Download References: Musculoskeletal - NHS Walsall Community Health

Acupuncture clinical procedure guidelines for Physiotherapy and Podiatry Departments
The NHS Walsall Community Health Integrated Governance Sub group approved this statement on:
Date: 30th June 2010
Please note that the Intranet version of this document is the only version that is maintained. Any printed
versions should therefore be viewed as ‘uncontrolled’ and may not be the most up-to-date.
Document reference information
Version:
Status
V 1.0
Lead Director/Manager responsible
Elaine Beeson interim head of physiotherapy and podiatry
Name of originator/author:
Ratified by:
Susan Harvey Bal orthopaedic extended scope physiotherapy
practitioner
Integrated Governance sub group
Date ratified:
30th June 2010
Date Policy is Effective From
30th June 2010
Review date:
April 2012
Expiry date:
June 2013
Date of Equality and Diversity Impact
Assessment
Date of Health Inequalities Impact
Assessment
Target audience:
1/06/2010
NHS Walsall/ WCH linked documents
Distribution of the document
Implementation of the document
1/06/2010
The group of staff affected by this document are physiotherapists
and podiatrists who have received validated post graduate training
in acupuncture.
Complementary therapies document :auricular acupuncture
Sharp’s policy
Blood spillage policy
Infection control policy
Cascaded to directors/Senior managers/team leaders via the
safeguard system. Information agenda item for team meetings.
Available on NHS Walsall Intranet site.
The physiotherapy and podiatry department staff will be made
aware of these guidelines and how to access them.
Staff will be encouraged to attend the Acupuncture interest group
and to include acupuncture training issues as part of their peer
review sessions.
Training should be recorded by the individual and evidenced for CPD
purposes and to fulfil the requirements of acupuncture association
of chartered physiotherapists’, and the respective podiatry
requirements for post registration membership. Currently this is
10 hours per 2 years.
New staff joining the trust, who practice acupuncture, should be
made aware of the guidelines at induction.
Staff will be made aware of the need for audit of outcomes for
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Document Control and Archiving
Monitoring Compliance and
Effectiveness
References
acupuncture treatment.
Obsolete or superseded documents will be removed from the
intranet and where relevant replaced with an updated version.
Previous versions will be archived in the safeguard system in
accordance with the Records Management NHS Code of Practice;
disposal and retention schedule.
Individual staff members are responsible for keeping their post
graduate 10 hours CPD training up to date, this may involve a
mixture of externally validated courses as well as internal peer
review sessions. These will be recorded in KSF files and presented
at appraisal as evidence of fulfilling criteria.
An acupuncture audit of treatment outcomes will be conducted
approximately every 6 months for physiotherapy and podiatry.
Meeting minutes of the Acupuncture interest group will be
circulated to the head of service.
See main document
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CONTRIBUTION LIST
Key individuals involved in developing the document
Name
Megan gwyther
Elaine Beeson
Heidi Burn
Susan Harvey Bal
Designation
Practice Education Facilitator for AHPs
Interim head of physiotherapy and podiatry
Team leader podiatry
Orthopaedic Extended scope physiotherapist
Circulated to the following for consultation
Name/Committee/Group/
Designation
Acupuncture interest group Walsall Community Physiotherapist and Podiatrists
Health
acupuncture
Elaine Cooper
Head of Complimentary Therapies
Rachel Clark
Complimentary Therapy
Margaret Kennedy
Clinical Lead Podiatry
trained
in
Version Control Summary
Significant or Substantive Changes from Previous Version
A new version number will be allocated for every review even if the review brought about no changes. This
will ensure that the process of reviewing the document has been tracked. The comments on changes should
summarise the main areas/reasons for change.
When a document is reviewed the changes should using the tracking tool in order to clearly show areas of
change for the consultation process.
Version
Date
Contents
1.0
Introduction
Comments on Changes
Author
Pg
6
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2.0
Purpose
6
3.0
Duties
7-8
4.0
Definitions
8-9
5.1
Principles of acupuncture
8-9
5.2
Referral process
10
5.3
Authority to proceed
10
5.4
Indications and contra-indications
10-11
5.6
Precautions
11-12
5.7
Risks
12
5.8
After care
13
6.0
Training and maintenance of CPD
13
7.0
Audit and monitoring
13
8.0
References
14-17
Appendix 1
Clinical procedure
18-19
Appendix 2 Acupuncture patient information leaflet : Physiotherapy and Podiatry
20-25
Appendix 3 Acupuncture consent form: Physiotherapy and Podiatry
26-29
Appendix 4 Acupuncture audit sheet: Physiotherapy and Podiatry
30-31
Appendix 5 CPD proforma : Physiotherapy and podiatry
32
Appendix 6 Acupuncture treatment sheet: podiatry
33
Appendix 10 Equality Impact Assessment
34-47
1.0 Introduction
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Acupuncture is one of the many skills used within Physiotherapy and Podiatry as an integrated approach
to the management of pain and inflammation, and as a means of enhancing the body's own healing
chemicals, in order to aid recovery and enhance rehabilitation.
Acupuncture is used by Physiotherapists and Podiatrists, against a background of sound research and
evidence based practice, as a means of enhancing pain modulation via the stimulation of the brain and
spinal cord to produce natural pain relieving chemicals, such as endorphins; melatonin to promote sleep,
and serotonin to promote well being. These assist the body's healing processes, and offer pain relief, as
a precursor, for other manual or exercise therapies.
Acupuncture involves the stimulation of specific points on the skin, usually by the insertion of needles. In
the UK, acupuncture is widely used in both private and NHS practice. In 1995 approximately 10% of GPs in
England either referred patients for acupuncture or administered it themselves. A survey in 1998
estimated, that the NHS provided one million acupuncture treatments in England.
The British Medical Acupuncture Society has among its members over 2000 doctors who use
acupuncture in hospital or general practice, and there are over 5000 Physiotherapists who are members
of the Acupuncture Association of Chartered Physiotherapists.
Acupuncture in Podiatry is still relatively new; all Podiatrists trained in acupuncture are accredited with
the Society of Chiropodist and Podiatrists (SOCAP) and are eligible to become members of the British
Medical Acupuncture Society.
2.0 Purpose
The objective of this document is to provide a coherent approach to the practice of acupuncture in
Walsall Community Health. It is to ensure there is a consistent approach to the preparation of the
patient, the clinical procedure and the rationale for treatment, together with audit and monitoring of the
effectiveness of treatment.
It is intended as a reference for all Physiotherapists and Podiatrists that practice acupuncture in the
trust, and have undergone the pre-requisite validated post graduate training in acupuncture. It also sets
out the ongoing Continuing Professional Development (CPD) requirements for maintenance of
professional membership of the respective Physiotherapy and Podiatry Acupuncture Associations.
3.0 Duties
3.1
Managing Director

