Safe Pracꢀce
Guidelines for
Acupuncture
Physiotherapists
V3 2017
Sponsored by
Produced by:
Acupuncture Associaꢀon of Chartered Physiotherapists limited,
Seꢁon House, Adam Court, Newark Road, Peterborough, PE1 5PP

Safe Pracꢀce Guidelines for Acupuncture
Physiotherapists
Acupuncture Associaꢀon of Chartered Physiotherapists
V3 2017
Produced by:
The Acupuncture Associaꢀon of Chartered Physiotherapists (AACP)
Seꢁon House,
8-9 Adam Court,
Newark Road,
Peterborough
PE1 5PP
Tel: 01733 390007
Email: clinicaladvisor@aacp.uk.com
Website: Cꢂꢃꢄꢅꢃꢄꢆ Pꢌgꢅ
Iꢃꢄꢇꢂꢈꢉꢊꢄꢋꢂꢃ 1
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Bꢌꢊꢍgꢇꢂꢉꢃꢈ 3
Wꢅꢆꢄꢅꢇꢃ Mꢅꢈꢋꢊꢌl Aꢊꢉꢎꢉꢃꢊꢄꢉꢇꢅ: bꢌꢆꢋꢊ ꢆꢌꢏꢅꢄꢐ
Pꢇꢋꢃꢊꢋꢎlꢅꢆ
Aꢊꢉꢎꢉꢃꢊꢄꢉꢇꢅ Lꢋꢊꢅꢃꢆꢋꢃg
Sꢊꢂꢎꢅ ꢂꢏ ꢎꢇꢌꢊꢄꢋꢊꢅ ꢋꢃꢆꢉꢇꢌꢃꢊꢅ
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Tꢇꢅꢌꢄꢑꢅꢃꢄ Rꢅꢊꢂꢇꢈꢆ
Aꢊꢉꢎꢉꢃꢊꢄꢉꢇꢅ ꢎꢂlꢋꢊꢐ
Pꢇꢌꢊꢄꢋꢊꢅ Eꢃvꢋꢇꢂꢃꢑꢅꢃꢄ
Pꢇꢌꢊꢄꢋꢊꢅ Eqꢉꢋꢎꢑꢅꢃꢄ
Iꢃꢏꢅꢊꢄꢋꢂꢃ Pꢇꢅvꢅꢃꢄꢋꢂꢃ ꢌꢃꢈ Cꢂꢃꢄꢇꢂl
Aꢊꢉꢎꢉꢃꢊꢄꢉꢇꢅ Tꢇꢅꢌꢄꢑꢅꢃꢄ
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Pꢇꢅꢊꢌꢉꢄꢋꢂꢃꢆ
Aꢈvꢅꢇꢆꢅ ꢅvꢅꢃꢄꢆ
Aꢊꢉꢎꢉꢃꢊꢄꢉꢇꢅ ꢋꢃ Pꢇꢅgꢃꢌꢃꢊꢐ
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Rꢅꢏꢅꢇꢅꢃꢊꢅꢆ
Iꢃꢈꢅx Iꢃꢄꢇꢂꢈꢉꢊꢄꢋꢂꢃ
This ꢓuideꢔine update has ꢕeen ꢔed ꢕy the AACP Cꢔinicaꢔ Adꢖisor and contriꢕuted to ꢕy the AACP Board of Directors. The incꢔuded adꢖice and informaꢀon is supported ꢕy scienꢀꢗc eꢖidence where aꢖaiꢔaꢕꢔe and eꢘpert consensus and it is intended to proꢖide a ꢕest pracꢀce reference point for all Acupuncture Physiotherapists.
The purpose of this guideline is to support individual Acupuncture
Physiotherapists in pracꢀce as weꢔꢔ as departments and orꢓanisaꢀons.
It may also be used as a point of reference for acupuncture licensing to ꢖaꢔidate the pracꢀces foꢔꢔowed ꢕy AACP reꢓistered Acupuncture
Physiotherapists.
Acupuncture Physiotherapists
AACP accredited Acupuncture Physiotherapists in the UK, ꢕeinꢓ Chartered
Physiotherapists follow a strict code of professional values and behaviour set out ꢕy the Chartered Society of Physiotherapy (CSP). A ꢕrief outꢔine of the code is set out below.
1. CSP memꢕers take responsiꢕiꢔity for their acꢀons
2. CSP memꢕers ꢕehaꢖe ethicaꢔꢔy
3. CSP memꢕers deꢔiꢖer an effecꢀꢖe serꢖice
4. CSP memꢕers striꢖe to achieꢖe eꢘceꢔꢔence
For fuꢔꢔ detaiꢔs of the Code of Professionaꢔ Vaꢔues and Behaꢖiour, foꢔꢔow the link. hꢙp:// csp-eꢘpectaꢀons-memꢕers/code-professionaꢔ-ꢖaꢔues-ꢕehaꢖiour
Professionalism
AACP Acupuncture Physiotherapists work with a hiꢓh deꢓree of professionaꢔism. This is encouraꢓed and enforced ꢕy the Heaꢔth and Care
Professions Counciꢔ throuꢓh their Standards of Conduct, Performance and Ethics as weꢔꢔ as ꢕy the CSP throuꢓh their Professionaꢔ Vaꢔues and Behaꢖiour ꢓuidance eꢘpꢔained in the introducꢀon of this document.
