Standards › ASF Health Standards v10 › Standard 55
Standard 55
Cosmetic and Plastic Surgery
Cosmetic and plastic surgery: suitability and realistic expectations assessed, consent informed with a cooling-off period, anaesthesia given by credentialed staff, the surgical safety checklist used, and recovery and follow-up planned..
Each criterion is shown in three settings: Humanitarian settings, Transition and fragile, and Standard. In standard settings, every criterion is Must.
Training colours: red means essential, green recommended, yellow optional. Each course shows its level for each setting: humanitarian, transition and fragile, and standard.
55.1Patients Are Assessed for Suitability and Realistic ExpectationsHumanitarian settings: MinimumTransition and fragile: MustStandard: Must
Every patient has a documented, surgeon-signed assessment of suitability before surgery, covering medical conditions, medicines, smoking, body weight and expectations. Unsuitable patients, or patients with unrealistic expectations, are not booked until the issue is resolved.
Why it matters.
How the surveyor verifies this criterion
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. 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.
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.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Nurse (ISCO 2221) | Completes the Pre-operative suitability and risk assessment (PLS-SOP-001); suitability assessment record | Must |
| Manager (ISCO 1342) | Checks the criterion at each review | Must |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| PLS-SOP-001 · Pre-operative suitability and risk assessment | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
| PLS-FRM-001 · Suitability assessment record | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Plastic & Cosmetic Surgery Safety Endorsement (AMB-19) | Manager; Nurse |
References
- Royal College of Surgeons of England (2016). Professional Standards for Cosmetic Surgery. Used for: Suitability and realistic expectations https://news.gmj.ge/guideline/professional-standards-for-cosmetic-surgery/
- WHO (2021). Global Patient Safety Action Plan 2021–2030: Towards Eliminating Avoidable Harm in Health Care. Used for: Pre-operative assessment and medicines https://news.gmj.ge/guideline/global-patient-safety-action-plan-2021-2030-towards-eliminating-avoidable-harm-in-health-care/
55.2Consent Is Informed, Realistic and Given Without PressureHumanitarian settings: MinimumTransition and fragile: MustStandard: Must
Consent records the risks, alternatives and realistic outcomes. Photographs are used only with separate consent, and elective patients have a cooling-off period before the final decision is confirmed.
Why it matters.
How the surveyor verifies this criterion
Sample. Review the consent records and photography consent for a sample of patients in the last 6 months.
1. 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.
2. 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.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Nurse (ISCO 2221) | Completes the Photography consent and cooling-off record | Must |
| Manager (ISCO 1342) | Checks the criterion at each review | Must |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| PLS-FRM-002 · Photography consent and cooling-off record | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Plastic & Cosmetic Surgery Safety Endorsement (AMB-19) | Manager; Nurse |
References
- Royal College of Surgeons of England (2016). Professional Standards for Cosmetic Surgery. Used for: Informed consent and cooling-off period https://news.gmj.ge/guideline/professional-standards-for-cosmetic-surgery/
55.3Anaesthesia and Sedation Are Given by Credentialed StaffHumanitarian settings: MustTransition and fragile: MustStandard: Must
Anaesthesia and sedation are given by credentialed clinicians, with monitoring to the basic anaesthetic standard, a recovery area ready, and emergency equipment available.
Why it matters.
How the surveyor verifies this criterion
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).
Pass when. Every sampled clinician has a current credential at the time of the procedure.
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.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Secretary (ISCO 3344) | Keeps the Procedure safety credential register (PLS-REG-001); sedation credential register | Must |
| Manager (ISCO 1342) | Checks the criterion at each review | Must |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| PLS-REG-001 · Procedure safety credential register | Secretary (ISCO 3344) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Plastic & Cosmetic Surgery Safety Endorsement (AMB-19) | Manager; Nurse |
References
- Royal College of Surgeons of England (2016). Professional Standards for Cosmetic Surgery. Used for: Credentialed anaesthesia and sedation https://news.gmj.ge/guideline/professional-standards-for-cosmetic-surgery/
- College of Physicians and Surgeons of Ontario (n.d.). Out-of-Hospital Premises Inspection Program (OHPIP) Standards. Used for: Premises and anaesthesia safety https://news.gmj.ge/guideline/out-of-hospital-premises-inspection-program-ohpip-standards/
- American Society for Dermatologic Surgery Association (n.d.). ASDSA Position Statement on Office-Based Surgery. Used for: Office-based surgery safety https://news.gmj.ge/guideline/asdsa-position-statement-on-office-based-surgery/
55.4The Surgical Safety Checklist and Infection Bundle Are UsedHumanitarian settings: MinimumTransition and fragile: MediumStandard: Must
The surgical safety checklist is completed for every operation, and the surgical site infection bundle and VTE prophylaxis are applied according to the patient assessment.