3.2
Has overall responsibility for the strategic direction and operational management of the
organisation, including ensuring that trust policies adhere to legal, statutory, and good practice
guidance requirements.
Heads of Service
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


3.3
Have a responsibility for the operational implementation of these guidelines and associated
procedures.
Ensure all necessary training, educational needs and methods required to implement the guidelines
are identified and resourced.
Monitor uptake of the service through robust monitoring and recording processes.
Team Leader

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

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
3.4
It will be the responsibility of the Musculoskeletal (MSK) team leader, Podiatry Team Leader and
Extended Scope Practitioner to coordinate the procedure within each setting.
The team leader must also ensure that there are adequate healthcare staffs available to ensure
effective client safety.
Ensure that all staff that work within the teams have read the guidelines.
Ensure staffs have up to date knowledge relating to national directives and local Implementation
plans.
Ensure that staff adheres to organisational policies and procedures.
Formulate risk assessments and action plan for the team.
Monitor within the team any staff safety issues, accidents and reportable incidents in line with risk
management policies.
Ensure that any staffs that are undertaking acupuncture have received relevant training.
Clinical Staff

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
All staff practicing acupuncture are expected to be aware of and follow these guidelines.
All healthcare professionals are accountable for their own actions and must exercise their own
professional judgements at all times (Health Professions Council, Standards of Conduct
Performance and Ethics, 2008). However, any decisions to vary from the agreed guidelines should
be documented, including the reason for the variance and subsequent action taken.
All healthcare professionals who undertake acupuncture must ensure that they have attended an
accredited training course recommended by CSP, SOCAP or ACCP.
All health care professionals must ensure that they are up to date with their Hepatitis B vaccination
and be able to provide evidence to support this.
All staff are responsible for ensuring that the environment is suitable for service delivery
All healthcare professionals are responsible for ensuring a safe environment for the acupuncture
to be delivered and to raise their concerns with the team leader if they identify any risk.
4.0 Definitions
Definitions that apply to this policy include
Acupuncture
Relevant training
Acupuncture in Physiotherapy
Acupuncture is derived from the Latin acus, needle and pungere, to
pierce. It is a therapeutic technique that involves the insertion of
fine needles into the skin and underlying tissues at specific points.
(Ernst, cited in National Guidelines, 2003, pg. 56).
Validated post graduate training in acupuncture undertaken by
Physiotherapists and Podiatrists
Relates to acupuncture to augment the treatment of
musculoskeletal and neurological conditions
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Acupuncture in Podiatry
Relates to acupuncture to augment the treatment of
musculoskeletal and neurological conditions in respect of
conditions from, and including, the knee to the foot.
This form is to be signed by the patient before undergoing
Acupuncture consent form
acupuncture treatment from a Physiotherapist or Podiatrist.
This information is given to the patient prior to obtaining consent
Acupuncture information sheet
for acupuncture from a Physiotherapist or Podiatrist.
Acupuncture
Association
of Special interest group for Physiotherapists who practice
Chartered Physiotherapists (AACP) acupuncture and have undergone validated post registration
training in acupuncture
Society of Chiropodists and Professional body for Podiatrist’s who validate post registration
courses in acupuncture. Members can then join the British Medical
Podiatrists (SOCAP)
Acupuncture Society and attend meetings.
Health profession council, regulatory body for health professionals.
HPC
This is to maintain membership for professionals to practice
Acupuncture CPD
acupuncture and is 10 hours per 2 years. This can include case
studies, review of journal articles, practical sessions, as well as
external or internal courses.
Although there are no current CPD guidelines set out by the Society
of Chiropodists and Podiatrists, it is the responsibility of the
practicing Podiatrist to maintain regular CPD in line with ACCP
recommendations.
It is the responsibility for physiotherapists and podiatrists
Professional responsibility
practicing acupuncture to provide evidence that they are complying
with this requirement, for HPC, AACP, and KSF purposes.
5.0 Principles
Acupuncture can be carried out in all settings i.e. clinics and patients home, provided all safety and