1Minimum training
There is no naꢀonaꢔꢔy aꢓreed, enforced minimum traininꢓ for the pracꢀce of acupuncture. Therefore AACP set the standard in traininꢓ and reꢚuire aꢔꢔ AACP memꢕers to haꢖe compꢔeted an AACP (or AACP accredited)
Foundaꢀon Course which eꢚuates to 300 noꢀonaꢔ hours of M-ꢔeꢖeꢔ eꢚuiꢖaꢔent traininꢓ. Aꢔꢔ traininꢓ is suꢕject to scruꢀny ꢕy the AACP’s
Educaꢀon, Traininꢓ and Research Commiꢙee (ETRC) and has to meet hiꢓh standards to ꢕe endorsed ꢕy AACP.
CPD requirements
It is a reꢚuirement of aꢔꢔ pracꢀcinꢓ AACP memꢕers that they compꢔete 10 hours of acupuncture reꢔated CPD eꢖery 2 years. As a means of monitorinꢓ this, the AACP randomꢔy audits the CPD of 5% of its memꢕership each year, achieꢖed ꢕy ꢚuarterꢔy audits.
Appreciaꢀon of evidence
Memꢕers of AACP pracꢀse Western Medicaꢔ Acupuncture, this is ꢕased on science, anatomy and physioꢔoꢓy as we understand it today. In order to foꢔꢔow Western Medicaꢔ Acupuncture principꢔes, physiotherapists need to pracꢀse eꢖidence ꢕased medicine, meaninꢓ they take scienꢀꢗc research eꢖidence into consideraꢀon when seꢔecꢀnꢓ a treatment. This does not mean ꢕasinꢓ treatments soꢔeꢔy on research eꢖidence, this means comꢕininꢓ ꢕest current eꢖidence with cꢔinicaꢔ eꢘperꢀse and paꢀent ꢖaꢔues.
The target audience
These ꢓuideꢔines are produced for memꢕers of the AACP, and are aꢖaiꢔaꢕꢔe free of charge to all members. These guidelines are also followed by aꢔꢔ AACP and AACP accredited courses, therefore aꢔꢔ physiotherapists aꢙendinꢓ an AACP accredited course wiꢔꢔ ꢕe tauꢓht to these minimum safety standards.
Referencing these guidelines
These guideline should be referred to using the following reference:
AACP (2017) Safe Pracꢀce Guideꢔines for Acupuncture Physiotherapists.
Acupuncture Associaꢀon of Chartered Physiotherapists. Peterborough.
2Bꢌꢊꢍgꢇꢂꢉꢃꢈ
These ꢓuideꢔines proꢖide a code of ꢕest pracꢀce for
Western medical acupuncture delivered by acupuncture physiotherapists in cꢔinicaꢔ pracꢀce. Aꢔꢔ AACP recoꢓnised foundaꢀon and CPD courses wiꢔꢔ teach to these minimum standards.
This issue, V3 2017 is an update of the preꢖious ꢖersion
ꢀtꢔed AACP ꢓuideꢔines for safe pracꢀce V2 2012.
It is acknowꢔedꢓed that there are different types of acupuncture pracꢀce and ꢖaryinꢓ different scienꢀꢗc and phiꢔosophicaꢔ ꢖiews eꢘisꢀnꢓ amonꢓst acupuncture pracꢀꢀoners, incꢔudinꢓ physiotherapists. Howeꢖer, it is a reꢚuirement that a consistentꢔy hiꢓh standard of acupuncture is achieved and maintained by all. It is understood that physiotherapists pracꢀce in a wide ꢖariety of seꢛnꢓs, ꢕoth within the NHS, priꢖate pracꢀce and other orꢓanisaꢀons. These ꢓuideꢔines are not mandatory, howeꢖer they form stronꢓ recommendaꢀons of ꢕest pracꢀce across aꢔꢔ seꢛnꢓs.
There are known and reported risk associated with acupuncture treatment. Improper and unhyꢓienic pracꢀce can increase the risk of acupuncture associated risks. It is eꢘcepꢀonaꢔꢔy important that acupuncture physiotherapists haꢖe safe workinꢓ pracꢀces and safe acupuncture techniꢚue and foꢔꢔow eꢘceꢔꢔent infecꢀon controꢔ procedures to insure risks to ꢕoth cꢔients/ paꢀents and acupuncture physiotherapists are reduced.
3Wꢅꢆꢄꢅꢇꢃ ꢑꢅꢈꢋꢊꢌl
ꢌꢊꢉꢎꢉꢃꢊꢄꢉꢇꢅ: bꢌꢆꢋꢊ ꢆꢌꢏꢅꢄꢐ
ꢎꢇꢋꢃꢊꢋꢎlꢅꢆ
This decꢔaraꢀon sets out key safe pracꢀce principꢔes for aꢔꢔ acupuncturists and heaꢔth professionaꢔs who use acupuncture or dry needꢔinꢓ techniꢚues.
It was deꢖeꢔoped with input from the Acupuncture Associaꢀon of Chartered Physiotherapists, the Briꢀsh Acupuncture Counciꢔ and the Briꢀsh Medicaꢔ Acupuncture Society to support the safe pracꢀce of acupuncture in aꢔꢔ cꢔinicaꢔ seꢛnꢓs.
