A Review of the Key Issues Involved in Prescribing within Aesthetic Medicine - Coursework Example

A review of the key issues involved in prescribing within aesthetic medicine NMAH 3338 Independent Study Module Christopher Worth P07113988 Introduction The purpose of this assignment is to look at two keys issues involved in prescribing within the field of aesthetic medicine. The two most contentious issues are Botox administration and “remote” prescribing. Aesthetic medicine is generally classified as surgical or non surgical. The non surgical field has grown in the UK so much over the last 10 years, and is now being driven by nurses rather than doctors. In the US non surgical procedures have grown from 1.2 million treatments in 1997 to 8.5 million in 2008 (ASAPS, 2009), the trend is similar in the UK. Aesthetic medicine using Botulinum Toxin-A has turned out to be a more affordable alternative got individuals wishing to enhance their appearance without the cost implications and other issues of risks and down time that are associated with surgical procedures towards the same objective. The main target areas that Botulin Toxin-A is employed for in aesthetic medicine are the medial eyebrows, crows feet, forehead, platysmal neckbands and the jowl (Mendez-Eastman, 2003). Botox™ Administration At present the aesthetic medicine industry is “unregulated”. The Healthcare Commission and the Independent Healthcare Advisory Service have been asked by the government to try and oversee and regulate the industry. Botulinum Toxin-A, or Botox/Vistabel/Dysport (Btx), is a prescription only medication. It has many medical licences as well as a cosmetic licence (BNF, 2009). Its cosmetic licence is for treatment of the glabella (frown) lines, although it is also used to treat other areas “off” licence. The fact that Btx needs to be prescribed means that the practitioner should be a doctor, dentist or nurse independent prescriber (MHRA, 2008). The primary function of the Nursing and Midwifery Council (NMC) is to ‘protect the public by setting standards and giving advice to nurses’ (NMC, 2007). Its guidelines for Btx administration are a grey area at best if one is not a nurse independent prescriber (NIP). Borland (2007) suggests that there are hundreds of nurses breaching safety guidelines on carrying out high-risk Btx injections. She also quotes the NMC guidelines stating that each patient should have been fully assessed by their medical history. Goodchild (2008) also highlighted that patients must be checked by a doctor prior to Btx treatment. Nurses who inject Btx have to have professional indemnity insurance cover by law (NMC, 2007. RCN, 2008). Anyone who is practising without it in aesthetics is doing so illegally. The Royal College of Nursing (RCN) has only recently allowed insurance of individual nurses to inject Btx (2008). There are strict guidelines that must be followed in order to maintain ones insurance. However most individuals obtain private insurance as the RCN does seem to change its mind rather frequently. If, as according to the NMC Code of Conduct (2007), a nurse must work within certain standards to maintain safety and professional accountability, then the nurse should also be appropriately trained to administer Btx therapy. The emphasis must then switch to training quality and how much experience the nurse must obtain to be deemed competent. There are many training courses of varying quality, so it can prove to be difficult to find the course that will offer the best training with an emphasis on practical injecting as well as theory. Many nurses actually end up doing 2 or 3 courses before they feel comfortable to start injecting on their own. The nurse must also check with their insurers, or potential insurers, that the course that they are going to undertake is suitable for them to then go on and practice. On successful completion of their training they must ensure that they keep abreast of all regulations and updates to keep up to date. As with NHS nursing nurses in the private sector should appraise themselves regularly and attend any relevant courses or updates, this includes anaphylaxis and CPR training. In many cases nurses are far more proficient injectors than doctors within non surgical medical aesthetics. This stems from the fact that the administration of injections through many of the routes of administration is a routine practice of the nursing professionals as a part of their daily functions (Wynaden et al, 2006). Nurses have proven themselves to be as proficient as their