hygiene procedures are adhered to, including the trust policies on infection control, and disposal of
sharps’.
Acupuncture will be used by those Physiotherapists and Podiatrists that have received relevant training,
including the Acupuncture Association of Chartered Physiotherapists ( AACP) and Society of Chiropodists
and Podiatry (SOCAP).
Acupuncture will be used as an adjunct to Physiotherapy and Podiatry treatment, and the trained
professional will decide on its use.
A record of all patients treated with acupuncture should be documented in the notes, and also on a
separate sheet for audit purposes (Appendix 4 & 8).
After receiving and reading the patient information sheet (appendix 1) all patients are required to sign a
consent form (appendix 1). At this stage patients will have the opportunity to ask questions or raise
queries regarding the treatment prior to the acupuncture.
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All needles and contaminated products should be disposed of in accordance with the sharps policy, and
infection control policy, of the trust.
Overall, the trained professional will take responsibility and accountability for the treatment.
5.1
Referral process
The patient is referred for acupuncture to the Physiotherapy or Podiatry department. The
suitability for acupuncture is checked against the criteria for contra-indications and precautions. If
the patient meets the criteria they are referred to an acupuncture Physiotherapist or Podiatrist
who will then explain further what acupuncture involves prior to gaining written consent from the
patient.
5.2
Authority to proceed
Those using acupuncture should be an HPC registered Physiotherapist and have AACP membership,
or be working towards AACP accreditation. Podiatrist’s practicing acupuncture must be HCP
registered and have attended a course or be working towards a course that is accredited by the
Society of Chiropodists and Podiatrists.
The AACP is a clinical interest group (CIG) affiliated to the Chartered Society of Physiotherapy and
HPC. The AACP represents those Physiotherapists who are interested in integrating Acupuncture
into mainstream Physiotherapy for the management of pain and restoration of function, in
musculoskeletal and neurological conditions.
5.3
Indications
Acupuncture will be administered as part of Physiotherapy or Podiatry treatment, for pain and
restoration of function, in the management of musculoskeletal and neurological conditions. In
respect of podiatry treatment this will be only applicable for conditions from the knee to the foot.
5.6
Contra-indications (See consent forms Appendix 1)
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Infectious/inflamed skin conditions.
Pregnancy –first trimester (see Precautions).
Acute heart problems i.e. unstable cardiac arrhythmias. If patient has a pacemaker, then electroacupuncture must not be used.
Haemophilic, blood clotting/bleeding disorders.
Patients who have a history of fainting easily, who have a definite needle phobia, or have known
metal allergies.
Acute respiratory problems
Lymph node clearance lymphoedema
History of recent stroke or undiagnosed seizures
Cancerous growths
Uncontrolled fits or uncontrolled epilepsy
Areas not to be punctured:
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

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
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5.7
Fontanels in babies
The external genitalia
Nipples
Umbilicus
Eyeball
Through or into the wall of the uterus.
Precautions

Pregnancy
There is risk of miscarriage when treating in the first trimester of pregnancy, if the wrong
combinations of points are used. Extra care must be taken with the selection of points at all times
during pregnancy, particularly with regard to the intensity of stimulation of such points, i.e strong
deqi should be avoided, points which are known to stimulate qi, and sacral points

Epileptics
There is a risk of the patient fitting whilst the needles are in the skin, or acupuncture may induce
fitting. Epilepsy should be well controlled with medication.

Diabetics
Where a patient may have poor circulation, it may decrease wound healing and cause bruising.
Some points may also reduce blood sugar levels.

Circulatory system
Care will need to be taken when needling areas of poor circulation and where there is risk of
infection and to avoid accidental puncturing of arteries. Low blood pressure can also be affected by
acupuncture.

Steroids
These inhibit down the immune system, which may increase the risk of infection.

Anticoagulants
The international normalised ratio (INR) needs to be stable

Confused/Anxious patients
Patients who are unable to understand the treatment must not be treated. Patients who are needle
phobic should be assessed for acupuncture suitability.

Reduced skin sensation
Patients should be able to feel the area that the needles are inserted into.
5.6
Risks
Risks associated should be explained to the patients before acupuncture.