Ensure that acupuncture is the most appropriate treatment for your paꢀent
• Check for siꢓniꢗcant underꢔyinꢓ diseases and ‘red flaꢓ’ symptoms and siꢓns and inform the paꢀent’s ꢓeneraꢔ pracꢀꢀoner or speciaꢔist immediateꢔy if siꢓns or symptoms of a serious condiꢀon are evident.
Minimise the risk of trauma or injury
• Pneumothoraꢘ is a serious adꢖerse eꢖent.
• When needꢔinꢓ oꢖer the thoracic reꢓion either use superꢗciaꢔ oꢕꢔiꢚue inserꢀon or direct the needꢔe at a tanꢓent to the riꢕcaꢓe.
Needling over or onto ribs must be performed with care.
• The depth of needꢔe inserꢀon must ꢕe within safe ꢔimits for each paꢀent and each ꢔocaꢀon reꢔated to the underꢔyinꢓ anatomy.
• Always note the number of needles retained during treatment and ensure that the same number are removed and disposed of safely.
4Reduce the risk of infecꢀon
• Wash your hands ꢕefore paꢀent contact, ꢕefore inserꢀnꢓ and remoꢖinꢓ needꢔes and wheneꢖer there is a risk of cross infecꢀon from pracꢀꢀoner or paꢀent to paꢀent.
• Maintain a cꢔean ꢗeꢔd for any eꢚuipment you use in your pracꢀce.
• Skin surface should be clean and free from emollients.
• Needꢔes shouꢔd ꢕe disposed of ꢖia standard BS-marked (BS7320) sharps containers
Check your equipment
• Your eꢚuipment must aꢔꢔ ꢕe CE-marked.
• Needꢔes must ꢕe steriꢔe, disposaꢕꢔe and sinꢓꢔe use onꢔy.
Maintain your pracꢀce in line with current laws
• Dispose of sharps containers and cꢔinicaꢔ waste in ꢔine with current hazardous waste ꢔeꢓisꢔaꢀon.
• Pracꢀꢀoners must ꢕe ꢔeꢓaꢔꢔy reꢓistered or ꢔicensed with the ꢔocaꢔ authority unꢔess eꢘempt under the ꢔaw.
Scope of pracꢀce
• Work only within your limits of competence and professional traininꢓ, and within the scope of your professionaꢔ pracꢀce.
• Joining an appropriate professional body that can keep you aꢕreast of current ꢕest pracꢀce in acupuncture and dry needꢔinꢓ is recommended.
Report serious adverse events or noꢀꢁable diseases immediately to:
• your professional body
• your professional insurers
• the Heaꢔth and Safety Eꢘecuꢀꢖe under RIDDOR procedures
• your ꢔocaꢔ authority or ꢔocaꢔ heaꢔth protecꢀon team (in the case of noꢀꢗaꢕꢔe diseases).
(Acupuncture Safety Resource 2016)
5Aꢊꢉꢎꢉꢃꢊꢄꢉꢇꢅ Lꢋꢊꢅꢃꢆꢋꢃg
In accordance with the Locaꢔ Goꢖernment Misceꢔꢔaneous Proꢖisions Act
1982, physiotherapists in Enꢓꢔand and Waꢔes must ꢔicence their premises and/or pracꢀꢀoners for the proꢖision of acupuncture. Each counciꢔ is aꢕꢔe to produce their own ꢕyꢔaws, meaninꢓ the ꢔicensinꢓ reꢚuirements, process and cost differ ꢕetween counciꢔs, and therefore reꢓions.
It is essenꢀaꢔ that anyone wishinꢓ to carry out acupuncture contacts their ꢔocaꢔ counciꢔ’s enꢖironmentaꢔ heaꢔth department to determine the ꢔocaꢔ ꢔicensinꢓ pracꢀces. In some areas AACP memꢕers are eꢘempt from the need to ꢔicence their acupuncture pracꢀces. Pracꢀꢀoners shouꢔd sꢀꢔꢔ contact their local council to ensure this is the case.
NHS premises exempꢀon
Naꢀonaꢔ Heaꢔth Serꢖice premises are eꢘempt from ꢔicensinꢓ. This incꢔudes hospitaꢔs as weꢔꢔ as heaꢔth centres and GP pracꢀces.
London boroughs exempꢀon
Some counciꢔs that operate within Greater London haꢖe ꢓranted ꢔicence fee eꢘempꢀon for AACP memꢕers under the London Locaꢔ Authoriꢀes Acts
1991/2000. This concerns ꢔicensinꢓ fees for priꢖate physiotherapy cꢔinics usinꢓ acupuncture as part of physiotherapy pracꢀce. AACP memꢕers are sꢀꢔꢔ reꢚuired to reꢓister, thouꢓh wiꢔꢔ not ꢕe charꢓed for a ꢔicence ꢕy the parꢀcipaꢀnꢓ counciꢔs.
