Educational Guidelines to CANNZ Accreditation
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Educational Guidelines
for Injectables in Cosmetic Medicine
for
New Zealand Registered Nurses
CANNZ Accreditation
Contents:
Introduction
CANNZ
Aesthetic Medicine History, Ethics and Law
Client Centred Care
Psychology
Dermatology
Botulinum Toxin
Dermal Fillers
How to gain CANNZ accreditation as a Registered Nurse
How to become a CANNZ accredited training facility
Auditing of Practice
Renewal of CANNZ accreditation
Educational Guidelines for injectables in Cosmetic Medicine for New Zealand Registered Nurses
Introduction
This guideline is aimed at providing a standard of training for injectables in cosmetic medicine for Registered Nurses in New Zealand. Client safety and improved aesthetic and health outcomes are the aim of standardising the training of RNs practicing in the field of cosmetic medicine. These guidelines serve as minimum training requirements for injectables for educators, training academies and trainees.
Various areas critical to the safe delivery of injectables in cosmetic medicine have been included: Aesthetic Medicine History, Ethics and Law, Client centered care, psychology, basic dermatology, botulinum toxin and dermal fillers. The scope of these guidelines do not outline standards of care for other cosmetic procedures, including the use of lasers or other modalities.
CANNZ
Cosmetic Appearance Nurses Network of New Zealand (CANNZ) is a society of Registered Nurses aiming to increase the safety and clinical outcomes of appearance medicine. CANNZ accreditation represents a standard of professionalism and training in cosmetic injectables that is accountable and of a safe standard. CANNZ accredited practitioners have physician over-sight, a Bachelor of Science in Nursing or equivalent degree and education, current New Zealand Practicing Certificates, Level 4 Resuscitation (at minimum) and are trained to international standards in cosmetic injectables.
Training Content
The following training content is the minimum amount of recommended education for Registered Nurses practicing cosmetic medicine. The objectives of training are described as abilities the RN should be able to perform or know. Key content concepts are described which should be included in training in order to successfully fulfil learning objectives.
Aesthetic Medicine History, Ethics and Law
Learning Outcomes Contents Knowledge of aesthetic medicine’s historical background · Historical contexts of the industry · Principles of practice: beneficence, autonomy, non-maleficence and justice
Understand the legal requirements associated with aesthetic medicine · Standing Orders · Relevant legislation
· Treaty of Waitangi
· HPCA
· Nursing Code of Conduct
Client Centred Care
Learning Outcomes Contents Know the importance of client-centred care in reference to aesthetic medicine · Client considerations to provide tailored care: client aims, goals, medical history, psychological needs, physiology, anatomy and recovery requirements. Know the components of treatment consultation and informed consent · Treatment consultation including a discussion of treatment, its aims and limitations, potential side-effects · Components of informed consent, including adequate time to discuss and consider treatment options
· Psychological vulnerability, coercion
Understand aesthetic medicine methodology · Environment safety, cleanliness, suitable equipment and compliance with regulatory requirements Know the components of a facial assessment · Facial assessment with consideration of age, ethnicity and gender identity · Concepts of balance and proportions as related to aesthetics
· Asymmetries, anatomy and physiology as it relates to a competent facial assessment
Describe the ageing process · The ageing process and its impacts on anatomy; treatment selection Know the importance of combining treatments to improve aesthetic outcomes for some individuals · The ageing process and how different treatment modalities can address these changes · The benefits and limits achieved by injectables in appearance medicine
Know the management of a needle-stick injury · Safe handling of sharps, prevention of needle-stick injuries · Management of client and/or practitioner should a needle-stick injury occur
Understand the need for routine auditing to evaluate clinical outcomes and improve care · Reflective practice and self-critique · Accountability
Know how to manage emergency care of a client · Vasovagal response and fainting · Management of client becoming unwell during treatment