Why it matters.
How the surveyor verifies this criterion
Sample. Review the surgical safety checklist and infection bundle records for every operation in the last 3 months.
Immediate fail (any one means the criterion is not met). An operation proceeds with no checklist completed, and the wrong site is treated.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Manager (ISCO 1342) | Checks the criterion at each review | Medium |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| SRG-SOP-001 · Surgical safety checklist procedure | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
| SRG-POL-001 · Surgical safety checklist and team pause | Chief executive (ISCO 1120) | Governing body members | N/A | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
| SRG-SOP-003 · Surgical site infection prevention bundle | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
| SRG-POL-003 · Surgical site infection prevention | Chief executive (ISCO 1120) | Governing body members | N/A | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Plastic & Cosmetic Surgery Safety Endorsement (AMB-19) | Manager; Nurse |
References
- WHO (2018). Global guidelines for the prevention of surgical site infection, second edition. Used for: Surgical site infection bundle https://news.gmj.ge/guideline/global-guidelines-for-the-prevention-of-surgical-site-infection-second-edition/
- WHO (2020). Implementation manual to support the prevention of surgical site infections at the facility level: turning recommendations into practice. Used for: Implementing the SSI bundle https://news.gmj.ge/guideline/implementation-manual-to-support-the-prevention-of-surgical-site-infections-at-the-facility-level-turning-recommendations-into-practice/
55.5Recovery, Discharge and Follow-Up Are PlannedHumanitarian settings: MinimumTransition and fragile: MediumStandard: Must
Each patient is discharged only when the criteria are met, with an escort and written advice. Each patient is contacted after discharge, and complications are followed up and recorded.
Why it matters.
How the surveyor verifies this criterion
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).
Pass when. Every sampled discharge has the criteria, the escort and written advice recorded.
2. 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.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Manager (ISCO 1342) | Maintains the Recovery, discharge and follow-up after plastic surgery (PLS-SOP-002); discharge and escort record | Medium |
| Nurse (ISCO 2221) | Completes the Discharge and complication follow-up record | Medium |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| PLS-SOP-002 · Recovery, discharge and follow-up after plastic surgery | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
| PLS-FRM-003 · Discharge and complication follow-up record | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Plastic & Cosmetic Surgery Safety Endorsement (AMB-19) | Manager; Nurse |
References
- Royal College of Surgeons of England (2016). Professional Standards for Cosmetic Surgery. Used for: Discharge and follow-up after cosmetic surgery https://news.gmj.ge/guideline/professional-standards-for-cosmetic-surgery/
Who is responsible for Standard 55
Each criterion names the positions responsible for it. Every position links to its own terms of reference.
| Criterion | Responsible | Supports |
|---|---|---|
| 55.1 Patients Are Assessed for Suitability and Realistic Expectations | Surgeon (general surgery) Aesthetic physician (injectables) |
Anaesthesiologist |
| 55.2 Consent Is Informed, Realistic and Given Without Pressure | Surgeon (general surgery) Aesthetic physician (injectables) |
Consent and complication follow-up nurse |
| 55.3 Anaesthesia and Sedation Are Given by Credentialed Staff | Anaesthesiologist Nurse anaesthetist |
Anaesthetic nurse |
| 55.4 The Surgical Safety Checklist and Infection Bundle Are Used | Theatre manager Operating theatre nurse |
Infection prevention and control (IPC) lead |
| 55.5 Recovery, Discharge and Follow-Up Are Planned | Same-day procedure nurse Operating theatre nurse |
Patient flow coordinator (clinic) |
Role details: reporting, supervision and training
Training shown is the general recommendation. Role-specific training is set in the next improvement round.
