Advanced esthetician

1. Continuing education. Each advanced esthetician shall complete annual continuing education which must commence on the calendar year following the year in which the initial license was issued to ensure knowledge of safety protocols for emerging products and procedures and regulatory changes is maintained. Continuing education includes: a. Hours. Each advanced esthetician shall complete at least eight hours of board-approved continuing education annually. b. Format. Continuing education may be completed in person, online, or virtually. c. Approval. All continuing education must be from board-approved courses or programs. d. Mandatory topics. The board may annually require specific topics within the eight hours. The board shall post mandatory topics, if applicable, on its website by February fifteenth annually. e. Trade shows. A maximum of one hour of continuing education annually is allowed for industry related trade show general attendance. 2. Scope and limitations. Each licensed advanced esthetician in North Dakota is authorized to perform the following procedures in a licensed establishment: a. All services permitted within the scope of practice of a licensed esthetician. b. Microneedling, encompassing both cosmetic and advanced needling techniques. Microneedling certification required. c. Advanced chemical peels, which includes the application of combination peels. Chemical peel certification required. d. Extractions utilizing lancets. e. Nonablative procedures. Laser certification required. 3. Limitations and supervision requirements. Advanced estheticians are permitted to perform the procedures outlined in subsection 2 and specific limitations regarding direction or supervision are as follows: a. Advanced needling procedures require direction or supervision by a licensed health care provider. b. Chemical peels utilizing an exfoliant formulated to penetrate beyond the epidermis, compounded in a pharmacy or a formulation that necessitates administration by a licensed health care provider due to its depth of exfoliation require direction or supervision by a licensed health care provider. c. Nonablative procedures require direction or supervision by a licensed health care provider. 4. Direction and supervision are outlined as follows and must be documented: a. "Direction" means the comprehensive, overarching authority and responsibility a licensed physician, physician assistant, or advanced registered nurse has over an advanced esthetics practice. This involves establishing and approving all medical protocols, delegating specific procedures, and ensuring the practice operates in compliance with all relevant laws and standards of care. b. "Documented supervision" means the creation and maintenance of a formal, written record for each advanced esthetic procedure that requires medical oversight. This record serves as legal proof of compliance and must include: (1) The specific procedure performed; (2) The date and time of the procedure; (3) The name and license number of the supervising medical professional and licensed advanced esthetician; and (4) A clear attestation that the required level of supervision was provided and that the supervising professional is accountable for the patient's care. c. "Supervision" means the active, direct, and continuous oversight of an advanced esthetician by a licensed medical professional. It requires the supervising professional to be available for immediate consultation and to have ultimate responsibility for all delegated medical procedures. The degree of supervision is determined by the complexity of the procedure and the specific protocols established by the supervising professional. 5. Licensed health care provider. The supervising health care provider shall hold an active, unencumbered North Dakota license in their respective profession and be sufficiently trained or certified in the specific procedures being supervised. Proof of such training or certification must be maintained and available to the board upon request. Health care providers eligible to oversee advanced estheticians are the following: a. A physician licensed under North Dakota Century Code chapter 43-17; b. A physician assistant licensed under North Dakota Century Code chapter 43-17; or c. An advanced practice registered nurse licensed under North Dakota Century Code chapter 43-12.1. 6. Supervision requirements. a. Collaborative agreement. A formal, written document, jointly developed and executed between a licensed advanced esthetician and a supervising health care provider must be in place prior to the advanced esthetician performing services requiring supervision. The agreement must define procedures performed, written protocols, and oversight mechanisms for all advanced esthetic procedures requiring oversight that are performed by the advanced esthetician. b. Written protocols. An individual written protocol must be established for each procedure performed under the supervision of a health care provider. This protocol must be signed and dated by both the individual advanced esthetician and the supervising health care provider, reviewed annually, and maintained at the practice location for each type of procedure performed. The protocol must detail: (1) Specific procedures covered and devices used. (2) Device parameters and settings guidelines. (3) Criteria for client selection and contraindications. (4) Preprocedure and postprocedure care instructions. (5) Plan for managing potential complications and adverse events. (6) Emergency procedures and contact information. (7) Method and frequency of supervision, including requirements for supervisor availability either via telecommunication or in person during procedures. (8) Method and frequency for supervisor review of client records and outcomes. (9) Requirements for client consultation with the supervising health care provider, specifying, at minimum: (a) Criteria or circumstances requiring an initial in-person or telehealth consultation between the client and the supervising health care provider prior to the first procedure. (b) Procedures for supervisor review and approval of the advanced esthetician's initial assessment and proposed treatment plan if an initial client-supervising health care provider consultation is not mandated by the protocol's criteria. (c) The minimum frequency and circumstances under which the supervising health care provider must review the client's progress or conduct followup consultations during a series of treatments. c. Health care provider availability. The supervising health care provider must be readily available for consultation during the hours procedures are performed, as defined in the written protocol. "Readily available" means reachable by telecommunication and able to respond promptly, generally expected within thirty minutes, to address urgent issues or clinical questions arising during treatment. The protocol must specify the methods of contact. The health care provider must