1. Purpose
This policy sets out how the Clinic assesses, administers, records and reviews local anaesthetic use and how Staff respond to medical emergencies.
It applies to outpatient cosmetic, dermatology, hair restoration and minor surgical procedures performed under local anaesthetic.
2. Sources to verify before adoption
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12: https://www.legislation.gov.uk/uksi/2014/2936/regulation/12
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 17: https://www.legislation.gov.uk/uksi/2014/2936/regulation/17
- GMC, Good medical practice: https://www.gmc-uk.org/professional-standards/the-professional-standards/good-medical-practice
- GMC, Good practice in prescribing and managing medicines and devices: https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/good-practice-in-prescribing-and-managing-medicines-and-devices
- Royal College of Surgeons of England, Professional Standards for Cosmetic Surgery: https://www.rcseng.ac.uk/standards-and-research/standards-and-guidance/service-standards/cosmetic-surgery/professional-standards-for-cosmetic-surgery/
- Resuscitation Council UK, Quality standards for cardiopulmonary resuscitation practice and training: https://www.resus.org.uk/quality-standards
- Association of Anaesthetists, guidelines and publications: https://anaesthetists.org/Home/Resources-publications/Guidelines
- MHRA Yellow Card scheme: https://yellowcard.mhra.gov.uk/
3. Scope
This policy applies to:
- local anaesthetic assessment
- dose calculation
- local anaesthetic administration
- vasoconstrictor use
- allergy and adverse reaction checks
- patient observations before and after procedure
- vasovagal episodes
- suspected local anaesthetic systemic toxicity
- anaphylaxis
- hypoglycaemia, seizure, chest pain, breathing difficulty and collapse in clinic
- emergency equipment and medicine checks
- post-event review and reporting
The Clinic does not provide sedation under this policy. If the Clinic offers sedation, it must adopt a separate sedation policy and verify it against current sedation guidance.
4. Local anaesthetic process
The Clinic follows a documented local anaesthetic process for every procedure.
4.1 Pre-procedure assessment
The clinician checks:
- patient identity
- procedure and treatment area
- weight where dose is weight-based
- allergies and previous anaesthetic reactions
- current medicines
- pregnancy or breastfeeding status where relevant
- cardiovascular, liver, renal or neurological history where relevant
- anxiety, fainting history or previous vasovagal episode
- whether the procedure can be completed safely under local anaesthetic
The clinician records the assessment before the local anaesthetic is given.
4.2 Dose calculation
The clinician calculates the maximum safe dose before administration.
The record includes:
- drug name
- concentration
- volume planned
- vasoconstrictor presence where relevant
- maximum safe dose source checked
- patient weight where relevant
- total dose administered
- time administered
- clinician administering
The Clinic sets exact dose limits from current clinical source material. This template does not restate medicine-specific dose thresholds.
4.3 Administration and monitoring
The clinician administers local anaesthetic only within competence and scope.
Staff monitor the patient for:
- faintness
- pallor
- agitation
- rash or swelling
- breathing difficulty
- chest pain
- altered consciousness
- seizure activity
- symptoms suggestive of toxicity
The Clinic records observations where the procedure, patient risk or local procedure requires them.
5. Medical emergency response
The Clinic keeps a documented medical emergency procedure.
5.1 Immediate response
If a patient deteriorates, Staff:
- stop the procedure
- call for senior clinical help
- assess airway, breathing and circulation
- call 999 where the patient's condition requires emergency transfer
- use emergency equipment and medicines within role and competence
- record time, symptoms, observations and actions
- inform the Registered Manager
Staff do not delay 999 escalation to complete internal paperwork.
5.2 Emergency medicines and equipment
The Clinic keeps emergency medicines and equipment appropriate to the procedures it provides.
The local emergency list covers:
- oxygen
- automated external defibrillator
- bag-valve-mask
- airway adjuncts where the Clinic's training and scope allow them
- anaphylaxis medicine
- hypoglycaemia treatment
- seizure-response arrangements
- blood pressure monitor
- pulse oximeter
- emergency contact and transfer information
The Clinic verifies the exact emergency medicines list against current Resuscitation Council UK, CQC and clinical source material before adoption.
5.3 Adverse drug reaction reporting
Where Staff suspect an adverse drug reaction, the Consultant considers MHRA Yellow Card reporting.
The decision record includes:
- drug involved
- dose and route
- batch number where available
- patient symptoms
- treatment given
- external advice sought
- reporting decision
- follow-up plan
6. Post-procedure observation and discharge
The Clinic records post-procedure observation where local anaesthetic, procedure type or patient risk requires it.
Before discharge, the clinician confirms:
- bleeding is controlled
- pain is manageable
- observations are stable where recorded
- the patient understands aftercare
- the patient has emergency contact instructions
- escort or transport needs have been considered where relevant
- follow-up appointment or wound review is arranged where needed
The Clinic does not discharge a patient who is clinically unstable.
7. Responsibilities
- Registered Manager: owns this policy, ensures emergency equipment governance and signs off annual review.
- Consultant: owns clinical local anaesthetic standards, emergency procedure approval and adverse-event review.
- Clinic Nurse: completes equipment checks, supports monitoring and escalates deterioration.
- Aesthetic Practitioner: administers local anaesthetic only where authorised, trained and competent.
- Administration staff: keep emergency contact information available and support emergency access to the premises.
- All staff: maintain basic life support competence required for their role and report emergency-equipment defects.
8. Recording requirements
The Clinic keeps the following records:
- pre-procedure assessment
- local anaesthetic dose calculation
- medicine administration record
- batch and expiry record where relevant
- observation record
- emergency equipment check
- emergency medicine expiry check
- BLS training record
- adverse reaction record
- 999 escalation record
- MHRA Yellow Card decision
- post-event debrief
- improvement action record
Records are kept in the clinical record and governance record according to local procedure.
9. Audit cadence
The Clinic uses the following Verivius default audit rhythm unless current source material requires a different rhythm:
- Weekly: the Clinic Nurse checks emergency equipment and emergency medicine expiry status.
- Monthly: the Consultant reviews local anaesthetic stock, adverse reactions and dose-calculation documentation.
- Quarterly: the Clinic runs a medical-emergency simulation and records learning.
- Annually: the Registered Manager reviews this policy, BLS training compliance and emergency readiness.
Audit findings are recorded as improvement actions with an owner and review date.
10. Version control and review date
The Clinic keeps a controlled copy of this policy. The footer or document-control table records:
- policy owner
- version number
- date approved
- next review date
- changes made since the last version
- source material checked during the review
11. Related records
- Procedure record
- Medicine administration record
- Emergency equipment log
- Emergency medicine log
- Training matrix
- Incident register
- MHRA Yellow Card record
- Minor surgical procedure and infection prevention policy
- Aesthetic procedure safety policy
- Improvement action register
Review cadence: annual or on regulatory change, whichever sooner. Owner: Registered Manager.