Scotland exempꢀon
In Scotꢔand HCPC reꢓistered physiotherapists do not need a ꢔicence when pracꢀsinꢓ acupuncture in a hospitaꢔ or independent/ priꢖate cꢔinic (Ciꢖic
Goꢖernment (Scotꢔand) Act 1982 (Licensinꢓ of Skin Piercinꢓ and Taꢙooinꢓ)
Amendment Order 2006 (2006/604)).
Northern Ireland exempꢀon
In Northern Ireꢔand HCPC reꢓistered physiotherapists are not reꢚuired to ꢔicense their cꢔinics (The Locaꢔ Goꢖernment (Misceꢔꢔaneous Proꢖisions)
(Northern Ireꢔand) Order 1985).
6

Taꢂooing and body piercing guidance toolkit
The taꢙooinꢓ and ꢕody piercinꢓ ꢓuidance tooꢔkit was puꢕꢔished in Juꢔy
2013 and has been endorsed by:
• Chartered Insꢀtute of Enꢖironmentaꢔ Heaꢔth
• Heaꢔth and Safety Laꢕoratory
• Puꢕꢔic Heaꢔth Enꢓꢔand
• Taꢙooinꢓ and Piercinꢓ Industry Union
Acupuncture deꢔiꢖered ꢕy a physiotherapist is ꢖastꢔy different from taꢙooinꢓ and piercinꢓ. Despite this, acupuncture sꢀꢔꢔ faꢔꢔs into the taꢙoo and piercing guideline because it shares one common trait; it involves the use of sharp oꢕjects piercinꢓ the skin. The taꢙooinꢓ and ꢕody piercinꢓ guidance toolkit was produced as a guidance document to facilitate
ꢔicensinꢓ and promote ꢕest pracꢀce within the taꢙooinꢓ and piercinꢓ community. Many counciꢔs wiꢔꢔ use this to assist in their judꢓement as to whether the pracꢀce is of a suitaꢕꢔe standard to ꢕe ꢔicensed. Some counciꢔs howeꢖer, do accept that acupuncture ꢕy a physiotherapist is
ꢖastꢔy different, and aꢔready ꢓoꢖerned throuꢓh the HCPC, therefore they take the AACP safety ꢓuideꢔines into consideraꢀon. AACP safe pracꢀce
ꢓuideꢔines differ from the taꢙooinꢓ and ꢕody piercinꢓ ꢓuideꢔines in certain areas hiꢓhꢔiꢓhꢀnꢓ the difference. It is adꢖised to famiꢔiarise yourseꢔf with the taꢙooinꢓ and ꢕody piercinꢓ ꢓuideꢔines prior to ꢔicensinꢓ.
7Sꢊꢂꢎꢅ ꢂꢏ ꢎꢇꢌꢊꢄꢋꢊꢅ
ꢋꢃꢆꢉꢇꢌꢃꢊꢅ
The CSP insurance wiꢔꢔ coꢖer you for treatments that faꢔꢔ within your scope of pracꢀce. Scope of pracꢀce faꢔꢔs into two disꢀnct cateꢓories, the ꢗrst ꢕeinꢓ the scope of physiotherapy in the UK, the second ꢕeinꢓ your personaꢔ scope of pracꢀce.
Scope of physiotherapy pracꢀce
The CSP set the scope of physiotherapy pracꢀce in the UK, and this determines what is and isn’t coꢖered within the insurance incꢔuded with
CSP memꢕership. Scope of physiotherapy pracꢀce in the UK consists of 4 piꢔꢔars, the 4th ꢕeinꢓ caꢔꢔed kindred methods of treatment. It is under this pillar that acupuncture falls. Acupuncture is accepted as being within the scope of physiotherapy in the UK as ꢔonꢓ as you are treaꢀnꢓ paꢀents as a physiotherapist, and the paꢀent is aware that you are a physiotherapist
(as opposed to an acupuncturist or a TCM pracꢀꢀoner for eꢘampꢔe). You wouꢔd need to ꢕe treaꢀnꢓ condiꢀons that the CSP aꢓree faꢔꢔ within the remit of a physiotherapist. An eꢘampꢔe of this is that muscuꢔoskeꢔetaꢔ condiꢀons faꢔꢔ within the remit of a physiotherapist; treatment for cosmeꢀc reasons does not. Where pracꢀces do not faꢔꢔ into the remit of a physiotherapist, you are unaꢕꢔe to proꢖide that parꢀcuꢔar serꢖice as a physiotherapist and therefore reꢚuire addiꢀonaꢔ insurance.
Personal scope of pracꢀce
You also need to determine if you are working within your personal scope of pracꢀce. Workinꢓ safeꢔy and competentꢔy within your personaꢔ scope of pracꢀce means that you must:
• Ensure you haꢖe the skiꢔꢔs, knowꢔedꢓe and aꢕiꢔiꢀes reꢚuired to carry out your role
• Idenꢀfy areas in which you need to further deꢖeꢔop in order to maintain your competence
There is further informaꢀon on this topic from the CSP hꢙp:// orꢓ.uk/professionaꢔ-union/professionaꢔism/scope-of-pracꢀce
8Acupuncture for ferꢀlity
The CSP PLI scheme does not coꢖer cꢔaims arisinꢓ from treatments of acupuncture to treat ferꢀꢔity issues on or aꢁer 1st Juꢔy 2016.