Drowsiness
Patients whom experience drowsiness with treatment must not drive until fully recovered.
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
Infection
Any areas of skin infection should not be needled. Any areas of very thin and fragile skin should not
be needled.
Extra care should be taken with auricular acupuncture and surface wax should always be removed
with an alcohol swab.
With facial acupuncture, any make up on the chosen acupuncture points, should be removed with a
sterile wipe.

Minor Bleeding or Bruising
This occurs in 3% of treatments.

Needle Stick Injury
Snapped needles should be circled and the patient sent to Accident and Emergency department
(A&E). If the practitioner is injured with a contaminated needle, they should be sent to the
occupational health department or A&E as appropriate.

Allergy: Metal allergies
Any allergy of this nature should be ascertained prior to treatment.

Fainting
First treatment must always be given with patient comfortably supported in a lying position.

Pain
Symptoms may increase initially post treatment.
5.7
After care

Advise the patient of possible side effects: Drowsiness, nauseous, dizziness, fatigue, fainting or an
increase in symptoms.

Following the treatment the patient is given an emergency number, and therapist’s number for
contact.

If a patient that has received acupuncture wishes to donate blood, the blood donor unit can contact
the AACP in respect of Physiotherapy for verification that the professional performing acupuncture
has undertaken the necessary training. In respect of Podiatry this would be through the British
Medical Acupuncture Society.
6.0 Training and maintenance of CPD
The Acupuncture Association of Chartered Physiotherapists (AACP) requires a minimum of 80 hours
training for Physiotherapists to become accredited members; thereafter 10 hours CPD is required for
each two years of membership. Advanced Membership of AACP may be awarded after a minimum of 200
practical hours. The AACP has a system to accredit both training courses and tutors. Training is only
recognized by AACP when both tutor and course are accredited by the AACP accreditation process.
The accredited course from the Society of Chiropodists and Podiatrists requires the podiatrist to
complete a 30 hour course, this includes the completion of 2 cases studies. Although SOCAP do not
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indicate specific criteria for CPD, Podiatrist’s at Walsall Community Health will under take CPD in line
with that of the Physiotherapist. This will include 10 hours over 2 years and will attend, where possible
regular acupuncture meetings with Physiotherapy.
CPD may be acquired by a variety of methods, including : In-service training (IST); critical appraisal of
research; attendance at training courses; lectures; conferences; acupuncture interest groups; review of
research; self directed learning; case report submission, to the required AACP protocol; clinical
reasoning, and completion of British Medical Acupuncture Society (BMAS ) Questionnaires. CPD hours
should be recorded for the Knowledge and Skills Framework, AACP accreditation and in the event of a
HPC audit. An example of the CPD proforma, used by the acupuncture interest group in the trust, is
illustrated in appendix 1.
7.0 Audit and monitoring
Acupuncture treatment will be recorded and audited every 6 months. A summary of activity will be
produced as an example of the effectiveness of acupuncture as a treatment modality. See examples of
audit sheets for physiotherapy and podiatry in the appendix 1.
Bibliography
References: Neurology.
Dilorenzo L et al (2004). Hemiparetic shoulder pain syndrome treated with deep dry needling during- Early
rehabilitation: A prospective, open-label, randomised investigation. Journal of musculoskeletal pain, vol.12 (2)
Erickson R.J. (2000) Acupuncture Therapy for stroke: approaches from the acupuncture literature.
Acupuncture in medicine, June 18 (1): 48-53.
Hopwood, V; Lewith G.T. (2005) Does acupuncture help stroke patients become more independent? The
Journal of alternative and complementary medicine. 11 (1); 115-177.
Leake, R, & J.E Broderick. (1998) Treatment Efficacy of Acupuncture: A Review of the Research Literature.
Integrative Medicine, vol 1, no.3, 107-115.
Linn S.L, Granat M.H & Lees K.R. (1999). Prevention of shoulder subluxation after stroke with electrical
stimulation. Stroke, 30 (50, 963-968.
Naeser M A et al (1994): Acupuncture in the treatment of hand paresis in chronic and acute stroke patients.
Clinical rehabilitation; 8: 127-141
Robinson, G (2008) Acupuncture in the management of central post stroke pain with associated dizziness and
nausea. Journal of AACP, spring, 61-66.
Sallstrom, S, A. Kjendahl, P.E. Osten, J.H. Stanghelle & C.F Borchgrevink. (1996) Acupuncture in the treatment
of stroke patients in the sub acute stage: a randomized, controlled study. Complementary Therapies in
Medicine, 4, 193-197.
Page 12 of 44
References: Musculoskeletal
Berman B, Lao L, Langenberg P, Lee W, Gilpin A, Hochberg M. (2004). Effectiveness of Acupuncture as
Adjunctive Therapy in Osteoarthritis of the Knee A Randomized Control Trial. Annals of Internal Medicine,
