Department of Dermatology: Procedure for Resident Cosmetic Clinics

Unit Procedure

Title

Department of Dermatology: Procedure for Resident Cosmetic Clinics

Introduction

Purpose

This Procedure provides the requirements and steps for the conduct of resident cosmetic clinics to ensure patient safety and successful resident training.

Scope

This Procedure applies to Department employees, residents and faculty involved in the scheduling and conduct of resident cosmetic clinics.

Procedure

The following are guidelines and steps for conduct of resident cosmetic clinics including curriculum, scheduling, patient pricing and product usage, including the proper use of Botox and filler products. 

General Guidelines for Resident Cosmetic Education Sessions

  1. Any desired/proposed session must be approved by the Cosmetic Curriculum Committee before scheduling and must have an identified faculty supervisor.

  2. All sessions must formally be scheduled. A supervising attending physician must be present for every encounter.

    1. Residents must send patient information (name/DOB/MRN) to Assistant Program Director at least 2 weeks prior to scheduled session.

    2. Assistant Program Director will send patient list to Lead EPIC Scheduler (Clinic Admin Team) to create a template under the name of the supervising attending physician for that session.

  3. All patients (a relative, your colleague, other, etc.) receiving a cosmetic treatment must have an encounter note entered into EPIC and routed to the supervising attending physician for co-signature.

  4. When an outside adjunct faculty member is assisting, a UNC attending physician must be present for the treatment and to co-sign the resident note.

  5. Cosmetic patients receiving free services should only be scheduled for services during formal resident cosmetic education sessions.  This scheduling ensures that the patients receive sufficient time and attention and that all policies are followed. 

  6. All patients receiving cosmetic treatments must be pre-screened for COVID. It is the residents’ responsibility to call patients prior to appointment to complete the COVID Travel prescreening in EPIC.

  7. Residents are responsible for:

    1. Normal rooming process including EPIC entries.

    2. Turn over and cleaning of the treatment rooms between patients and after the session.

  8.  If expired products are identified during the session, they must be discarded in the lockbox provided for this purpose.

  9. Products must be stored in temperature-monitored refrigerators designated for medications. Any products found elsewhere will be discarded and a SAFE report which may trigger a risk management investigation must be completed.

  10. Attending physicians cannot use resident cosmetic product to inject patients in a solo clinic. Attending physicians must order any needed product separately via the nurse manager and charge the patient accordingly.

Botox Guidelines

  1. The neurotoxin consent must include a patient’s sticker. The form must be complete and signed by the patient. The completed signed consent form is sent to medical records to be scanned into the patient’s medical record.

  2. The approved Botox template must be used for Botox procedures. All elements of the form including pre-treatment pictures and Botox lot number must be completed. The Botox form includes the following dotphrase: UNCDCOSMETICBOTOXTEMPLATE.

  3. Per UNC guidelines, a reconstituted vial of Botox may only be used for a single patient (50 units /100 units), and the remainder must be discarded. A single vial is used for a single patient during a single encounter. In order to minimize waste, vial size should be chosen carefully.

  4. Clinic Botox stock is not to be used at resident cosmetic clinic sessions. It is restricted for use on patients who will be charged for product in accordance with the standard Botox charge sheet.

  5. Resident Botox stock must be used for resident cosmetic education sessions.

  6. Follow-up/Touch-up appointments

    1. An automatic follow-up is usually only scheduled for new Botox patients, not for return patients. Return patients should be advised to contact the provider with any issues. Once a person gets Botox the first time, we usually know what they need every time, and it’s not an issue.

    2. Touch up appointments should be done when you don’t lose a patient appointment slot (e.g., end of clinic, etc).  There is no charge for touch-ups.

    3. Resident product will be used If the touch-up or the initial treatment was done by a resident

  7. When preparing a Botox tray for treatment, follow the laminated photo of the Botox tray and the included list of supplies This guide is posted at Nurse Station 2.

Filler Guidelines

  1. Filler patients can only be scheduled in regular, non-education clinic slots if they are being charged for product and the attending physician approves. Otherwise, patients receiving filler free of charge should only be scheduled for slots in resident cosmetic clinic education sessions.

  2. The filler consent form must include the patient’s sticker. The form must be complete and signed by the patient. The completed signed consent form is sent to medical records to be scanned into the patient’s medical record.

  3. The approved filler form template must be used. All elements including pictures and filler lot number must be entered. The form has the following dotphrase: UNCDCOSMETICFILLERTEMPLATE

  4. Filler can be scheduled on an attending template in a designated 1 hour appointment if a resident will be injecting the filler. In this scenario, resident product can be used. However, we cannot charge for the resident product. The cost for the hour is the COS350 code on the cosmetic sheet -- $350 due at the door. This allows an hour with us with a 350 dollar charge per syringe/filler type used. There is not a separate fee. This is a flat rate.

  5. Before any filler is injected, the resident must confirm that non-expired hyaluronidase is available in the medicine refrigerator in case filler needs to be dissolved. The resident must  notify the attending physician that the hyaluronidase is available. 

Definitions

  • Cosmetic Curriculum Committee: Internal department committee, comprised of faculty members, dedicated to creating the curriculum for Cosmetic clinics.

Related Requirements

Unit Policies, Standards, and Procedures 

Department of Dermatology Policy on Resident Cosmetic Clinics

Contact Information

Primary Contact

Name: Laura Ferris, MD, PhD - Chair

Telephone: 919-966-0785

Email: Laura_Ferris@med.unc.edu

Other Contacts 

Name: Paul Von Hofen, Jr., MSN, RNC-OB, CNOR - Interim Clinical Director

Telephone: 984-215-3352

Email: Paul.VonHofen@unchealth.unc.edu

Name: Margaret Coates, MD - Director of Cosmetics

Telephone: 984-974-3900

Email: Margaret_Coates@med.unc.edu

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