The CSP has not made a decision aꢕout whether the use of acupuncture for ferꢀꢔity reꢔated treatments is within the scope of physiotherapy pracꢀce.
To support our memꢕers the AACP offers an addiꢀonaꢔ insurance coꢖerinꢓ acupuncture for ferꢀꢔity treatments at a discounted rate. Pꢔease contact the AACP head office for further informaꢀon.
Pꢔease see the CSP’s informaꢀon on acupuncture and the CSP PLI scheme for further informaꢀon. hꢙp:// pracꢀce/insurance/hot-topics-faꢚs/acupuncture-csp-pꢔi-scheme
Acupuncture for cosmeꢀc purposes
Acupuncture for cosmeꢀc purposes is not within the scope of physiotherapy pracꢀce in the UK. This is ꢕecause pureꢔy cosmeꢀc interꢖenꢀons which haꢖe no physiotherapeuꢀc purpose are outside the scope of physiotherapy pracꢀce.
Addiꢀonaꢔ insurance is essenꢀaꢔ for the pracꢀce of cosmeꢀc acupuncture.
For more informaꢀon pꢔease see the CSP’s informaꢀon on acupuncture and dry needling. hꢙp:// insurance/acupuncture-dry-needꢔinꢓ
9Cꢂꢃꢆꢅꢃꢄ
This secꢀon is ꢕased on CSP (2016) Consent and Physiotherapy Pracꢀce
Informaꢀon paper PD078 2nd ediꢀon.
Recent changes to consent legislaꢀon
Paꢀents are now enꢀtꢔed to receiꢖe any informaꢀon they ask for in order to make their own decisions about their treatment. There is a change in stance from “what the heaꢔth professionaꢔ reasonaꢕꢔy is eꢘpected to proꢖide” to “what the paꢀent wants to know”.
You must answer any ꢚuesꢀon that your paꢀent asks in reꢔaꢀon to their physiotherapy treatment, or siꢓnpost them to someone who can answer their ꢚuesꢀon if it is ꢕeyond your professionaꢔ eꢘperꢀse, ꢕefore you can be sure that they have given informed consent to the treatment you are proposing.
The standard of care for adꢖice and informaꢀon sharinꢓ moꢖes to the “Montꢓomery Standard” which is “what the paꢀent wants to know”.
This foꢔꢔows a case at the Supreme Court ꢕetween Montꢓomery and Lanarkshire Heaꢔth Board in 2015.
What is consent?
Consent is the ꢖoꢔuntary aꢓreement ꢓiꢖen ꢕy a person to aꢔꢔow somethinꢓ to happen to them, and/or to ꢕe done to them, and/or to aꢔꢔow their parꢀcipaꢀon in somethinꢓ. It is a fundamentaꢔ riꢓht that eꢖery aduꢔt with capacity has the absolute right to determine what happens to their own
ꢕody. This riꢓht is protected ꢕy ꢔaw and is reflected in the HCPC standards and the CSP Code of Conduct.
Valid consent has to meet the following:
• The paꢀent must haꢖe the capacity to ꢓiꢖe their consent
• The consent must be given voluntarily
• The paꢀent must haꢖe ꢕeen ꢓiꢖen aꢔꢔ the informaꢀon they ask for in order to make their decision
10 If any one of the reꢚuirements outꢔined are not met then the consent may not be legally valid.
Wriꢂen consent
In the conteꢘt of physiotherapy, ꢓood pracꢀce shouꢔd ꢕe to oꢕtain wriꢙen consent for any interꢖenꢀon that is inꢖasiꢖe incꢔudinꢓ:
• Western medical acupuncture
• Injecꢀon therapy
• Nerꢖe conducꢀon studies
Wriꢙen consent is onꢔy reꢚuired ꢕy ꢔaw for treatment under secꢀons of the Mentaꢔ Heaꢔth Act, Human Ferꢀꢔisaꢀon and Emꢕryoꢔoꢓy Act and Human Tissue Act. Howeꢖer, Department of Heaꢔth and CSP recommend wriꢙen consent in the foꢔꢔowinꢓ cases:
• Where treatment is compꢔeꢘ or inꢖoꢔꢖes siꢓniꢗcant risk
• For treatment involving general or regional anaesthesia
• Where cꢔinicaꢔ care is not the prime aim of the interꢖenꢀon
• Where treatment couꢔd resuꢔt in siꢓniꢗcant adꢖerse conseꢚuences to a paꢀents empꢔoyment, sociaꢔ or personaꢔ ꢔife eꢖen when performed properly.
AACP consent and health screening tool
The AACP adꢖise their memꢕers to use the AACP consent and heaꢔth screeninꢓ tooꢔ with aꢔꢔ paꢀents who wish to receiꢖe acupuncture treatment.
Consent for 16 17 year olds
Younꢓ persons of 16 and 17 years of aꢓe with capacity are permiꢙed ꢕy
ꢔaw to ꢓiꢖe their own consent for physiotherapy. It is ꢓood pracꢀce to inꢖoꢔꢖe the parents/ ꢓuardians in treatment decisions whereꢖer possiꢕꢔe providing the young person is willing.
