Dialogue Volume 15, Issue 2 2019 - Page 30

OHP PROCEDURES You are not required to notify the College if the only procedures you are performing in an out-of- hospital premises are any of the following:  urgical alteration or excision of lesions or tissue for a clinical purpose, including examination, S treatment or diagnosis of disease;  inor dermatological procedures including, without being limited to, the removal of skin tags, m benign moles and cysts, nevi, seborrheic keratoses, fibroepithelial polyps, hemangioma and neurofibromata; Lasik surgeries; or  osmetic procedures that do not involve general, regional or parenteral anesthesia including, c without being limited to, temporary fillers, laser skin resurfacing, botox and sclerotherapy. There are three levels of OHPs. The level has two determinants: Anesthesia and procedures – the level is decided by the higher ranking of the two procedures, e.g. if the patient is receiving a minor nerve block (level 1) for limited invasive procedure (level 2), the OHP is considered level 2. Each level is provided its own requirements outlined in a standards document that is available on our website. OHP Level Anesthesia Procedure OHP Level 1 • Local infiltration • Minor nerve block (e.g. digital) • Tumescent anesthesia <500cc of infiltrate solution Minimally Invasive • No surgical wound is created; and • Procedure does not interfere with target organ function or general physiological function OHP Level 2 • IV Sedation • Regional anesthesia (e.g major nerve blocks, spinal, epidural or caudal) • Tumescent anesthesia >500cc of infiltrate solution Limited Invasive • Surgical wound is created, but not for the purpose of penetration of a body cavity or viscus (e.g. rhinoplasty, facelift); and • Procedure has minimal impact on target organ or general physiological response; and/or • Liposuction 1 to 1000 cc of aspirate; and/or • A small subcutaneous implant is inserted (e.g. lip, chin) OHP Level 3 General Anesthesia Significant Invasive • Surgical wound allows access to a body cavity or viscus (e.g. laparoscopic banding surgery, arthroscopy): OR • A significant amount of liposuction aspirate (e.g. 1000-5000 cc) is removed; OR • A large prosthesis is inserted (e.g. augmentation mammoplasty). The above article is intended as general guidance. Please consult the relevant statutory provisions and the OHP Standards document if you are operating or intending to apply to operate an OHP. Please also refer to the Change of Scope policy if you are considering changing your area of practice to include interventional pain management procedures. These documents are available on the Col- lege’s website at www.cpso.on.ca. 30 DIALOGUE ISSUE 2, 2019