· Identification of a vascular occlusion, potential blindness/ stroke and best practice guidelines on management
· Management of Anaphylaxis
Psychology
Learning Outcomes Contents Knowledge of why clients seek treatment in aesthetic medicine · Drivers for appearance medicine, including: personal aspirations, expectations, social pressure, cultural pressure and advertising. · Psychological considerations, including: life events, vulnerability and dysmorphia
Understand the need for proper client selection · Ethics · At-risk groups
· Coping abilities to facilitate recovery
Understand client-practitioner communication · Professional boundary setting · Managing expectations
· Strategy for managing unmet expectations
· Post-procedural regret management
· Pathways of emotional support
Ability to identify clients who are vulnerable or who are presenting with a potential mental condition · Inability to communicate and/or make an informed decision · Obsessive or compulsive behaviours
· Suicidal ideation
· Maladaptive bias
· Appearance fixation
· Social avoidance
· Self-worth doubts
· Home and family instability
· Unrealistic expectations
Know how to manage clients who may be ‘at-risk’ · Managing expectations · Referral to appropriate level of care
· Ethical considerations
Be able to provide psychological strategies for management of post-procedural regret and unmet expectations · Use of pre and post treatment photos · After-care plan
· Continuity of care
· Share decision making
· Referral and consultation as needed
Dermatology
Learning Outcomes Contents Know the anatomy and physiology of the skin · Structure of the skin · Skin as barrier
· Thermo regulation
Understand the impact of the ageing process on the skin · Intrinsic and extrinsic ageing · UV damage
· Free-radical damage
Know the use and indication for skin treatments and products · Cosmeceuticals vs cosmetic topicals · Effects of Sun block and Sun protection factor (SPF)
· Anti-ageing products
· Pigmentation lightening products
· The use of lasers, needling and other modalities and their effect on skin
Know aspects of skin microbiology pertinent to cosmetic medicine · Skin flora · “Biofilm” /delayed nodules as a complication
· Acne bacteria
Understand skin wound healing · Stages of wound healing · Stages of bruising
· Scarring, causes of and potential treatments
Skin grading scales · Fitzpatrick and Glogau scales and how they apply to cosmetic medicine Botulinum toxin
Learning Outcomes Contents Know the anatomy and physiology of the muscles of the face and neck · Bone, muscle, fat and skin · Origin, insertion and action of muscles
· Muscle elevators and depressors; their impact on overlying skin
Understand the indications and contraindications of treatment with botulinum toxin · Static vs dynamic lines · Medical and psychological contraindications to treatment
· Impact of treatment on surrounding structures
· Client physical assessment, including: asymmetry, previous scarring and pre-existing ptosis
Understand the biochemistry, mechanism of action and pharmacodynamics for botulinum toxin · Components of neuromuscular synaptic transmission · How botulinum toxin blocks signal transmission
· Desired effects
· Duration of action
· Dose-response curves
Know the reconstitution of botulinum toxin and recommended dosages · Reconstitution and storage · On-label and off-label uses
· Typical doses for female and male
Know the risks of treatment and complication management · Adverse events and complications · Management of complications
Be able to assess the face and develop a treatment plan · Facial assessment · Treatment considerations, including client’s expectations
· Follow-up appointment timing
· Timing of subsequent treatments
Be able to administer botulinum toxin safely and effectively · Observe 10 botulinum toxin administrations · Administer 10 botulinum toxin treatments supervised by a skilled specialist* or over-sight doctor
· Complete *documentation for 10 botulinum treatments
*A skilled specialist can be identified by at least one of the following criteria: NZSCM certified doctor, plastic surgeon, dermatologist, CANNZ approved trainer or Product Clinical Specialist
*Documentation should include a minimum of: Client name, date, client goals/concerns addressed, treatment provided, areas treated, techniques used, product used and in what units, product information, ie. Manufacturers numbers (batch and expiry) , safety considerations eg not pregnant/ breastfeeding, medications used, allergies, date of verbal or written consent last obtained, after-care instructions and planned follow-up.