11 Children under 16 years old
Chiꢔdren under 16 years oꢔd may ꢓiꢖe their consent to treatment proꢖided they can:
• Understand the informaꢀon ꢕeinꢓ ꢓiꢖen to them
• Retain the informaꢀon
• Weiꢓh up the informaꢀon in order to make a decision
A child who has the capacity to make their own decisions may be referred to as ‘Giꢔꢔick Competent’ aꢁer the ꢔeꢓaꢔ case that estaꢕꢔished that chiꢔdren could make their own decisions in certain circumstances. It is advised to inꢖoꢔꢖe the chiꢔd’s parents/ ꢓuardians where possiꢕꢔe and ꢔeꢓaꢔꢔy sound in treatment decisions. For more informaꢀon search for Giꢔꢔick competency and Fraser guidelines.
Further informaꢀon
For further informaꢀon on consent for physiotherapy pꢔease see CSP
(2016) Consent and Physiotherapy Pracꢀce Informaꢀon paper PD078 2nd ediꢀon.
12 Tꢇꢅꢌꢄꢑꢅꢃꢄ ꢇꢅꢊꢂꢇꢈꢆ
AACP memꢕers, ꢕeinꢓ CSP memꢕers haꢖe a professionaꢔ and ꢔeꢓaꢔ oꢕꢔiꢓaꢀon to keep an accurate record of their interacꢀon with serꢖice users in whateꢖer system or format (paper or eꢔectronic) the orꢓanisaꢀon speciꢗes (CSP 2012). Pꢔease see CSP Quaꢔity Assurance Standards secꢀon
6, record keepinꢓ and informaꢀon ꢓoꢖernance for fuꢔꢔ detaiꢔs on treatment records.
What to include in your acupuncture treatment records:
• A copy of the informed wriꢙen consent form
• Locaꢀon of the needꢔes usinꢓ WHO recoꢓnised nomencꢔature
• If triꢓꢓer point needꢔinꢓ, the ꢔocaꢀon of the needꢔes shouꢔd ꢕe described using muscle name and depth of needle. A diagram of needꢔe appꢔicaꢀon may someꢀmes ꢕe usefuꢔ
• Leꢁ, riꢓht, ꢕiꢔateraꢔ or centraꢔ needꢔe pꢔacement
• DeQi present or not present for each needꢔe
• Has the needꢔe ꢕeen remoꢖed foꢔꢔowinꢓ treatment
• How the needꢔe was sꢀmuꢔated and how many ꢀmes
• Was a ꢀmer used and set
• The duraꢀon of needꢔes in situ
• Was the paꢀent ꢔeꢁ aꢔone durinꢓ the acupuncture treatment, if so was a ꢕeꢔꢔ or a means of contacꢀnꢓ the physiotherapist issued to the paꢀent
• Any adverse events or comments
The following can also be included:
• Depth of needꢔe
• Anꢓꢔe of needꢔe (such as oꢕꢔiꢚue/perpendicuꢔar)
• Anythinꢓ to reduce risk at risky points, E.ꢓ. pick up upper trapezius muscle when needling
Some physiotherapists might wish to record the last three points above in each paꢀent record, howeꢖer some may ꢕe conꢗdent that they foꢔꢔow the recommendaꢀons in their traininꢓ manuaꢔ or preferred teꢘt ꢕook and refer to that should any incident occur.
13 Paper based notes
Documenꢀnꢓ acupuncture treatment on paper ꢕased notes is common and reꢔaꢀꢖeꢔy straiꢓht forward. To ensure aꢔꢔ necessary informaꢀon is incꢔuded the AACP recommend the use of the AACP acupuncture treatment tempꢔate. This tempꢔate can ꢕe modiꢗed to meet the reꢚuirements of indiꢖiduaꢔ users/ departments/ cꢔinics.
See appendices for a template acupuncture treatment documentaꢀon for paper based notes.
Digital notes
The increasing popularity of digital notes means we need to consider the acupuncture documentaꢀon chaꢔꢔenꢓes some may face. The documentaꢀon of treatment is eꢚuaꢔꢔy as simpꢔe with onꢔine notes, it can
ꢕe typed into a pre-determined taꢕꢔe as suꢓꢓested aꢕoꢖe, or typed free hand. The difficuꢔty is recordinꢓ informed wriꢙen consent diꢓitaꢔꢔy.
There are three simpꢔe opꢀons aꢖaiꢔaꢕꢔe (there may ꢕe more aꢖaiꢔaꢕꢔe dependinꢓ on the diꢓitaꢔ note system used):
• Scanning a copy of the signed paper consent form and storing it with the notes diꢓitaꢔꢔy, and then destroyinꢓ the paper copy if paper based notes are not stored
• Usinꢓ a paper ꢕased consent form and storinꢓ it separateꢔy ꢕut making reference to it on the digital notes
• Deꢖeꢔopinꢓ a diꢓitaꢔ consent form on the diꢓitaꢔ note system used that a paꢀent couꢔd siꢓn directꢔy onto with the use of a touch screen device such as a tablet computer.
Unfortunateꢔy there is no set standard method of oꢕtaininꢓ consent for acupuncture diꢓitaꢔꢔy, therefore pracꢀꢀoners are encouraꢓed to ꢕe creaꢀꢖe in order to oꢖercome this issue.
