Management (Treatment, Hygiene and Safety Protocols) • Written and Photo Documentation

3. The Cosmetic Medical Team (Doctor/surgeon, cosmetic nurse and dermal therapist)

4. About the Dermal Therapist • A Dermal Therapist (DT) has completed a formal qualification in the field of dermal therapy… • …and is recognised as a specialist in dermal therapy procedures such as laser, IPL, microdermabrasion and chemical peels • A DT is different to a beauty therapist or a paramedical aesthetician as they have specialised their training specifically in the field of dermal therapy

5. Role of the Dermal Therapist • Specialist in non-medical dermal therapy procedures (IPL, laser, microdermabrasion, superficial chemical peels and skin needling) • Providing advice in relation to other surgical and/or medical cosmetic procedures • Aspects of pre and post operative care • Doctor’s assistant (role varies according to workplace) • Practice/clinic management and administration

6. Code of Ethics for DTs • Adhere to your Scope of Services • Provide a Duty of Care to all Patients • Promote Your Services with Honesty • Appropriately Deal with Adverse Events • Keep Skills and Knowledge Current • Reduce the Risk of Litigation • Promote and Maintain a Professional Image (See handout for details)

7. About the Cosmetic Nurse • Qualified Registered Nurse or Enrolled Nurse/Division 2 Nurse • Completed a formal postgraduate qualification in cosmetic nursing and dermal therapies • Nurses may also have training in injectable procedures (botulinum toxin and dermal fillers) • Injectable procedures are performed under medical supervision as they are schedule 4 medications

8. Role of the Cosmetic Nurse • Treatment provider non-medical dermal therapy procedures (IPL, laser, microdermabrasion, superficial chemical peels and skin needling) • Treatment provider of injectable procedures • Providing advice in relation to other surgical and/or medical cosmetic procedures • Pre and post operative care • General nursing duties (role varies according to workplace) • Practice/clinic management and administration

9. About the Cosmetic Physician • Graduated with an MBBS • May or may not be a General Practitioner • Has completed courses in aspects of cosmetic medicine such as injectable procedures and some dermal therapies • Provides more invasive procedures than the cosmetic nurse or dermal therapist • May also perform minor surgery

10. Role of the Cosmetic Physician • Treatment provider of cosmetic medical procedures such as injectables (both temporary and semi-permanent) • Minor surgical procedures such as skin lesion removal and liposuction • May perform some dermal therapies • Provides a supervisor role to the cosmetic nurse and dermal therapist • Generally the practice owner

11. About the Cosmetic/Plastic Surgeon • Graduated with an MBBS • May have completed a further 4 years specialty training in either ear, nose and throat surgery or plastic and reconstructive surgery in order to gain their FRACS • May have completed a training program offered by the Australasian College of Cosmetic Surgery • On-going dispute as to which type of surgeon is more qualified

12. Role of the Cosmetic/Plastic Surgeon • Performs a range of cosmetic surgical procedures such as face lift, blepharoplasty, rhinoplasty, liposuction, breast augmentation etc. • May perform injectable procedures • May perform minor cosmetic procedures • Provides a supervisory role to the cosmetic nurse and dermal therapist • Generally the practice owner

13. Societies For Cosmetic Physicians & Surgeons • Cosmetic Physicians Society of Australasia • Australasian Society of Cosmetic Medicine • Australasian College of Cosmetic Surgery • Australasian Academy of Facial Plastics Surgery • Australasian Society of Plastic and Reconstructive surgeons

14. Societies for Dermal Therapists and Cosmetic Nurses • Aesthetics Practitioners Advisory Network (APAN) • Association of Professional Aestheticians of Australia • Australian Day Surgery Nurses Association • Operating Room Nurses Association

15. Team Work! • Best outcome for both patient and treatment provider is achieved with team work • A holistic approach to practice • Respect your colleagues qualifications and experience

16. The transition from public to private practice • Do not double book patients • Allow adequate time for each appointment • Do not answer phone calls whilst with patients • Professional dress standards

17. Insurance and Liability

18. Risky Business? • Procedures performed in the cosmetic medical practice or advanced skin clinic carry risk of litigation due to: - Patient expectations - Downtime associated with procedures - Potential complications - Negligence - Perceived financial gain

19. Professional Indemnity Insurance • Covers you for services and advice whether you charge a fee or not • As a sole provider you must have your own professional indemnity insurance • Employer’s are responsible for taking out professional indemnity insurance for employees

20. Professional Indemnity cont’d… • Choose a specialty insurance broker for dermal therapies or cosmetic medicine (Beauty Plus, Parmia, AMA, AMP, Allianz, QBE, Zurich, Sparrow Group) • Be sure to state all services you provide to the insurance company • Be sure to let the insurance company know if you are providing new services • Be sure to read your policy thoroughly

21. Common Claims in Dermal Therapies (Source: Beauty Plus Insurance) • The most common claims in dermal therapies are associated with laser, IPL and chemical peels • The main reason why a patient sues is because the practitioner has NOT fully informed the patient about the procedure and/or the practitioner as failed to correctly deal with a complication

22. Be Aware! • Each policy will have additional conditions or an exclusion criteria stated • This will be stated on the certificate of currency • The additional conditions will significantly affect a claim • Read thoroughly!

