Remote Prescribing of BOTOX banned

[Cheeky Charlie]

This is absolute twaddle. Complete and utter garbage! She has mislead you. If she is not a prescriber then she cannot administer botox from a remote prescription service (regardless of the organisation she belongs to - which I can hazard a guess at)! The patient MUST have a FACE TO FACE consultation with a prescriber - ie a Nurse Prescriber, Doctor or Dentist.

I would never, ever mislead any of my patients this way. Please do not accept what you have been advised.

Remote prescribing is banned and comes into force on Monday 23rd July. Any nurse saying she is fine to carry on using such a service is listening to a desperate doctor eager to hang onto his dying business. Don't get caught up in the lies. protect your patients and look for a doctor or nurse prescriber to do your clinics x

 

[ashalina23]

Plus the biggest insurer Hamilton Fraser issued a statement today saying they wouldn't insure nurses unless they were qualified prescribers.

 

[AMO]

As I understand it, as long as the client undertakes a consultation with either a doctor or nurse prescriber then a prescription can be written and the Botox administered by a different nurse with Botox training.

Now I believe there are some very competent and experienced therapists out there who are just as knowledgable as doctors and nurses in this field. There are bad doctors and nurses as well as therapists.

As an independent nurse prescriber I emailed the NMC for their advice on prescribing for non-nurses. As I expected their response was useless!

Does any one else have any pearls of wisdom as I just don't want to risk losing my registration.

Thanks

 

[ssuk]

I dont think this issue is purely the competency of the therapist/nurse administering the drug, or been as experienced as Drs or Nurses.

There are many conditions which would result in Botox been Contraindicated. Drs would [or in theory should] be able to recognise these.

There can be serious side effects with the injection. Could you recognise these? Some may be very subtle side effects that later develop.

If a client was to react to the Botox injection in your salon,would you recognise it immediately and have the skills and training [and ideally drugs] to help that client - ie. anaphylaxis?

To put this into context. I have a diploma in Primary and Emergency Care and numerous other medical quals. I have give asmany different injections as you can imagine. I have dealt with everything from anaphylaxis, to Strokes.

I would not feel confident administering Botox in a salon. The technique may be easy, the complications could be a nightmare.

But then thats just my view.- doesn't mean im right.

Look another way.would you trust your GP to tint your lashes or do a full set of acrylics?

 

[AMO]

Hi,

Well if my GP was suitably trained in acrylics I would consider it but knowing how much a GP earns I probably couldn't afford him/her! Never had my eyelashes tinted!

I'd like to think that personally, I would recognise said reactions and early onset of of an allergic/anaphylactic reaction, being an A and E nurse practitioner! I am also aware that many BTs have undertaken BLS and anaphylaxis trg but am not sure if they hold any epipens etc.

The facts remain that Botox is and will be given in salons by BTs, nurses and doctors so I would just like to know where nurse prescribers stand professionally prescribing Botox for a BT to administer. Aren't we prescribing for the client, the prescription Is theirs and therefore they are free to choose who administers it?

 

[AMO]

Oh, I also checked with Hamilton Fraser and they got their first statement wrong!
They have issued a new one stating they will insure nurses to administer Botox providing the client has undergone a face to face cons with the prescriber and they are acting within professional guidelines.

 

[ssuk]

dont get me wrong amo, i have nothing against you are anyone administering botox. what i am against is the belief that the only issue is experience in injecting the botox. the issue is far wider. i think wether dr, nurse or bt the person administering needs to understand the pharmacology, contraindications, side effects and a whole lot more. wouldnt it be far better for the gmc or another body to take responsibility, and put togeter a standatd training package for all if the above then allow qualified therapists to administer and even order. also give them epi pens and first aid training as a min

Sent from my GT-S5830i using SalonGeek

 

[AMO]

Hi SSUK,

Well yes that would be a good idea but I am sure that's never going to happen! There is so much disparity between the training doctors receive to perform the same function as the nurse as it is. I know that the doctors training in general is more difficult academically but nurses undergo stringent training with a subsequent competency package for cannulation and auguring, for example- doctors don't, they just get shown and then are left to get on with it!

The problem is that all the courses teaching Botox don't have a set curriculum so none of us know what others have actually been taught and what 'hands on' they receive. The insurance companies however, should be aware of what company teaches to standard. Hamilton Fraser, for example, have assessed various companies training and will only insure for the ones thayer have approved.