14 Aꢊꢉꢎꢉꢃꢊꢄꢉꢇꢅ ꢎꢂlꢋꢊꢐ
Because acupuncture is inꢖasiꢖe and potenꢀaꢔꢔy carries a hiꢓh risk if not pracꢀced correctꢔy, haꢖinꢓ a poꢔicy in pꢔace is important. Somethinꢓ ꢀtꢔed to the effect of the ꢕeꢔow shouꢔd suffice:
• Acupuncture Poꢔicy (inc manaꢓement of sharps) or
• Policy for the use of acupuncture within the physiotherapy service
The following items should be included in a policy. This is by no means an eꢘhausꢀꢖe ꢔist, as the content wiꢔꢔ depend on your indiꢖiduaꢔ/companies pracꢀce.
• Traininꢓ (what minimum ꢔeꢖeꢔ of traininꢓ must acupuncture physiotherapists haꢖe to pracꢀce in your serꢖice and what onꢓoinꢓ traininꢓ is reꢚuired as a minimum)
• Memꢕership of professionaꢔ ꢕody
• Insurance
• Reꢔated poꢔicies (such as Safe Pracꢀce Guideꢔines for Acupuncture
Physiotherapists 2017 V3, taꢙoo and piercinꢓ ꢓuidance tooꢔkit 2013 etc.)
• Consent and paꢀent Informaꢀon (detaiꢔinꢓ the need to oꢕtain wriꢙen consent, which informaꢀon ꢔeaflet you are usinꢓ etc.)
• The type of needꢔes you use incꢔudinꢓ eꢘpiry date checkinꢓ
• Preparaꢀon (hand washinꢓ, when to use ꢓꢔoꢖes, aꢔcohoꢔ swaꢕs etc.)
• Paꢀent posiꢀon durinꢓ treatment
• Manaꢓement of adꢖerse eꢖents incꢔudinꢓ ꢗrst aid traininꢓ reꢚuirements
• Contraindicaꢀons and precauꢀons reꢔated to acupuncture
• Aꢁercare
• Documentaꢀon
• Disposaꢔ of needꢔes
• Needꢔe sꢀck injury
This AACP Safe Pracꢀce Guideꢔines for Acupuncture Physiotherapists can
ꢕe used to ꢓuide indiꢖiduaꢔ poꢔicies, with reference made to it where reꢚuired.
15 Pꢇꢌꢊꢄꢋꢊꢅ Eꢃvꢋꢇꢂꢃꢑꢅꢃꢄ
Treatment room requirements
The treatment room must provide:
• Sufficient space for moꢖement, safe handꢔinꢓ of eꢚuipment and performance of treatment
• Sufficient work surfaces to estaꢕꢔish a cꢔean ꢗeꢔd for treatment
• Safe storaꢓe of aꢔꢔ eꢚuipment reꢔated to acupuncture and physiotherapy especiaꢔꢔy in reꢔaꢀon to the risk of contaminaꢀon and to aꢖoid risk of injury
• Cꢔean couches and couch paper roꢔꢔ
• Good iꢔꢔuminaꢀon and adeꢚuate ꢖenꢀꢔaꢀon
The treatment room shouꢔd proꢖide (ꢕest pracꢀce recommendaꢀons):
• A hand wash basin with hot and cold running water
• This should be located within the treatment room so that no doors have to be navigated between washing your hands and treaꢀnꢓ the paꢀent
• A paper towel holder containing paper towels
• A soap dispenser containinꢓ ꢔiꢚuid soap
• A dispenser containinꢓ hand saniꢀser
• A waste bin with a pedal operated lid
• A non-porous floor coꢖerinꢓ, such as ꢔinoꢔeum
Home visits/ mobile clinic
Pracꢀꢀoners shouꢔd ensure that they are coꢖered under their acupuncture license from the local council to carry out acupuncture treatment outside of their clinic premises.
Pracꢀꢀoners must aꢔso ensure that:
• Treatment is carried out in a weꢔꢔ-ꢔit, cꢔean enꢖironment with easy access to hand washinꢓ faciꢔiꢀes
• The treatment couch is clean and covered with a disposable cover
• Needles are disposed of in a sharps container which is lockable and suitaꢕꢔe for transportaꢀon
• Enouꢓh ꢀme has ꢕeen pꢔanned to monitor the paꢀent for any adverse events before your departure
16 • Best pracꢀce suꢓꢓests that cꢔean and non-cꢔean items shouꢔd ꢕe kept apart, preferaꢕꢔy in separate containers/ ꢕaꢓs
• Aꢔꢔ usuaꢔ cꢔinic infecꢀon preꢖenꢀon and controꢔ measures are foꢔꢔowed and where necessary, adapted to meet the needs of the different enꢖironment
Risk assessments
Manaꢓement of Heaꢔth and Safety at Work Reꢓuꢔaꢀons 1999 reꢚuires empꢔoyers to assess risks within the workpꢔace. Speciꢗcaꢔꢔy empꢔoyers are reꢚuired to make assessments of:
• Risks to the health and safety of their employees whilst at work
• Risks to the health and safety of others including service users
In addiꢀon to the responsiꢕiꢔiꢀes of empꢔoyers, indiꢖiduaꢔ pracꢀꢀoners are reꢚuired to undertake indiꢖiduaꢔ risk assessments with each paꢀent to determine their suitaꢕiꢔity for acupuncture treatment. Pracꢀꢀoners need to take in account any medical history and other appropriate factors. If this means the treatment techniꢚue is aꢔtered, how to aꢔter the techniꢚue to manage risks appropriately needs to be considered. These risk assessments should be documented within clinical notes.