be physically onsite a minimum of four hours per week. A log of these hours must be maintained. d. Health care provider responsibility. The supervising health care provider is responsible for ensuring that the supervision provided complies with all statutes, rules, and standards of practice applicable to their specific license as determined by their respective regulatory licensing board. Compliance with this section does not absolve the health care provider of the professional responsibilities under the provider's own licensing act. e. Protocol submission. A complete, signed, and dated copy of the collaborative agreement accompanied by any written protocols required under this section must be submitted to the board office prior to the commencement of supervised procedures and upon any subsequent revision. The protocol must be available to the board during inspection of the establishment. f. Change of health care provider notification. The establishment and advanced esthetician shall notify the board in writing within forty-eight hours of any change in the supervising health care provider. This notification must include the name and contact information of the new supervising health care provider and be accompanied by a new collaborative agreement that is signed by each advanced esthetician and the new health care provider. Advanced estheticians may not perform procedures requiring health care provider supervision immediately upon the termination of an agreement until such time a new valid, signed collaborative agreement with an active supervising health care provider is on file with the board and at the establishment. g. Supervision across multiple locations. A single supervising health care provider may supervise advanced estheticians performing procedures at multiple licensed establishments, provided that: (1) The health care provider can realistically meet the availability requirements outlined in this article for all locations under the provider's supervision with a maximum of five locations at a time. (2) A separate, written protocol specific to the devices, procedures, and staff at each individual location is developed, signed by the health care provider and each advanced esthetician at each location, submitted to the board, and maintained at each respective establishment. h. Termination of supervision agreement. (1) If a supervision agreement documented in a collaborative agreement is terminated by either the supervising health care provider or the advanced esthetician, the terminating party shall notify the board in writing within forty-eight hours of the termination date. (2) Upon termination of the supervision agreement, the advanced esthetician immediately shall cease performing all procedures that require health care provider supervision under these rules. (3) The advanced esthetician may only resume performing such procedures after establishing a collaborative agreement with a new qualified health care provider and providing the board office with a copy of the collaborative agreement and written protocols that meet the requirements of this section. 7. Device compliance and maintenance. a. All laser, light, and energy devices must be FDA cleared or approved for the specific intended cosmetic use. Proof of FDA status must be available. b. Devices must be used, maintained, and calibrated strictly in accordance with manufacturer's instructions and safety guidelines. Maintenance and calibration logs must be kept and made available for inspection. 8. Laser safety requirements. For licensed facilities using nonablative laser or light and energy devices, a laser safety program, consistent with American national standards institute Z136.3 principles, must be implemented, and must include the following: a. Laser safety officer. (1) Designation and qualification. Designation of a laser safety officer who has obtained certification from a board-approved laser safety officer training program is required. Such certification must demonstrate competency consistent with the requirements of the American national standards institute Z136.3 and relevant occupational safety and health administration standards. A licensed advanced esthetician who meets these certification requirements may serve as the laser safety officer. Proof of current laser safety officer certification must be maintained and available during inspection. (2) Responsibilities. The officer is responsible for overseeing and enforcing the establishment's laser, light and energy device safety program, including: (a) Hazard evaluation; (b) Specifying control measures; (c) Verifying operator training and credentials; (d) Ensuring compliance with all safety protocols and recordkeeping requirements; and (e) Conducting periodic safety audits. (3) Recordkeeping. The laser safety officer shall establish and maintain specific laser safety records, including: (a) Current certification. (b) Inventory of all class 3B and class 4 lasers. (c) Documentation of hazard assessments for each laser treatment-controlled area. (d) Written laser safety policies and standard operating procedures. (e) Records of laser safety training for all personnel working in or having access to the laser treatment-controlled area. (f) Records verifying appropriate laser protective eyewear are available and periodically inspected. (g) Device service and maintenance logs. (h) Records of internal laser safety audits and corrective actions taken. (4) Laser safety officer per location requirement. Each licensed establishment where nonablative laser procedures are performed shall designate a certified laser safety officer specifically for that location. An exception allowing a single certified laser safety officer to oversee multiple locations may be granted only upon written application to and approval from the board. The application must demonstrate, to the board's satisfaction, how the officer will effectively fulfill all required duties at each specified location, including regular onsite presence, audits, record maintenance, and availability. b. Laser, light and energy treatment-controlled area. Establishment of a treatment-controlled area where laser, light or energy procedures are performed, controlling access during operation. c. Warning signage. Use of appropriate American national standards institute-compliant laser warning signs at entrances to the laser treatment-controlled area and appropriate warning signs for light and energy treatment areas. d. Protective eyewear. Provision and mandatory use of appropriate protective eyewear specifically designed to filter the wavelengths of light or energy emitted by the device being used for the licensee, client, and any other individuals within the treatment-controlled area during operation. e. Hazard control. Implementation of controls for beam hazards such as window coverings, nonreflective surfaces where applicable and nonbeam hazards such as plume evacuation for procedures generating airborne contaminants, electrical safety.