Dermal Fillers
Learning Outcomes Contents Know the anatomy and physiology of the face and its relevance for dermal fillers · Fat compartments of the face · Vasculature
· Bones of the skull
· Ligaments
· Nerves
· Parotid gland
Understand the indications and contraindications of treatment with dermal fillers · Volume loss · Ageing process on the face
· Bone resorption
· Aesthetic proportions
· Medical contraindications including but not limited to those listed in the product information
· Previous dermal fillers and compatibility
· Pre-existing facial implants and potential risks with dermal fillers
· Recent dental procedures, upper respiratory infections and Gastrointestinal infections and potential for complications
· Upcoming Overseas travel
· Importance of ability to access client during treatment recovery
· Contraindications to anaesthetics in dermal fillers
Understand the biochemistry and mechanism of action for dermal fillers · Stimulatory dermal fillers vs permanent vs semi-permanent vs temporary dermal fillers · Time of expected duration
· External and internal factors influencing longevity
Know the risks of treatment and complication management · Potential risks associated with dermal fillers, including: bruising, swelling, lumps, haematoma, hardening of product, allergy or anaphylaxis, infection, vascular events, stroke and blindness · Management of adverse event
Know the indications and contraindications of Hyaluronidase · Vascular occlusion · Uneven product and lumpiness
· Superficial product
· Tyndall effect
· Post treatment regret
· Contraindications and precautions to Hyaluronidase
Understand techniques employed in delivering dermal fillers · Safe techniques for treatment areas · Cannula technique vs needle technique in treatment
· High risk areas of the face
· Techniques to minimise injection into a vessel
Be able to assess the face and develop a treatment plan · Facial assessment · Treatment considerations, including client’s expectations
· Follow-up appointment timing
· Timing of subsequent treatments
Be able to administer dermal fillers safely · Observe 10 dermal filler administrations · Administer 10 dermal filler treatments supervised by a skilled specialist* or over-sight doctor
· Complete *documentation for 10 dermal filler treatments
*A skilled specialist can be identified by at least one of the following criteria: NZSCM certified doctor, plastic surgeon, dermatologist, CANNZ approved trainer or Product Clinical Specialist
*Documentation should include a minimum of: Client name, date, client goals/concerns addressed, treatment provided, areas treated, techniques used, product used and in what volumes, product information, ie. Manufacturers numbers (batch and expiry), safety considerations (pregnant/ breastfeeding, fit and medically well, concurrent medications, allergies, upcoming dental treatment, overseas travel,) adjuncts used for analgesia (if applicable, dose, location etc) after-care instructions and planned follow-up.
Application for CANNZ accreditation (Registered Nurse)
- Current NZ Practicing Certificate
- Level 4 Resuscitation Certificate or equivalent
- Proof of Indemnity insurance
- Name of doctor with who you have Standing Orders
- Application fee, made payable to CANNZ
- Proof of Appearance medicine education. One of the following options is acceptable:
Option: Trainee pathway Level 1
- Evidence of Educational Guidelines for Cosmetic injectables as part of practice. This can be achieved by short answer essays speaking to each of the educational objectives and how your work meets this standard
- Competence* injecting Glabella (frown), Orbicularis oculi (crows) and Frontalis (Forehead) muscles with botulinum toxin
- Competence* injecting a basic lip, fine lines in the lower face (lower than the upper white lip) and marionettes
- Be a member of a peer review group with a minimum attendance of 10 hours per annum
- Proof of on-going education with a sum of 60 hours required in the past three years
Option: Trainee pathway Level 2
- Evidence of Educational Guidelines for Cosmetic injectables as part of practice. This can be achieved by short answer essays speaking to each of the educational objectives and how your work meets this standard
- Competence* injecting Glabella (frown), Orbicularis oculi (crows) and Frontalis (Forehead) muscles with botulinum toxin
- Competence* injecting ‘Off-label’ botulinum toxin areas: Nasalis (Bunnies and Gummy smile), Levator labii superioris alaeque nasi (Bunnies and Gummy smile), Orbicularis oris (lip wrinkles), Depressor anguli oris (Mouth frown), mentalis (Popply chin), masseters and platysmal bands
- Competence* injecting a basic lip, fine lines in the lower face (lower than the upper white lip) and marionettes
- Competence* injecting pre-auricular, anterior cheek with cannula, chin and more complex peri-oral area
- Proof of on-going education with a sum of 60 hours required in the past three years
- Certificate of attendance from an Appearance Medicine conference within the last year
- Be a member of a peer review group with a minimum attendance of 10 hours per annum
- Two peer-reviews of practice, accountability and professionalism
Option: Trainee pathway Level 3
- Evidence of Educational Guidelines for Cosmetic injectables as part of practice. This can be achieved by short answer essays speaking to each of the educational objectives and how your work meets this standard
- Competence* injecting Glabella (frown), Orbicularis oculi (crows) and Frontalis (Forehead) muscles with botulinum toxin
- Competence* injecting ‘Off-label’ botulinum toxin areas: Nasalis (Bunnies and Gummy smile), Levator labii superioris alaeque nasi (Bunnies and Gummy smile), Orbicularis oris (lip wrinkles), Depressor anguli oris (Mouth frown), mentalis (Popply chin), masseters and platysmal bands
- Competence* injecting a basic lip, fine lines in the lower face (lower than the upper white lip) and marionettes
- Competence* injecting pre-auricular, anterior cheek with cannula, chin and more complex peri-oral area
- Competence* injecting jaw-lines and lid-cheek junctions
- Proof of on-going education with a sum of 60 hours required in the past three years
- Certificate of attendance from an Appearance Medicine conference within the last two years
- Be a member of a peer review group with a minimum attendance of 10 hours per annum
- Two peer-reviews of practice, accountability and professionalism
Option: Full CANNZ Accreditation (Recognition of prior learning)
- Proof of attendance and completion of education at an approved Appearance Medicine Training facility OR proof of *expertise.