Near misses and lessons learnt
It is vital to consider a near miss seriously should it occur. Following each near miss a thorouꢓh reflecꢀon shouꢔd ꢕe carried out with siꢓniꢗcant aꢙenꢀon paid to preꢖenꢀon of reoccurrence. For siꢓniꢗcant injuries, pracꢀꢀoners shouꢔd refer to RIDDOR reꢓardinꢓ the reꢚuirement to report the injury. See “RIDDOR” secꢀon for further informaꢀon.
17 Pꢇꢌꢊꢄꢋꢊꢅ Eqꢉꢋꢎꢑꢅꢃꢄ
Acupuncture needles
Aꢔꢔ acupuncture needꢔes must ꢕe sinꢓꢔe-use, pre-steriꢔised, disposaꢕꢔe needles. Needles with guide tubes are recommended but it is the decision of the physiotherapist as to if they wish to use them or not. All needles shouꢔd ꢕe purchased from a reputaꢕꢔe medicaꢔ suppꢔier. Do not use the needꢔes if you haꢖe any douꢕt of their ꢚuaꢔity, such as, ꢕent or ꢕroken needꢔes, torn steriꢔe packaꢓinꢓ etc. Ensure any needꢔe used is within its use by date.
Since May 2014 there has ꢕeen a recoꢓnised Internaꢀonaꢔ Standard for needꢔe ꢚuaꢔity which has ꢕeen adopted as a Briꢀsh Standard ꢕy the Briꢀsh
Standards Insꢀtute. The ꢀtꢔe for this is steriꢔe acupuncture needꢔes for sinꢓꢔe use and the Standard Numꢕer is BS ISO 17218:2014.
Electro-acupuncture
Aꢔꢔ eꢔectro-acupuncture eꢚuipment must ꢕe checked and serꢖiced ꢕy a reꢓistered eꢔectrician foꢔꢔowinꢓ the Eꢔectricity at Work Reꢓuꢔaꢀons (1989).
Documentaꢀon of its eꢔectricaꢔ safety test cerꢀꢗcate shouꢔd ꢕe retained.
Indwelling needles
The AACP recommend aꢓainst the use of indweꢔꢔinꢓ/ semi-permanent needle because the use of semi-permanent needles carries a greater risk of infecꢀon than with reꢓuꢔar acupuncture techniꢚues (Ernst ꢜ White
1999).
Acupressure balls/ Vaccaria seeds
The use of acupressure ꢕaꢔꢔs or seeds in the ear is a techniꢚue that carries less risk than semi-permanent needles. We advise that acupressure balls or seeds shouꢔd not ꢕe used unꢀꢔ fuꢔꢔ traininꢓ has ꢕeen compꢔeted in auricular acupuncture.
Re-usable equipment
Re-usaꢕꢔe eꢚuipment such as ꢓꢔass or pꢔasꢀc cups, proꢕes and massaꢓe eꢚuipment shouꢔd ꢕe washed ꢕetween uses in hot water with deterꢓent
18 and stored in a cꢔean dry pꢔace. If possiꢕꢔe, washinꢓ of re-usaꢕꢔe eꢚuipment shouꢔd ꢕe done in a dishwasher at hiꢓh temperature.
Alcohol swabs
Aꢔcohoꢔ swaꢕs shouꢔd aꢔways ꢕe aꢖaiꢔaꢕꢔe shouꢔd they ꢕe reꢚuired thouꢓh their use is not mandatory (Cumminꢓs ꢜ Reid 2004). They shouꢔd aꢔways be used within their use by date. Visibly soiled or dirty skin or skin which has recentꢔy had emoꢔꢔients appꢔied can ꢕe cꢔeaned with 70% isopropanoꢔ or 0.5% chꢔorheꢘidine or soap and water.
Coꢂon wool
Coꢙon wooꢔ ꢕaꢔꢔs are recommended to ꢕe used to controꢔ a smaꢔꢔ ꢕꢔeed foꢔꢔowinꢓ the remoꢖaꢔ of the acupuncture needꢔe. Coꢙon wooꢔ ꢕaꢔꢔs must remain cꢔean, ꢕut steriꢔe coꢙon wooꢔ is not mandatory.
First aid kit
Aꢔꢔ pracꢀces shouꢔd haꢖe a fuꢔꢔy stocked ꢗrst aid kit. The ꢗrst aid kit shouꢔd be regularly checked and restocked and there should be an appointed person to take charꢓe of ꢗrst aid arranꢓements. There is no mandatory
ꢔist of items to put in a ꢗrst aid ꢕoꢘ. The contents of any ꢗrst aid kit shouꢔd reflect the outcome of your ꢗrst-aid needs assessment. The Heaꢔth and Safety Eꢘecuꢀꢖe haꢖe a suꢓꢓested ꢔist of contents, pꢔease see hꢙp://www. hse.ꢓoꢖ.uk/puꢕns/indꢓ214.pdf for more informaꢀon.