Using Protocols and Standing Orders Legally in Texas Med Spas

In a Texas med spa, where aesthetic treatments often involve medical procedures such as Botox, dermal fillers, IV therapy, and laser services, standing orders and treatment protocols are essential tools for ensuring consistency, safety, and legal compliance. However, improper use of these tools can expose the business—and supervising physicians—to liability and regulatory scrutiny. This article outlines how to legally implement and manage protocols and standing orders in a Texas med spa setting.

Understand the Difference: Standing Orders vs. Protocols

• Standing Orders are written instructions that authorize non-physician personnel to perform specific clinical tasks under defined circumstances without a direct patient-specific order. These are often used for routine procedures.

• Protocols are detailed plans or guidelines developed and approved by the supervising physician that outline the steps for evaluating and treating specific conditions or for performing aesthetic services.

In a med spa, both tools allow RNs, LVNs, and other licensed providers to deliver treatments without waiting for direct, real-time physician orders, but only within strict legal parameters.

Legal Requirements for Standing Orders and Protocols

To be legally compliant, standing orders and protocols must meet the following criteria:

A. Created and Approved by a Physician

The protocols and standing orders must be authored or formally approved by the delegating physician who oversees the med spa. They must include:

• The specific services that may be performed

• Eligibility criteria for patients

• Instructions for referral or physician consultation

• Documentation requirements

B. In Writing and Signed

All protocols and standing orders must be:

• Documented in writing

• Signed and dated by the supervising physician

• Reviewed and updated regularly (at least annually or when scope of services changes)

C. Follow Scope of Practice Laws

Every individual using the protocols must:

• Be licensed for the tasks delegated

• Work within the scope of their professional license

• Be appropriately trained in the protocol and procedure

Delegation Rules in Med Spas

Per the Texas Medical Practice Act and 169.25-28 of the Texas Administrative Code:

• Physicians may delegate certain medical acts to qualified licensed professionals.

• Physicians may delegate certain medical acts to qualified persons, including estheticians. But note in addition to being licensed, estheticians pursuant to a recent change in the law must now obtain a certificate form TDLR.

• A proper delegation agreement must exist, and the physician must be available for consultation.

• The physician remains ultimately responsible for the patient’s medical care.

Standing delegation orders are most commonly used for:

• Injectables (Botox, dermal fillers)

• Laser hair removal (if administered by a properly trained individual)

• Microneedling or PRP

• IV therapy

• Prescriptions for skincare products

Documentation and Compliance Practices

To ensure compliance:

• Maintain signed copies of protocols and standing orders at the med spa location.

• Keep records of training for staff operating under the protocols.

• Ensure all charting reflects that treatments were done in accordance with approved orders.

• Conduct routine audits and protocol reviews.

Avoiding Common Pitfalls

Med spas often fall into legal gray areas due to:

• Using generic or outdated protocols

• Allowing unlicensed staff to perform delegated tasks

• Failing to have physician-approved documentation in place

• Misunderstanding the difference between cosmetic and medical treatments

All aesthetic services that involve breaking the skin, altering body structures, or using prescription-only substances are considered medical treatments under Texas law.

Best Practices for Med Spas

• Develop protocols in collaboration with your medical director.

• Clearly define who can perform what, and under what conditions.

• Update your standing orders and protocols annually or sooner as services evolve.

• Make sure protocols are readily accessible to staff and not just filed away.

Conclusion on Using Protocols and Standing Orders Legally in Texas Med Spas

Protocols and standing orders are powerful tools that allow med spas to operate efficiently while maintaining safety and legal compliance—but only when implemented correctly. Med spa owners and physicians must understand Texas law, maintain documentation, and ensure that only properly licensed professionals perform delegated medical services.

Feel free to reach out if you need more specific information or further clarification.

Weitz Morgan is a leading law firm in Texas in providing comprehensive advice and guidance to med spas. With a deep understanding of the unique challenges and complexities faced by this rapidly growing industry, our team of experienced attorneys is dedicated to helping med spas navigate the legal landscape successfully.

We recognize that med spas operate at the intersection of healthcare and beauty, which necessitates a multifaceted approach to representation. Our firm offers a range of services, including a flat-fee med spa formation package and an outside general counsel subscription, tailored to meet the specific needs of med spas, ensuring compliance, mitigating risks, protecting licenses, and fostering a legally sound business environment.