141(12), 901-910.
Bradnam L. (2007). A Proposed Clinical Reasoning Model for Western Acupuncture. Acupuncture Association
for Chartered Physiotherapists.
Franca D, Senna- Fernandes V, Cartez C, Jackson M, Bernardo- Filhe M, Gumaraes M. (2008). Tension Neck
Syndrome Treated by Acupuncture Combined with Physiotherapy: A Comparative Clinical Trial (Pilot Study).
Complimentary Therapies in Medicine, 16(5), 268-277.
Jena S, Witt A, Brinkhaus B, Wegscheider K, Williah S. (2008). Acupuncture in Patients with Headaches.
Cephalalgia: An International Journal of Headache, 28(9), 969-979.
Lundeberg T. (1998 August). The Physiological Basis of Acupuncture. Paper presented at the MANZ/PANZ
Annual Conference, New Zealand.
Manheimer E. (2006). Acupuncture for Knee Osteoarthritis. Acupuncture in Medicine, 24, S7-17.
Wang O, DePablo P, McAlindon T, Chen X, Schmid C. (2008). Acupuncture for Pain Relief in Rheumatoid
Arthritis. Arthritis and Rheumatism, 59(9), 1249-1256.
Wedenburg K, Moen B, Norling A. (2000). A Prospective Randomized Study Comparing Acupuncture with
Physiotherapy for Low back and Pelvic Pain in Pregnancy. Acta Obstetrics and Gynaecology Scandinavia, 79,
331-335
Witt C, Brinkhaus B, Jena S, Linde A, Steng A, Wagenpfeil S, Hummelsberger H, Walther D, Melchart S, Willich S.
(2005). Acupuncture in Patients with Osteoarthritis of the Knee a Randomized Trial. Lancet 2005, 366, 136143.
Yuan J, Purepong N, Kerr D, Bradbury I, McDonough S. (2008). Effectiveness of Acupuncture for Low Back
Pain. Spine, 33(23), E887-900.
References: Cost Effectiveness
Canter PH, Coon JT, Ernst E, and (2006) Cost-effectiveness of complementary therapies in the United
Kingdom-a systematic review. Preview (eng; includes abstract) Evidence-Based Complementary and
Alternative Medicine: Ecam [Evid Based Complement Alternat Med. Dec 3(4) 425-432
Reinhold T; Witt CM; Jena S; Brinkhaus B; Willich SN ;( 2008). Quality of life and cost-effectiveness of
acupuncture treatment in patients with osteoarthritis pain. Preview European Journal of Health Economics,
Aug; 9 (3): 209-19
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Reinhold T, Witt C M, Willich S N (2008). Cost effectiveness of acupuncture in the treatment of selected
musculoskeletal system disorders. J.eujim 08. 101
Witt CM, Reinhold T, Jena S, Brinkhaus B, Willich SN,( 2008) Cephalalgia: Cost-effectiveness of acupuncture
treatment in patients with headache. Previewheadache. Preview (eng; includes abstract) An International
Journal of Headache [Cephalalgia], vol 28 issue 4, pp 334-345
References: General
AACP: (2004). Safety Standards. Acupuncture association of chartered physiotherapists. Cambridge
AACP guidelines for safe practice. (2007). Acupuncture association of chartered physiotherapists.
Cambridge
Anderson, S.(1993): The functional background in acupuncture effects. Scand J Rehab Med, Suppl 29:31-60.
CSP (2002): Chartered Society of Physiotherapy rules of professional conduct 2nd edition. Accessed
www.csp.org 29/03/09
Darzi (2008): High quality care for all. NHS next stage review final report. Department of Health.
DOH (2008): Report to the ministers from the Department of Health steering group on the state registration
of practitioners of acupuncture practiced in the UK. Department of Health.
Hoffman, P. (2001): Skin disinfection and acupuncture. Acupuncture in Medicine: 19 (2): 112-116.
NICE (2009) Low Back Pain. Early management of persistent non –specific low back pain. NICE clinical
guideline 98. May. NICE London
Pearce, L. (2002): To swab or not to swab – An exploration of opinion. AACP: 62-66.
`Walsh, B. (2001): Control of infection in acupuncture. Acupuncture in Medicine, 19 (2): 109-111.
1.
White, A.R., Cummings, M.J., Hopwood, V., Macpherson, H. (2001): Informed consent for acupuncture – An
information leaflet developed by consensus. Acupuncture in Medicine, 19 (2): 123-129.
References: Walsall Community Health Trust policies (recent versions).
Health and safety policy
Infection control policy
Sharp’s policy
Spillages’ policy
Complementary therapy policy: auricular acupuncture.
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Appendix 1
Clinical Procedure
Acupuncture Needling Guidelines
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AACP recommended methods of treatment and acupuncture safety guidelines. AACP (2004)
Equipment
Sterile single use disposable needles
Sharps box
Cotton wool
Sterile wipes (as appropriate)
Anatomy/acupuncture book (as appropriate)
Procedure
1
Read patients’ notes, ensuring an accurate history has been taken (noting contra-indications and
precautions)
2
Patient is invited to sign the consent form, after having had the treatment explained, read the
patient information leaflet, and had any questions answered.
3
Position patient appropriately. Always have patient fully supported during first session.
4
Clinician washes hands and covers any open wounds with a plaster.
5
Find needling points.
6
Ensure patient’s skin is clean with no wounds, cuts or abrasions.
7
Check expiry date on needles prior to treatment. Any out of date needles should be disposed of
safely in accordance with the trust’s sharp’s policy. Do not re-use needles.