The consultation process, if done thoroughly, should help eliminate those with contraindications to Botox, but clients, like patients, aren't always honest if they really want something. And often they don't view an illness as an actual illness and don't declare it. As long as we do everything we can to ensure we have taken a full history and done a full consultation with full paperwork and written consent.......
As part of the nurse prescribing course these aspects are covered, so if nothing else, it takes away this burden of responsibility from other nurses and BTs even if it does cost them a little more....

 

[smooth]

As I understand it, as long as the client undertakes a consultation with either a doctor or nurse prescriber then a prescription can be written and the Botox administered by a different nurse with Botox training.

As an independent nurse prescriber I emailed the NMC for their advice on prescribing for non-nurses. As I expected their response was useless!

Does any one else have any pearls of wisdom as I just don't want to risk losing my registration.

Thanks

All clients require a face to face consultation prior to the prescription being written and dispensed by the pharmacy. If a nurse is delegated to administer that POM they need to be competent at the task and sure that it is safe and appropriate to do so. They can refuse to administer if they are not happy to do so.

As a prescriber you have to adhere to the Standards and Proficiencies for Nurse and Midwife Prescribers along with Medicines Management and The Code etc. The RCN can also offer you advice if you are a member.

Everyone is in a panic at the moment, the GDC, GMC and NMC are all singing from the same hymn sheet at the moment so regardless of who does the injection the consultation etc should be carried out the same way. Telephone calls, faxes, e-mails etc cannot be used to obtain botox. Going against all guidance will invalidate your insurance. Hope this answers your question?

 

[ashalina23]

2. Who is an appropriate practitioner?

A doctor, a dentist or, subject to certain limitations, a nurse or pharmacist independent prescriber or supplementary prescriber. In this document, references to a practitioner mean an appropriate practitioner.

 

[smooth]

I'd like to think that personally, I would recognise said reactions and early onset of of an allergic/anaphylactic reaction, being an A and E nurse practitioner! I am also aware that many BTs have undertaken BLS and anaphylaxis trg but am not sure if they hold any epipens etc.

The facts remain that Botox is and will be given in salons by BTs, nurses and doctors so I would just like to know where nurse prescribers stand professionally prescribing Botox for a BT to administer. Aren't we prescribing for the client, the prescription Is theirs and therefore they are free to choose who administers it?

An epipen is prescribed for one person only and as such should only be used on that person, a BT cannot keep that in stock for someone else, so this brings a whole new legal aspect to this which as an INP you should know.

Oh, I also checked with Hamilton Fraser and they got their first statement wrong!
They have issued a new one stating they will insure nurses to administer Botox providing the client has undergone a face to face cons with the prescriber and they are acting within professional guidelines.

They are not however stating what those professional guidelines are...

dont get me wrong amo, i have nothing against you are anyone administering botox. what i am against is the belief that the only issue is experience in injecting the botox. the issue is far wider. i think whether dr, nurse or bt the person administering needs to understand the pharmacology, contraindications, side effects and a whole lot more. wouldnt it be far better for the gmc or another body to take responsibility, and put togeter a standard training package for all if the above then allow qualified therapists to administer and even order. also give them epi pens and first aid training as a min

Sent from my GT-S5830i using SalonGeek

again if you hold an epi pen that can only be legally administered to who it prescribed for, if you use that on another person that is breaking the law and invalidating your insurance!! Will they say... oh well you saved thier life... NO, the lawyers would have a field day. The standards you talk about are there ia treatments you can trust. The GMC etc cannot bring about standards as they can only regulate who they register. TYCT however, can standardise the industry and do, however they do not believe anyone other than a registered medical professional should inject.

Seeing what they have achieved so far, they do have some power... look at their history with Dr Harrison... says it all

Hi SSUK,

Well yes that would be a good idea but I am sure that's never going to happen! There is so much disparity between the training doctors receive to perform the same function as the nurse as it is. I know that the doctors training in general is more difficult academically but nurses undergo stringent training with a subsequent competency package for cannulation and auguring, for example- doctors don't, they just get shown and then are left to get on with it!

The problem is that all the courses teaching Botox don't have a set curriculum so none of us know what others have actually been taught and what 'hands on' they receive. The insurance companies however, should be aware of what company teaches to standard. Hamilton Fraser, for example, have assessed various companies training and will only insure for the ones thayer have approved.