- Proof of work within the Cosmetic Injecting Industry for a minimum of four years with a sum of time worked being no less than 4,000 hours
- Competence* injecting Glabella, Orbicularis oculi and frontalis muscles with botulinum toxin
- Competence* injecting ‘Off-label’ botulinum toxin areas: Nasalis (Bunnies and Gummy smile), Levator labii superioris alaeque nasi (Bunnies and Gummy smile), Orbicularis oris (lip wrinkles), Depressor anguli oris (Mouth frown), mentalis (Popply chin), masseters and platysmal bands
- Competence injecting a basic Lip, fine lines in the lower face (lower than the upper white lip), oral commissures, basic cheek along zygoma
- Competence* injecting pre-auricular, anterior cheek with cannula, chin and more complex peri-oral area
- Competence* injecting jaw-lines and lid-cheek junctions
- Optional* Treatment of Nasolabial fold alar base, forehead, tear trough, necklace lines, temples, nasolabial fold with a cannula, nose and hands
- Certificate of attendance from an Appearance Medicine conference within the last two years
- Two peer-reviews of practice, accountability and professionalism
- Be a member of a peer review group with a minimum attendance of 10 hours per annum
- Proof of on-going education with a sum of 60 hours required in the past three years
*Expertise can be demonstrated by: 1. Description of scope of practice, years and hours worked, number of treatments delivered, dedication to the appearance medicine industry and self-reflective discussion of strengths and weaknesses and 2. Peer reviews describe expertise with cosmetic injectables and exemplary professionalism
*Competence in a stated area must be achieved by formal training with a Skilled Specialist. Following training with a Skilled Specialist, competency must be evaluated and approved by a CANNZ Accredited Peer and over-sight doctor. The Registered Nurse must have standing-orders in the stated area of competency
*A skilled specialist can be identified by at least one of the following criteria: NZSCM certified doctor, plastic surgeon, dermatologist, CANNZ approved trainer or Product Clinical Specialist
*Optional treatments are to only be carried out by fully accredited CANNZ nurses who have received specialised training in these areas and have over-sight and Standing Orders for these areas
Application for CANNZ accreditation (Training Facility)
- Submit introductory letter with list of *Skilled Specialists facilitating training
*A skilled specialist can be identified by at least one of the following criteria: NZSCM certified doctor, plastic surgeon, dermatologist, CANNZ approved trainer or Product Clinical Specialist
- Submit a list of course curriculum that meets the Education Guidelines for Cosmetic Medicine in New Zealand for Registered Nurses
Once your application has been lodged with CANNZ, you will be contacted to schedule an appointment.
Auditing of Practice
CANNZ accredited practitioners will be subject to random auditing of practice. This may be by means of partial or full audit of practice. Standards of knowledge and care will be benchmarked against the Education Guidelines for Cosmetic Medicine in New Zealand. Those who do not meet standard will be given a two month time frame to meet standard. Those who do not comply will lose CANNZ accreditation.
A fee will be charged for auditing of practice.
Renewal of CANNZ accreditation
Membership of CANNZ and accreditation must be made annually. Renewal fees pertain per annum.
Renewal must be applied for with the following documents:
- Current NZ Practicing Certificate
- Level 4 Resuscitation Certificate or equivalent
- Proof of Indemnity insurance
- Name of doctor with who you have Standing Orders
- Two peer reviews
- Proof of 10 hours in attendance with peer-review group
- Proof of attendance at an appearance medicine conference
- Proof of hours worked in the previous year
Do you have printable copy for this? Thanks
yes what’s your email? I cant post it here it didn’t work.
ok so this doesn’t actually have a printable version its just pasted straight in here, so just copy the document and paste it into a word document and print.
Hi Stacey,
Where can we find the peer review groups? I am located in Wellington.
Hi Nicole, Have accepted your application to the CANNZ website page,sorry I was so slow. You will find out why really soon. On there we have started a peer review group for Auckland. It would be great if you started one for Wellington. Post it up in there and watch them join, just like I have done in Auckland.
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