medical professional colleagues in several areas of functioning in health care, much removed from the days of Florence Nightingale and the role of nursing as handmaidens to the medical profession. This is highlighted by the nurse-led interventions in emergency situations. Thrombolysis in acute myocardial infarction (AMI) has for long remained an intervention in the domain of cardiac specialists. This led to delays in the initiation of this intervention. In the United Kingdom the strategy of nurse-led or nurse-initiated thrombolysis has been in place to reduce the door to needle times in AMI, with a significant reduction in time taken for initiating thrombolysis in AMI and better patient outcomes. Nurses have shown a willingness to undertake such specialist oriented roles after receiving adequate input of knowledge, skill and experience and the medical professionals have relented to nurses undertaking such enhanced roles (Chaney, 2004). Therefore the issues with prescribing and administering do not really pertain to the capacity and willingness of nurses to take up this additional responsibility. It pertains to providing the appropriate training and certification for nurses. Nurse prescribing for a wide range of medications oral and by injection that are on the General List is increasing with nurses acquiring the relevant knowledge and skills (Peniston-Bird, 2007). Botox is only a single prescription medication the knowledge and skills of the medication and its administration are not beyond the capacity of nurses to acquire. The Royal College of Nursing (RCN) has an assessment tool for nurses in aesthetic medicine that assesses the competency of nurses in the several areas of practice in aesthetic and acts a career and competency framework. Skin rejuvenation is an area of nursing practice that finds a place in this assessment tool. Botox administration does not find a place in this assessment tool (RCN, 2007). The RCN can easily amend this assessment tool to provide for nurses taking up Botox prescription and administration. Such a move is not without precedence. The Board of Nursing in the State of Ohio in the United States of America has permitted nurses to administer Botox. Such permission has been granted on the basis of plastic surgeons believing that by allowing nurses to administer Botox, patients would be served more effectively and efficiently and in addition save the time and resources of the plastic surgeons (Goulder, 2008). This is the attitudinal change that is required in the United Kingdom, to remove the issues pertaining to Botox administration by nurses. Remote Consultation for Nurses Nurses may be skilled in the administration of Botox, but not legally sanctioned to prescribe Botox in the United Kingdom, unless they have qualified for prescribing, as Botox is a prescription only medicine (Which? Bid to Stop Online Botox Promotions). Botox is administered not just in the medical practitioners’ offices, but also in premises of beauty therapists by nurses under the guidance of medical practitioners (Hillingdon, 2007). In December 2008, new General Medical Council rules have made it mandatory for medical practitioners to vet patients prior to Botox administration for ant-ageing treatment (Goodchild, 2008). This makes it difficult for nurses to administer Botox affecting the availability of Botox as an aesthetic medication inconveniencing those that would like to have Botox administered for ant-ageing effects. Advances have been made in the telecommunication technologies that have the potential to alter the spatial and temporal relationship between health professionals and their patients (May et al, 2001). The use of this telecommunication does not incur any further investment than in a telephone that is already available (Carr & Sheikh, 2003). There is no doubt that the standard face-to-face traditional method of consultation is the most suitable means to the delivery of medical care and the best means to evaluation for treatment. However, there are occasions, like in the case Botox prescription, when such an interaction may not be required and remote consultation over the telephone is swerving as an alternative to the traditional face-to-face consultations in the recent past (Cohen, 2008). In the United Kingdom this practice of telephonic consultation has gained ground, particularly with general practitioners as a means to managing demands and meeting same day appointments. The use of telephonic consultation has gained ground because of the time saving in the consultation