8
Apply needles using trained technique. Keep needle tubing separate, to remember the number of
needles inserted into the patient. Needle handle must not be inserted – ¾ needle only.
9
A shorter first treatment is suggested, then one may increase gradually on consecutive treatments.
10
11
Always ensure patient is supervised throughout treatment.
Remove needles as trained, and place immediately in sharps box. Count needles inserted into
patient. Watch for bleeding and cover with cotton swab as appropriate.
12
Allow patient to rest 5 minutes minimum after treatment.
13
Give patient after care advice.
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14
15
16
Record treatments in patient’s notes. This should include, acupuncture points used, number of
needles, and whether De Qi was obtained. The audit sheet should also be filled in for patients
receiving acupuncture.
Arrange follow up appropriately.
Ensure all sharps’ boxes are disposed of appropriately according to Trust policy. Any dropped
needles must not be used and be disposed of safely.
Ref AACP ( 2004)
Appendix 2
Acupuncture patient information leaflet for Physiotherapy
Please read this information carefully and ask your physiotherapist if there is anything that you do not
understand.
What is acupuncture?
Acupuncture is a form of therapy in which fine sterile needles are inserted into specific points on the skin. It
is one of the oldest forms of medicine having been used for over 3,000 years in China. Modern science has
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shown that acupuncture stimulates the brain to produce natural pain relieving chemicals, endorphins. These
assist the body to heal itself and give pain relief. The traditional view is that Qi (energy) flows round the body
in channels. If the Qi is flowing freely, the body is in a healthy state. If there is a problem, energy stagnates.
The stimulation of appropriate acupuncture points frees this stagnation.
Will it work for me?
Research has shown that most people gain relief from pain with acupuncture. It does not work for everybody
and every condition, but frequently good results are achieved when more conventional medicine has failed.
There is nothing spiritual about it and you don’t need to believe in acupuncture for it to work for you. The
effects of acupuncture are cumulative, with pain relief building up as treatment progresses. Some people
are particularly good responders, while others may see little benefit until they have had a few treatments;
this is more likely with a chronic condition. Occasionally the condition may become slightly worse at first;
this is not a bad sign, and usually means that the condition will respond.
Is acupuncture safe?
Acupuncture is generally very safe. Serious side effects are very rare- less than one per 10,000 treatments.
Acupuncture is safe when performed by physiotherapists who have had specialist training in acupuncture and
use the strictest hygiene; the acupuncture needles used are single, sterile and disposable. Blood donors
please inform your physiotherapist.
Will it hurt?
This is the most common question when needles are used. When the fine needles are inserted it gives rise to
a sensation like a pinprick, which should only give mild temporary discomfort. The deep needling sensation is
part of effective stimulation.
Does acupuncture have side effects?
You need to be aware that:
 Drowsiness occurs after treatment in a small number of patients. This can occur during the
session, for the strong reactors, or later the same day. Some people may not experience it at all.
This does not
necessarily mean that acupuncture will not work. If affected, you are advised not to drive.
 Many patients sleep very heavily on the same night as their first treatment.
 Minor bleeding or bruising occurs after acupuncture in about 3% of treatments.
 Pain during treatment occurs in about 1% of treatment.
 Symptoms can get worse after treatment (less than 3% of patients). You should tell your
physiotherapist about this, but it is usually a good sign.
 Fainting or nausea can occur in certain patients, particularly at the first treatment.
 In addition, if there are any particular risks that apply in your case, your physiotherapist will
discuss these with you.
Why a physiotherapist?
They have undergone 3 year training in western medicine before training for acupuncture at a postgraduate
level. Chartered physiotherapists are bound by a strict professional and ethical code. Additionally the
Acupuncture Association of Chartered Physiotherapists has its own code of practice. You are therefore
assured of safe and effective treatment. Physiotherapists who practice acupuncture can combine this with
other natural treatment methods, such as exercise, manipulation and relaxation techniques, as well as heat,
ice, and electrotherapy. All physiotherapists who practice acupuncture have taken approved training in
acupuncture to provide pain relief.
Page 18 of 44
Conditions that may be helped by acupuncture are acute/chronic injuries, arthritis and rheumatism, back and
neck pain, sports injuries, headaches, muscle and joint problems
Is there anything your practitioner needs to know?