23. Example of Additional Conditions(Source: Parmia Insurance Brokers)

24. Minimising Your Risk of Litigation

25. Minimise the Risk of Litigation by: • Effective communication between the DT and patient • Providing a thorough consulation • Using consent forms • Written and photo documentation • Minimise treatment errors • Risk Assessment and Management procedures • Planning treatment, safety and hygiene protocols

26. Effective Communication: friendly and personable • Greet patient with a smile • Apologise if you’ve kept the patient waiting • Keep eye contact • Do not use complicated terminology • Do not patronise • Do not rush the patient and allow them to ask questions

27. Who’s more likely to be sued?

28. 2. Provide a thorough consultation • Establish the patient’s needs/concerns • Establish the dermal therapy or cosmetic procedure most likely to treat the patients needs • Patient can make an informative decision • Disclose costs associated with the treatment plan • Provide written information and pre and post-treatment instructions

29. 3. Informed Consent • Consent forms should be used for every dermal therapy and cosmetic procedure • Use specific consent forms for each type of procedure • Must specify expected side effects • Must specify potential complications

30. 4. Written and Photo Documentation • Initial consultation notes • Progress notes • Should be clear, precise, adequate and up-to-date • Must be adequate for another treatment provider to easily take over • Good quality pre/post photographs

31. 5. Minimise Treatment Errors by: • Choose candidates wisely • Select treatment options wisely • Manage your appointment schedule (allow adequate time for each patient) • Establish a relationship with a Protocol Doctor • Refer patient to another treatment provider for diagnosis and/or treatment outside your scope of practice • Record errors and learn by them (incident reports)

32. 6. Risk Assessment and Management Procedures • Assess risks associated with your practice/clinic • Example: professional indemnity, staff illness or non-compliance, fire and theft • Assess management or procedures/policies you have in place to minimise (mitigate) the potential risks • A Risk Assessment and Management Procedure is very useful in a litigation situation

33. 7. Planning Treatment, Safety & Hygiene Protocols • A protocol is a systematic plan of action • Write a protocol for each procedure you provide encompassing; treatment, hygiene and safety • Implement your protocols! • Ensure all staff are familiar with them • Store in an easily accessible file • Review and update regularly

34. Treatment Protocols • Treatment protocol outlines the steps involved in performing a specific procedure, e.g. IPL hair reduction, AHA peels etc. • Very useful for training purposes and maintaining staff compliance (See handout for example)

35. Safety Protocols • Consider the patients safety in case of an emergency and/or an adverse event • Example: what if you were to get a chemical peel in a patients eye? • Example: What if you were to cause a burn during IPL? (See handout for example)

36. Hygiene Protocols • Outlines the hygiene standards for each procedure you perform • Hygiene protocols are necessary in the case of a Health Department Audit, especially in the case of an adverse event (see handout for example)

37. Putting it all together • Whether you work in or own a medical or non-medical clinic, consider how you can minimise litigation risks • This will help the practice run smoothly, meet OHS regulations and minimise potential litigation for you and/or the doctor you work for • Follow the seven steps mentioned, though fine tune for each practice/clinic

38. The Consultation

39. About the Consultation • Prior to all cosmetic procedures a consultation must take place between the treatment provider and patient • This is a critical factor in providing a professional service and a desirable outcome for both the patient and the treatment provider • The average initial consultation takes approximately 30 minutes • DVD outlines important aspects of the consultation

40. Consultation Structure & Sequence • Discuss the patients concerns • Establish the dermal therapy or cosmetic procedure most likely to treat the patients needs • Establish a treatment plan • Disclose the costs associated with the treatment plan • Provide written information about the procedure(s)discussed and pre and post-care • Book the patient for the first treatment session

41. Written and Photo Documentation

42. What to Record • New patient questionnaire (completed before the initial consultation. Also covers medical history) • Initial consultation notes • Signed consent forms • Patient progress notes • Pre/post photographs

43. Initial Consultation Notes • Patients concerns • Skin type and skin condition • Treatment(s) options discussed • Treatment plan • No contra-indications have been noted • Test spots performed (if applicable) • Written information provided (See handout for example)

44. Patient Progress Notes • Information recorded after each procedure performed • Type of procedure • Type of equipment and products used • Parametres, percentages and strengths • Skin’s reaction • Review appointment date (See handout for example)

45. Photo Documentation • A picture is worth a thousand words has never been more applicable to cosmetic medicine and dermal therapies • Good quality pre/post photos should be an essential part of every cosmetic medical and non-medical clinic • Why?

46. Importance of Taking Photos • Enables a patient to see themselves from a different view (more applicable to surgery) • Monitoring progress • Marketing tool • Minimises potential litigation • Reminds us who the patients are!

47. Producing Good Quality Pre/Post Photos • Consistency is the answer: Same lighting, background, angles and positioning • Inconsistency is a ‘trick’ often used by salespersons to purposely mislead consumers

48. Regulations • You cannot retouch pre and post photographs as this is considered misleading or deceptive conduct according to the Department of Commerce and Consumer Protection • Penalties may apply if conduct breaches Australian Consumer Protection laws • Each state may have regulations/guidelines pertaining to the use of pre and post cosmetic images

49. Trick Photography

50. Note the angle oflight causingexcess shadowingon the facialcontours and wrinkles