Complication SOP: How to Build One for Your Practice

When a complication happens, the professional has a few seconds to decide and the team has even fewer to react. At that moment, improvising is costly. A complication SOP (standard operating procedure) is the document that turns the question "what do we do now?" into an answer that has already been agreed on. This guide proposes a structure for building yours, at a review level. Clinical management, doses and regimens are decisions for the qualified professional, according to the product leaflet and their professional board's rules, and the SOP should be validated by whoever is technically responsible for the service.

What is a complication SOP for?

The SOP serves four practical functions:

1. Speeding up the response. Knowing the steps in advance saves the team time at the critical moment.
2. Reducing reliance on memory. Under stress, thinking slows down, and a written script helps.
3. Standardizing the record. Everyone notes the same information, which makes follow-up and the service's technical defense easier.
4. Training the team. The document is the basis for drills and for onboarding new members.

It does not replace clinical judgment or life support training. It is a map, and the professional is still the one who makes the decisions.

What parts should an SOP have?

A lean structure that is easy to consult is more likely to be used than a lengthy document. Here is one possible skeleton:

Which complications should be included?

The list depends on what you do, and it is better to start with a few well-made flows than with dozens that are rarely used. In an HOF practice, the usual ones are:

• Vascular compromise after filler, including visual signs. See vascular occlusion and visual complication after filler.
• Allergic reaction and anaphylaxis. See anaphylaxis in the HOF practice.
• Infection, abscess and cellulitis. See abscess after filler.
• Expanding hematoma. See expanding hematoma of the face.
• Neurological complication or suspected stroke. See suspected stroke in the practice.
• Malaise, syncope, hypoglycemia, hypertensive crisis and other medical events. See hypoglycemia in the practice and hypertensive crisis in the practice.
• Sharps injury. See sharps injury.
• Cardiorespiratory arrest, with activation of the emergency service. See when to call SAMU (Brazil's emergency ambulance service) and AED in the HOF practice.

How do you write a good flow?

A flow that works in an emergency follows simple rules:

1. Starts with recognition: which signs make the team think of that event.
2. Defines the first immediate action: what is done in the first seconds (stop the procedure, call for help, position the patient).
3. Says who does each thing: the professional, the assistant, reception.
4. Points to the supplies: where they are and who fetches them. See emergency kit for the HOF practice.
5. Defines the trigger for calling outside help: when to call and what to say.
6. Provides for the record: what to note afterward and where.
7. Fits on one page, with short sentences and verbs in the imperative.

A ten-paragraph flow will not be read in the moment. A ten-line flow, with the triggers in bold, has a chance.

How do you organize the record?

The record is one of the most useful and most forgotten parts. It is worth having a short complication form, which complements the patient record. The most useful fields:

Use factual language, without value judgments or speculation. The record is a technical document, and it is read by other professionals and, in some cases, by third parties. See also security incident for events involving data and technovigilance for events related to products.

How do you train the team?

An SOP left in a drawer does not work. Training is what turns paper into habit. A few practices:

• Periodic drills of at least one flow at a time, with a stopwatch and a script.
• Supply checks on a fixed date, with a record. See injectable inventory control.
• Basic life support training for the whole team, following the guidelines of recognized organizations.
• Posters and quick-reference cards in strategic places.
• Review after real events or near misses, with a learning approach and not a blame approach. See near miss.

How does the SOP connect with the patient?

The SOP also guides what to say to the patient. In a complication, the patient wants to know what is happening, what will be done and what to expect. Defining in advance who talks to them, and in what language, reduces the risk of mixed messages. See communicating a complication to the patient and the duty to inform.

What mistakes are common when drafting it?

1. Copying a ready-made SOP without adapting it to the service's structure, team and procedures.
2. A long, theoretical document, that nobody consults in the moment.
3. Not naming people responsible, leaving the role vague.
4. Forgetting reception, which is often who answers the phone and opens the door for the ambulance.
5. Not planning for the aftermath, such as recording, communication and reporting.
6. Never reviewing, leaving expired medications and outdated phone numbers.
7. Including clinical management the service cannot carry out, without training or supplies.

What to take back to the practice

Building a complication SOP is a job of a few days, but it can make a difference when the day goes badly. Start with the three or four most relevant events for your service, write one-page flows, validate with whoever is technically responsible, train the team and review regularly. The SOP does not eliminate risk: it ensures that, when the event arrives, nobody has to invent the response.