If you have experienced a faint or funny turn
If you have a pacemaker or any other electrical implants
If you have a bleeding disorder
If you are taking anti-coagulant or any other medication
If you have damaged heart valves or have any other particular risk of infection
Have you eaten in the last 2 hours
Ladies only – are you pregnant or actively trying for a pregnancy
Have you any medical condition that your physiotherapist should be
informed about
Do you suffer from any allergies including metal?
Are you diabetic

Have you been informed of the positive and negative effects of acupuncture?
What should I expect?
When you visit a chartered physiotherapist, you will be given a detailed examination and, based on the
findings, the physiotherapist will agree a treatment programme with you.
Summing up

Acupuncture is safe and virtually painless.

Acupuncture works naturally with little or no side effects.

Acupuncture stimulates the body to help itself.

Chartered physiotherapists work closely with doctors.

To complement the wide range of treatment methods many chartered physiotherapists now use
acupuncture.

Acupuncture and physiotherapy can be used to treat a wide range of conditions.
AACP (2004)
Page 19 of 44
Acupuncture patient information leaflet for Podiatry
Please read this information carefully and ask your podiatrist if there is anything that you do not understand.
What is acupuncture?
Acupuncture is a form of therapy in which fine sterile needles are inserted into specific points on the skin. It
is one of the oldest forms of medicine having been used for over 3,000 years in China. Modern science has
shown that acupuncture stimulates the brain to produce natural pain relieving chemicals, endorphins. These
assist the body to heal itself and give pain relief. The traditional view is that Qi (energy) flows round the body
in channels. If the Qi is flowing freely, the body is in a healthy state. If there is a problem, energy stagnates.
The stimulation of appropriate acupuncture points frees this stagnation.
Will it work for me?
Research has shown that most people gain relief from pain with acupuncture. It does not work for everybody
and every condition, but frequently, good results are achieved when more conventional medicine has failed.
There is nothing spiritual about it and you don’t need to believe in acupuncture for it to work for you. The
effects of acupuncture are cumulative, with pain relief building up as treatment progresses. Some people
are particularly good responders, while others may see little benefit until they have had a few treatments;
this is more likely with a chronic condition. Occasionally the condition may become slightly worse at first;
this is not a bad sign, and usually means that the condition will respond.
Is acupuncture safe?
Acupuncture is generally very safe. Serious side effects are very rare- less than one per 10,000 treatments.
Acupuncture is safe when performed by podiatrists who have had specialist training in acupuncture and use
the strictest hygiene; the acupuncture needles used are single, sterile and disposable. Blood donors please
inform your podiatrist.
Will it hurt?
This is the most common question when needles are used. When the fine needles are inserted it gives rise to
a sensation like a pinprick, which should only give mild temporary discomfort. The deep needling sensation is
part of effective stimulation.
Does acupuncture have side effects?
You need to be aware that:
Page 20 of 44

Drowsiness occurs after treatment in a small number of patients. This can occur during the
session, for the strong reactors, or later the same day. Some people may not experience it at all.
This does not necessarily mean that acupuncture will not work. If affected, you are advised not to
drive.




Many patients sleep very heavily on the same night as their first treatment.
Minor bleeding or bruising occurs after acupuncture in about 3% of treatments.
Pain during treatment occurs in about 1% of treatment.
Symptoms can get worse after treatment (less than 3% of patients). You should tell your podiatrist
about this, but it is usually a good sign.
Fainting or nausea can occur in certain patients, particularly at the first treatment.
In addition, if there are any particular risks that apply in your case, your podiatrist will discuss
these with you.


Why a podiatrist?
They have undergone 3 year undergraduate training in western medicine before training to study for the post
graduate certificate in acupuncture. Chartered podiatrists are bound by a strict professional and ethical
code. The society of Chiropody and Podiatry ensure that the course is accredited. You are therefore
assured of safe and effective treatment. Podiatrists who practice acupuncture can combine this with other
natural treatment methods, such as exercise, stretching and orthotics. All podiatrists who practice
acupuncture have taken approved training in acupuncture to provide pain relief. Conditions that may be
helped by acupuncture are acute/chronic injuries, arthritis and rheumatism, sports injuries, muscle and joint
problems
Is there anything your practitioner needs to know?












If you have experienced a faint or funny turn
If you have a pacemaker or any other electrical implants
If you have a bleeding disorder
If you are taking anti-coagulant or any other medication
If you have damaged heart valves or have any other particular risk of infection
Have you eaten in the last 2 hours
Ladies only – are you pregnant or actively trying for a pregnancy
Have you any medical condition that your physiotherapist should be
informed about
Do you suffer from any allergies including metal?
Are you diabetic
Have you been informed of the positive and negative effects of acupuncture?
What should I expect?
When you visit a chartered podiatrist, you will be given a detailed examination and, based on the findings, the
podiatrist will agree a treatment programme with you.
Summing up

Acupuncture is safe and virtually painless.
Page 21 of 44

Acupuncture works naturally with little or no side effects.

Acupuncture stimulates the body to help itself.

Chartered podiatrists work closely with doctors.

To complement treatment methods chartered podiatrists can now use acupuncture.