The consultation process, if done thoroughly, should help eliminate those with contraindications to Botox, but clients, like patients, aren't always honest if they really want something. And often they don't view an illness as an actual illness and don't declare it. As long as we do everything we can to ensure we have taken a full history and done a full consultation with full paperwork and written consent.......
As part of the nurse prescribing course these aspects are covered, so if nothing else, it takes away this burden of responsibility from other nurses and BTs even if it does cost them a little more....

2. Who is an appropriate practitioner?

A doctor, a dentist or, subject to certain limitations, a nurse or pharmacist independent prescriber or supplementary prescriber. In this document, references to a practitioner mean an appropriate practitioner.

 

[ashalina23]

Thanks for that smooth however it was not my opinion as you may have interpreted it but the relevant section extracted from the mhra website.

 

[smooth]

whoops poor spelling of their!! Sorry about that. Again Ashalina, MHRA guidance as you quoted clearly states that independent nurse prescribers can prescribe and administer botox, this is WITHOUT the need for a doctor to be involved in the process.

 

[Christine Mary]

I can see both sides of the argument here, but what concerns me is that when something is regulated as plans to be the case here, there is always some unscrupulous person who attempts to make a fast buck by "coming in the back door", and consequently possibly putting people at risk with sub standard products.

I sincerely hope it dosn't happen with this.

 

[AMO]

Apologies,

I meant to write suturing but obviously did a typo and my ipad changed it to auguring!

 

[AMO]

Botox prescriptions over phone or internet (Remote Prescribing) to be banned says GMC. So there needs to be a face to face ie in the same room for the patient receiving the treatment ie Botox and the prescriber whether they are a Dr, Dentist or Nurse Prescriber.

As you have correctly stated here, Nurse Prescriber! Why then are you trying to suggest elsewhere that nurse prescribers can't prescribe or administer Botox?

 

[smooth]

As you have correctly stated here, Nurse Prescriber! Why then are you trying to suggest elsewhere that nurse prescribers can't prescribe or administer Botox?

he he x:hug:

 

[brow queen]

ok, so can nurse prescribers still prescribe and administer botox, fillers etc? I have been approached by both a nurse and an ex beauty therapist (apparently fully trained/insured for these services but no nursing background) wanting to advertise these services in my salon, I'm inclined to go with the nurse but if these new rules change the goal posts for her as well then I'll politely decline both ladies.

Yes I understand you'd prefer a doctor or consultant surgeon! As they don't make mistakes? They would know how to improve a clients looks especially being a gynaecological doctor. Come on!! Doctors make mistakes and kill people! Consultant surgeons mess up every day! Lop sided belly buttons after tummy tucks, uww nearly forgot the great hash on the pip implants! So yes they're so reliable? There are fantastic doctors and surgeons also rubbish ones!
Stop patronising the people out there who really DO know the a&p of the face. And really do know where to inject and all the contraindications of these products. It's seriously not taken lightly by the true professionals who are dedicated to this work. And yes!! Get rid of the ones who are a danger to clients.

 

[BRH]

Yes I understand you'd prefer a doctor or consultant surgeon! As they don't make mistakes? They would know how to improve a clients looks especially being a gynaecological doctor. Come on!! Doctors make mistakes and kill people! Consultant surgeons mess up every day! Lop sided belly buttons after tummy tucks, uww nearly forgot the great hash on the pip implants! So yes they're so reliable? There are fantastic doctors and surgeons also rubbish ones!
Stop patronising the people out there who really DO know the a&p of the face. And really do know where to inject and all the contraindications of these products. It's seriously not taken lightly by the true professionals who are dedicated to this work. And yes!! Get rid of the ones who are a danger to clients.

Here here, someone else talking some sense!!:biggrin:

On another note have you all seen the new Aesthetic Therapists Association the AAIC I think its - (association of aesthetics Injectables and Cosmetic lasers). Chairman is a therapist and does his own training in Grantham. Just so all you therapists out there are aware there is a lot of support for you.
He has suppport from Belotaro and Teosyal on the site so there you go!

 

[nailzoo]

It must be remembered that 'Botox', although commonly used within the salon environment is a Prescription Only Medication. Its a Toxic substance and can have life threatening side effects.

Whether you have used it regularly or not, be careful.

Not only life threatening, but can be quite dis-figuring also .... I've seen some lopsided results, over prescription and downright fugly botch jobs.

Pretty girls one day, the next they look like a stroke victim.

Just like the tanning industry, it's about time there was more law and order with botox, i'm sure there will be many making quite a bit of money that won't like the restrictions ...... but if you meet the qualifications, there should be no problems, so why would anyone worry ........ if they are competent and qualified?