Cosmetic Medicines Ordering, Storage, Supply and Incident Reporting

This article gives an overview of the systems and processes that must be followed by cosmetic clinics when supplying prescription medicines.

A prescription medicine or drug legally requires a qualified doctor, dentist, nurse or pharmacist to write a prescription for a named patient. The list of drugs and prescribing qualifications may vary in different countries.

A cosmetic clinic must ensure that all medicines are ordered, stored and supplied within the legislative and other relevant pharmaceutical guidelines available.

Therefore ordering, storage and supply of medicines for use within the practice must be undertaken according to appropriate procedures and guidelines to ensure all relevant legislation and pharmaceutical information is adhered to.

Any medicines stored within a typical cosmetic clinic are those used for aesthetic purposes, this includes drugs such as Botox ® and Hyaluronidase. These must be stored according to manufacturer's guidelines in a locked refrigerator or locked cabinet as appropriate. The temperature of the refrigerator should be monitored and documented daily. If the temperature is found to be outside the recommended range the pharmacy supplier must be informed as soon as possible and if necessary the medicines are returned to the supplier and a new supply obtained.

Supply of Medicines and Maintaining Patient Records for Cosmetic Clinics

The Medical Practitioner is responsible for maintaining a record of medicines obtained from the supplier for use during treatment. A copy of the prescription is retained in the patient's notes and the following information is noted in the Medicines IN register. The Medical practitioner must include the following details:

- the name of the medicine (generic)

- the dose provided by the pharmacy

- the amount provided by the pharmacy

- the format of the medicine (oral I IM etc)

- the batch numbers and expiry dates

The Medical Practitioner is responsible for ensuring that details of the medicines administered are recorded in the patient notes, including:

- the name of the medicine (generic)

- the dose provided

- the route of administration

- the batch number and expiry date of the medicine

- the date and time of administration

The Medical Practitioner must also document in the Medicines OUT register the name of the patient the medicine was administered to and the date and time of administration. This will ensure an audit trail is available for each practitioner.

All medicines not used or expired must be returned to the pharmacy.

In conclusion only a medical professional should be accepted on a cosmetic training course. This will ensure all practitioners have experience with the use of prescription only medicines and record keeping. The medical practitioner who facilitates a cosmetic intervention should be a qualified doctor, dentist, nurse or pharmacist. These specialists have the prerequisite medical experience plus understand their legal and ethical requirements in prescribing, dispensing and administration of such drugs.

Any errors with the medication must be recorded and reported.

Reporting a Medication Incident

A cosmetic clinic must ensure that all medication incidents follow local legislative and other guidelines for your country of practice. The following is based on the UK CQC guidelines.

All practitioners involved with medication prescribing, dispensing or administration must be aware of the procedures to be followed in the event of a medication error or near miss.

Medication errors or near misses will occur despite having risk procedures in place, and all personnel involved in medication prescribing, dispensing or administration are at risk of being involved an error or a near miss. Because of this, comprehensive reporting of all medication incidents is crucial to enable the organisation to learn from mistakes and improve practice wherever possible.

All incidents involving medication prescribing, dispensing or administration, 'near misses' and serious drug reactions must be documented on the Incident Report Form. A medication error is a preventable incident or omission that results in an increase in the risk of patient harm. A 'near miss' is a medication error that is discovered before it reaches the patient, thus preventing harm to the patient.

What to Report

The following are some of the issues that require an incident report:

- incorrect dose administered (both over and under dosing)

- incorrect route of administration

- incorrect rate of administration

- incorrect drug administered

- administration to the wrong patient

- failure to document administration in the patient's medical notes

- administration of an expired drug

- prescribing errors

- incorrect labels

- allergies not recorded

- serious adverse effects including allergic reactions

Near Misses will also be recorded on the Incident Report form.

How to Report Medication errors

Medication errors involving administration to a patient will be documented in the patient's notes. The Medical Practitioner should inform the patient.

The incident should be documented fully before the end of the day. This report form must be completed by the Medical Practitioner and given to the Practice Manager without delay.

Follow Up Procedures for Medication Errors

A follow-up is undertaken by the Medical Practitioner to ensure the safety of the patient. If necessary the patient must be referred to the nearest Emergency department for further review. The Practice Manager must undertake an investigation into the event ensuring a statement is taken from those involved.

The incident must be discussed at the next Clinical Governance meeting and an action plan developed to aim to prevent recurrence; this may include further training for the personnel involved.

Any severe medication incident must be reported to the within 24 hours of it occurring.

I hope you enjoyed the article. For more information about medicines and their regulations you can check with the Department of Health and MRHA in the UK. In the USA please refer to The Food and Drug Administration (FDA).