and has acceptance with patients (McKinstry et al, 2002). Telephonic consultation involves the components of exchange of medical information between and the creation and issuance of a formal report (Cohen, 2008). This can be translated into use for nurses administering Botox within the prescribed norms of the General Medical Council of the United Kingdom in the prescribing and administering of Botox. There are limited issues with regard to nurses administering Botox injections as giving injections is part of their normal routine (Wynaden et al, 2006). The main issue stems in the prescribing of Botox by nurses not qualified to do so and this can be overcome through a telephonic consult, wherein the requisite medical information is made available to the medical professional, who then ascertains the suitability of use of Botox in the patient and then issues the requisite formal orders. In this way remote consultation can be utilized to overcome any issues with nurses administering Botox in aesthetic medicine. References American Society for Aesthetic Plastic Surgery (ASAPS) (2008), Cosmetic Surgery National Data Bank Statistics 2008 British Medical Association and Royal Pharmaceutical Society of Great Britain (57), British National Formulary (BNF) Borland, S.2007 ‘Nurses ‘endanger patients with Botox’. The Telegraph Newspaper [Online] Available at: http://www.telegraph.co.uk/news/uknews/1573640/Nurses-endanger-patients-with-Botox.html (Accessed March 27, 2009). Carr, J. & Sheikh, A. 2003, ‘Telephonic consultation’, BMJ, vol.326, no.7396, pp.966-969. Chaney, U. 2004, Attitudes and perceptions of nurses and doctors to nurse-led and nurse-initiated thrombolysis--an Irish perspective, European journal of cardiovascular nursing, vol.3, no.4, pp.303-313. Cohen, B. H. 2008, ‘Remote Consultation Offers a Valuable Alternative to Face-to-Face Medical Treatment’, American Academy of Neurology [Online] Available at: http://www.aan.com/news/?event=read&article_id=4744 (Accessed March 27, 2009). Goodchild, S. 2008. ‘Party’s over for Botox’, Evening Standard Newspaper [Online] Available at: http://www.thisislondon.co.uk/standard/article-23598801-details/Party%27s+over+for+Botox/article.do (Accessed March 27, 2009). Goulder, M. 2008, ‘Nurses can give Botox injections’, The Columbus Dispatch.com [Online] Available at: http://www.columbusdispatch.com/live/content/business/stories/2008/08/17/Botox.ART_ART_08-17-08_D1_9CB1E66.html?sid=101 (Accessed March 27, 2009). Hillingdon. 2007, ‘London Borough of Hillingdons position on advanced therapies’ [Online] Available at: http://www.hillingdon.gov.uk/index.jsp?articleid=7294 (Accessed March 27, 2009). May, C., Gask, L., Atkinson, T., Ellis, N., Mair, F. & Esmail, A. 2001, ‘Resisting and promoting new technologies in clinical practice; the case of telepsychiatry’, Social Science Medicine, vol.52, no.12, pp.1889-1901. McKinstry, B., Walker, J., Campbell, C., Heaney, D. & Wyke, S. 2002, ‘Telephone consultations to manage requests for same-day appointments: a randomised controlled trial in two practices’, British Journal of General Practice, vol.52, no.477, pp.306-310. Mendez-Eastman, 2003, ‘BOTOX: a review’. Plastic surgical nursing, vol.23, no.2, pp. 64-69. MHRA. 2008, ‘Supply and administration of Botox, Vistabel, Dysport and other injectable medicines in cosmetic procedures’. NMC. 2007, ‘The Code: Standards of conduct, performance and ethics for nurses and midwives’. Peniston-Bird, F. 2007, ‘Key Questions - Non-medical Prescribing’, Nursing times.net [Online] Available at: http://www.nursingtimes.net/nursing-practice-clinical-research/key-questions-non-medical-prescribing/287915.article (Accessed March 27, 2009). RCN. 2008, ‘An Assessment tool for nurses in aesthetic medicine’ [Online] Available at: http://www.rcn.org.uk/__data/assets/pdf_file/0007/78766/003185.pdf (Accessed March 27, 2009). RCN. 2008, ‘RCN indemnity insurance FAQs’ [Online} Available at: https://www.rcn.org.uk/development/communities/specialisms/management_and_leadership/formsgroups/aesthetic_nurses/indemnity_insurance (Accessed March 27, 2009). ‘Which? Bid To Stop Online Botox Promotions’, 2008, Medical News Today [Online} Available at: http://www.medicalnewstoday.com/articles/133761.php (Accessed March 27, 2009). Wynaden, D., Landsborough, I., McGowan, S., BaigMohamad, S., Finn, M. & Pennebaker, D. 2006, ‘Best practice guidelines for the administration of intramuscular injections in the mental health setting’, International journal of mental health nursing, vol.15, no.3, pp. 195-200. Read More