| Role | Reports to | Supervises | Recommended training |
|---|---|---|---|
| Infection prevention and control (IPC) lead | Quality manager | IPC nurse | Facility induction; safeguarding adults (general recommendation) |
| Surgeon (general surgery) | Head of department (per specialty) | None | Facility induction; safeguarding adults (general recommendation) |
| Anaesthesiologist | Head of department (per specialty) | None | Facility induction; safeguarding adults (general recommendation) |
| Operating theatre nurse | Theatre manager | None | Facility induction; safeguarding adults (general recommendation) |
| Anaesthetic nurse | Head of department (per specialty) | None | Facility induction; safeguarding adults (general recommendation) |
| Same-day procedure nurse | Walk-in clinic physician | None | Facility induction; safeguarding adults (general recommendation) |
| Patient flow coordinator (clinic) | Practice manager | None | Facility induction; safeguarding adults (general recommendation) |
| Aesthetic physician (injectables) | Aesthetic clinic medical director | None | Facility induction; safeguarding adults (general recommendation) |
| Consent and complication follow-up nurse | Aesthetic clinic medical director | None | Facility induction; safeguarding adults (general recommendation) |
| Theatre manager | Head of department (per specialty) | None | Facility induction; safeguarding adults (general recommendation) |
| Nurse anaesthetist | Head of department (per specialty) | None | Facility induction; safeguarding adults (general recommendation) |
Questions and answers
The criterion text is the authority. These answers summarise it.
Who does Standard 62 apply to?
Services that carry out cosmetic or plastic surgery, including office-based and hospital surgery and the anaesthesia that goes with it.
What do the colours mean for this standard?
Red (Must) is required. Green (Medium) is recommended. Yellow (Minimum) is the lowest acceptable level in humanitarian settings. Standard setting is Must on every criterion.
Is every patient assessed before surgery?
Yes. Under 55.1 every patient has a surgeon-signed assessment of suitability covering medical conditions, medicines, smoking, weight and expectations before surgery.
How is consent given?
Under 55.2 consent records the risks, alternatives and realistic outcomes, photographs need separate consent, and elective patients have a cooling-off period before the final decision.
Who gives anaesthesia?
Under 55.3 anaesthesia and sedation are given only by credentialed clinicians, with monitoring, a recovery area and emergency equipment ready.
Is the surgical safety checklist used?
Under 55.4 the surgical safety checklist is completed for every operation, and the infection bundle and VTE prevention are applied according to the patient’s assessment.
When is a patient discharged?
Under 55.5 a patient leaves only when the discharge criteria are met, with an escort and written advice, and is contacted after discharge.
Guidelines for this standard
7 guideline(s) are held in the GMJ Guidelines Library and listed here. Each link opens the full guideline on news.gmj.ge. The complete library, grouped by standard, is at Guidelines.
- Guidelines for registered medical practitioners who advertise cosmetic surgery (Medical Board of Australia)
- Professional Standards for Cosmetic Surgery (Royal College of Surgeons of England)
- ASPS Statement on Cosmetic Tourism (Australian Society of Plastic Surgeons)
- Out-of-Hospital Premises Inspection Program (OHPIP) Standards (College of Physicians and Surgeons of Ontario (Canada))
- Briefing Paper: Cosmetic Surgery Tourism (American Society of Plastic Surgeons)
- ASDSA Position Statement on Office-Based Surgery (American Society for Dermatologic Surgery Association)
- Treatment of a simple wound — MSF Clinical guidelines (Médecins Sans Frontières)
Also relevant to this standard:
- Guidelines for Day-Case Surgery (Association of Anaesthetists & British Association of Day Surgery)
- Guidelines for Safe Surgery 2009: Safe Surgery Saves Lives (World Health Organization)
- Guidelines for medical practitioners who perform cosmetic surgery and procedures (Medical Board of Australia)
- EN 16372:2014 Aesthetic surgery services (European Committee for Standardization)
- Routine preoperative tests for elective surgery (National Institute for Health and Care Excellence (UK))
- Guidelines for Essential Trauma Care (WHO)
- Anaesthesia at the district hospital (World Health Organization)
- Surgical Care at the District Hospital (World Health Organization)
- BAAPS Cosmetic Tourism Guidelines, version 1 (British Association of Aesthetic Plastic Surgeons)
- Implementation manual to support the prevention of surgical site infections at the facility level: turning recommendations into practice (World Health Organization)
- Global guidelines for the prevention of surgical site infection, second edition (World Health Organization)
- Pyomyositis — Clinical guidelines — Diagnosis and treatment manual — MSF Clinical guidelines (Médecins Sans Frontières)
- Cutaneous abscess — Clinical guidelines — Diagnosis and treatment manual — MSF Clinical guidelines (Médecins Sans Frontières)
- Dressings — MSF Clinical guidelines (Médecins Sans Frontières)