In this slideshow, Patti Owens, R.N., M.H.A., C.M.L.S.O. describes six steps practices can take to improve laser and energy device safety for patients and staff.
Laser and energy devices can drive cosmetic revenue in dermatology practices. But to reap the benefits and avoid what can be serious hazards, practices need to take deliberate and consistent steps, according to Patti Owens, R.N., M.H.A., C.M.L.S.O. (Certified Medical Laser Officer), who has made a career of teaching healthcare providers about laser and energy device safety.
Owens, who owns AestheticMed Consulting Services and Online Laser Training USA (OLTUSA), spoke on how to develop an energy device and laser safety program at the May 2017 Aesthetics and Medical Dermatology symposia in Coeur d’Alene, Idaho.
“It’s important to look at these various aspects of a safety program because it can definitely influence your design of facility-based policies and procedures and what safety controls you will need to implement in order to mitigate any potential hazards,” Owens says.
Owens cites six steps that are pivotal for a practice-based energy device and laser safety program, based on administrative controls summarized in the American National Standards Institute (ANSI) Z136.3 2011 publication. The ANSI document provides recommended standards for the United States that are considered the benchmark for safe laser practice. These voluntary guidelines, which are consensus-based practices for all areas of laser use, are utilized by the Occupational Safety and Health Administration (OSHA), some state regulatory agencies and state licensing boards, according to Owens.
Create a safety program that encompasses national and state regulations and recommended standards of practice, including ANSI Z136.3 2011.
The national benchmark document on safety, ANSI, requires that each practice that offers laser devices create laser safety committee. Some states have adopted and made the recommendation part of their state regulations, according to Owens.
Members should include someone from the administrative staff, such as the office manager, as well as stakeholders, including device users and the practice Laser Safety Officer (LSO) (see #2). Bigger practices could involve risk management personnel and biomedical technicians. Depending on the size of the practice and safety issues, best practices dictate that the committee should meet quarterly or at least every six months, she says.
These committees engage practice stakeholders to monitor potential hazards, comply with facility policies and procedures and resolve issues that might arise from new devices, third-party rental lasers and more, according to Owens.
#2 Authority and responsibility
Delegate authority and responsibility for the management of laser hazards to a Laser Safety Officer (LSO).
The practice’s Laser Safety Officer is an individual that has undergone advanced training and education to ensure that the appropriate protective safety policies and procedures are in place, along with the evaluation of facility-based device hazards to mitigate possible injuries to the patient and staff members. The LSO must be empowered to conduct a laser hazard analysis for the facility and implement compliance from all users and staff members, she says.
“There are advanced courses for [Laser Safety Officer training] available throughout the United States,” Owens says. “It’s a requirement of the ANSI document along with some states that now legislate the presence of a LSO at the facility.”
Facility audits are not meant to be punitive; rather, audits are an opportunity for enhancement of one’s clinical practice and the foundation of any quality assurance program. An audit is conducted using a systematic approach for assessment of lasers and energy based devices, staff knowledge and the associated physical area to address potential problems before they occur. It’s important to conduct the audits not only because they help to keep the practice safe for patients and staff, but also because OSHA and ANSI require audits, according to Owens.
An executive summary outlining deficiencies found in the completed audit is then presented to the safety committee. The committee can propose corrective actions, new types of procedures and enhanced patient care measures. Any proposed recommendations or practice improvement actions will need to be initiated, evaluated and re-audited, according to Owens.
Develop policy criteria for authorized and credentialed laser and device practitioners.
Practices that offer lasers and energy devices need to have onsite policies and procedures for anyone working with the devices. Among those polices, a facility protocol needs to be established for credentialing of all users that are trained and licensed to utilize the devices. Education and training can include: In-house courses from manufacturers, preceptorships, attending national workshops or seminars, doing additional reading, or participating in online webinars or e-learning modules, according to Owens.
“All educational undertakings should be documented along with yearly skill reviews and competency-based evaluations. The objective is to not only demonstrate competency in the user’s knowledge of safety policies and procedures, but also how they deliver safe medical treatment to patients,” she says.
Implement and monitor compliance of the practice’s policies and procedures to mitigate hazards.
Practices that use lasers, intense pulsed light and radiofrequency devices need to determine that their policies and procedures not only reflect national consensus and evidence based practices (ANSI) but also state regulations and manufacturer procedural recommendations found in device manuals, Owens says.
Policies and procedures need to address direct laser beam hazards, such as ocular injuries and skin burns, along with non-beam hazards, which include laser-generated smoke/plume, electrical and fire hazards according to Owens.
Compliance includes having the appropriate signage on doors; taking steps to keep potential dangers within the treatment area; and using appropriate protective measures, including eye protection.
“There are some lasers that can create superficial tissue injuries, only, like the carbon dioxide or erbium lasers-utilized for facial resurfacing. With accidental ocular exposure, they can cause corneal damage or burns to the patient,” Owens says. “However, other visible or invisible laser wavelengths, which represent the majority of lasers utilized in cosmetic dermatology, can transmit to the retinal tissue in back of the eye with the sequelae of temporary or permanent eye damage-even blindness.”
Ocular safety measures include designated laser safety eyewear that correlates to the appropriate laser wavelength and optical density for awake patients and staff. Occlusive laser eyewear needs to be applied for procedures performed on the face.
Protective eyewear for laser treatment on the eyelids and peripheral ocular adnexa should never be performed without metal corneal scleral shields. Eye protection for radiofrequency electrical energy-based devices, on the other hand, should always be plastic per manufacturer’s recommendations, according to Owens.
The last essential step in establishing a laser safety program pertains to education and training, Owens says. Cosmetic practice providers should have extensive knowledge of laser and energy-based device safety, with special emphasis not only on the technical aspects of the machine, but also bio-tissue responses, device physics, patient treatment protocols, treatment parameters, along with possible complications and medical surveillance in case an injury does occur.
“Compliance can be very overwhelming for the laser and energy based device user. Practice oversight by a trained medical physician or delegated mid-level provider is essential for a laser safety program. The user’s medical judgment and expertise is critical in the decision making for the safety of the patient and staff. In regard to present medical-legal standards and regulations, the principle hazard control always rests with the laser user,” she says. Â
Disclosure: Patti Owens is in the business of teaching laser and energy device safety.