Standard 55: Cosmetic and Plastic Surgery

Sample. Review the suitability assessment for every operation in the last 3 months, including any cancelled or deferred bookings.

1. Every patient has a documented suitability assessment before surgery.

Method. Check each sampled booking for the assessment date against the operation date.

Evidence to show. Pre-operative suitability and risk assessment (PLS-SOP-001); suitability assessment record (PLS-FRM-001).

Pass when. Every sampled operation has an assessment dated before the operation.

2. The assessment is signed by the surgeon.

Method. Check each sampled assessment for the surgeon signature.

Evidence to show. Suitability assessment record (PLS-FRM-001).

Pass when. Every sampled assessment is signed by the surgeon.

3. Expectations are recorded as realistic, and unrealistic expectations are resolved before booking.

Method. Check each sampled assessment for the expectations entry and any deferral.

Evidence to show. Aesthetic procedure consent and reconsideration record (AES-FRM-001, existing, reused).

Pass when. Every sampled assessment records the expectations and any deferral is resolved.

Immediate fail (any one means the criterion is not met)

• A patient with active smoking and unrealistic expectations is booked for a face lift with no assessment, and suffers wound breakdown.

Sample. Review the consent records and photography consent for a sample of patients in the last 6 months.

1. Consent records the risks, alternatives and realistic outcomes.

Method. Check each sampled consent record for the three elements.

Evidence to show. Consent, realistic outcomes and reconsideration (AES-SOP-001, existing, reused); aesthetic procedure consent record (AES-FRM-001, existing, reused).

Pass when. Every sampled consent records the risks, alternatives and realistic outcomes.

2. Photographs are used only with separate consent.

Method. Check each sampled use of photographs for the consent entry.

Evidence to show. Photography consent and cooling-off record (PLS-FRM-002).

Pass when. Every sampled photograph has a separate recorded consent.

3. Elective patients have a cooling-off period before the final decision is confirmed.

Method. Check each elective sample for the cooling-off period and the confirmation after it.

Evidence to show. Photography consent and cooling-off record (PLS-FRM-002).

Pass when. Every elective sample has a cooling-off period recorded before confirmation.

Immediate fail (any one means the criterion is not met)

• A patient signs for surgery on the day of the operation, with no cooling-off period and no record of the risks.

Sample. Review credential records and anaesthesia and sedation monitoring for every procedure with sedation or anaesthesia in the last 6 months.

1. Anaesthesia and sedation are given by credentialed clinicians.

Method. Compare the clinician for each sampled procedure with the credential register.

Evidence to show. Procedure safety credential register (PLS-REG-001); sedation credential register (DAY-REG-001, existing, reused).

Pass when. Every sampled clinician has a current credential at the time of the procedure.

2. Monitoring meets the basic anaesthetic standard.

Method. Check the monitoring record for each sampled procedure.

Evidence to show. Sedation and anaesthesia safety (AES-SOP-003, existing, reused); sedation and anaesthesia monitoring record (AES-FRM-003, existing, reused).

Pass when. Every sampled procedure has the monitoring recorded throughout.

3. A recovery area and emergency equipment are ready.

Method. Inspect the recovery area and the emergency equipment on the sampled days.

Evidence to show. Resuscitation area readiness (ED-POL-002, existing, reused).

Pass when. The recovery area and equipment are ready on every sampled day.

Immediate fail (any one means the criterion is not met)

• A sedated patient has a respiratory arrest in recovery, and the emergency equipment is not in the room.

Sample. Review the surgical safety checklist and infection bundle records for every operation in the last 3 months.

1. The surgical safety checklist is completed for every operation.

Method. Compare the list of operations with the checklist records.

Evidence to show. Surgical safety checklist procedure (SRG-SOP-001, existing, reused); surgical safety checklist record (SRG-FRM-001, existing, reused).

Pass when. Every operation in the sample has a completed checklist.

2. The surgical site infection bundle is applied.

Method. Check the bundle compliance record for each sampled operation.

Evidence to show. Surgical site infection bundle compliance record (SRG-FRM-004, existing, reused).

Pass when. Every sampled operation has the bundle recorded as applied.

3. VTE prophylaxis follows the patient assessment.

Method. Check the VTE assessment and any prophylaxis for each sampled operation.

Evidence to show. VTE risk assessment record (CLN-FRM-007, existing, reused).

Pass when. Every sampled operation has a VTE assessment and prophylaxis as indicated.

Immediate fail (any one means the criterion is not met)

• An operation proceeds with no checklist completed, and the wrong site is treated.

Sample. Review discharge and follow-up records for every procedure in the last 6 months, including complications.

1. Each patient is discharged only when the criteria are met, with an escort and written advice.

Method. Check each sampled discharge for the criteria, the escort and the advice.

Evidence to show. Recovery, discharge and follow-up after plastic surgery (PLS-SOP-002); discharge and escort record (DAY-FRM-002, existing, reused).

Pass when. Every sampled discharge has the criteria, the escort and written advice recorded.

2. Each patient is contacted after discharge within the set time.

Method. Check the contact date against the discharge date for each sampled patient.

Evidence to show. Post-discharge contact register (AFT-REG-001, existing, reused).

Pass when. Every sampled patient was contacted within the set time.

3. Complications are followed up and recorded.

Method. Check each recorded complication for the follow-up and the action.

Evidence to show. Discharge and complication follow-up record (PLS-FRM-003).

Pass when. Every recorded complication has a follow-up and action recorded.

Immediate fail (any one means the criterion is not met)

• A patient with a wound complication is not contacted after discharge and presents to the emergency department with sepsis.