Acupuncture and podiatry can be used together to complement treatment.
Appendix 3
Acupuncture consent form physiotherapy
Name
NHS no.
As acupuncture will promote chemical effects on the body, it is important that you let your therapist know if
you have the following
Contra-indications
Yes
No
Acute heart problem
History of recent stroke or undiagnosed seizures
Cancerous growths/infection
Page 22 of 44
Uncontrolled fits or uncontrolled epilepsy
Phobia of needles
Do you have any allergies or sensitivities, or specific metal allergies? If so to what
Lymph node clearance /lymphoedema
Acute chest problems
Bleeding disorders
Pregnancy- first trimester
Precautions
Have you had acupuncture before?
If so did you have any adverse reaction from it?
Ladies only -Are you pregnant or think you might be?
Are you actively trying to become pregnant?
Do you suffer from any heart conditions
Is this controlled?
Do you have Diabetes?
is this controlled with medication?
Do you have any history of blood disorders?
(Hepatitis/Haemophilia/blood clotting disorders)
Anticoagulant treatment
Frail elderly constitution
Long term steroid use
Hypotension/hypertension
Reduced sensation
Immuno compromised
Pacemakers
Hungry patient- Have you eaten in the last 2 hours?
Areas of poor circulation
Swelling/inflammation
Have you ever suffered from fits/epilepsy?
Are these controlled on medication?
Skin disorders
Warnings given
Possible drowsiness
Possible nausea
Possible fatigue or faint
Possible slight bleeding or bruising
Possible trauma to internal organs (certain points only )
Needle breakage
Yes
No
Yes
No
I confirm that I have understood the information given, and I consent to having acupuncture treatment. I
understand that I can withdraw from the treatment at any time.
Signed
Print full name
Page 23 of 44
Physiotherapist’s signature
Print full name………………………………………….
Date
Summary of treatment to be added to the acupuncture audit located on the g drive/ physiotherapy/
acupuncture folder
Duration of
symptoms
Area of Body
De Qui √ or X
Acupuncture consent form podiatry
Name
Subjective Outcome pre and
post
Objective Outcome
Pre and post
NHS no.
As acupuncture will promote chemical effects on the body, it is important that you let your therapist know if
you have the following
Contra-indications
Yes
No
Acute heart problem
History of recent stroke or undiagnosed seizures
Cancerous growths/infection
Uncontrolled fits or uncontrolled epilepsy
Phobia of needles
Do you have any allergies or sensitivities, or specific metal allergies? If so to what
Lymph node clearance /lymphoedema
Page 24 of 44
Acute chest problems
Bleeding disorders
Pregnancy – first tri-mester
Precautions
Have you had acupuncture before?
If so did you have any adverse reaction from it?
Ladies only -Are you pregnant or think you might be?
Are you actively trying to become pregnant?
Do you suffer from any heart conditions
Is this controlled?
Do you have Diabetes?
is this controlled with medication?
Do you have any history of blood disorders?
(Hepatitis/Haemophilia/blood clotting disorders)
Anticoagulant treatment
Frail elderly constitution
Long term steroid use
Hypotension/hypertension
Reduced sensation
Immuno compromised
Pacemakers
Hungry patient- Have you eaten in the last 2 hours?
Areas of poor circulation
Swelling/inflammation
Have you ever suffered from fits/epilepsy?
Are these controlled on medication?
Skin disorders
Warnings given
Possible drowsiness
Possible nausea
Possible fatigue or faint
Possible slight bleeding or bruising
Possible trauma to internal organs (certain points only )
Needle breakage
Yes
No
Yes
No
I confirm that I have understood the information given, and I consent to having acupuncture treatment. I
understand that I can withdraw from the treatment at any time.
Signed
Print full name
Podiatrist’s signature
Page 25 of 44
Print full name………………………………………….
Date
Appendix 4
Audit sheet for acupuncture for physiotherapy
Measurement outcomes for those undergoing acupuncture will be audited approximately every 6 months.
The audit sheet is on the back of the consent form. The information will be transferred to the audit folder
/acupuncture/physiotherapy/g drive.
The following will be audited:
 Duration of symptoms
 Area of body
 De qui
 Subjective outcome pre and post treatment
 Objective outcome pre and post treatment
Duration of
symptoms
Area of Body
De Qui √ or X
Subjective Outcome pre and
post
Objective Outcome
Pre and post
Page 26 of 44
Audit sheet for acupuncture for podiatry
Measurement outcomes for those undergoing acupuncture will be audited every 6 months. Podiatry will audit
patient measurement outcomes recorded at every appointment; this will be kept in patient notes until
discharge when it will be filed at Forrester St Clinic.
The following will be audited:
 Condition treated
 Area needled
 VAS
condition
Needle
site/s
Chi
VAS1st
review
VAS
2nd
VAS
3rd
VAS
4th
Vas
5th
VAS
6th
Failure
Or success
Page 27 of 44
Appendix Five
CPD Proforma for Physiotherapy and Podiatry
Acupuncture CPD
Name
Date
Purpose of the session
Page 28 of 44
Attendees and designation
Summary of topics covered and application to clinical practice.
Duration of the session
Signature of participant…………………………
Designation………………………………..
Counter signature…………………………………. Designation………………………………..
Appendix 6
Podiatry treatment sheet. Areas of needling are indicated on a body map.
PRESENTING COMPLAINT & SYMPTOMS –
Plan
Page 29 of 44
Advise Given
Consent Gained
Area’s to Needle – Mark on Diagram
Comments
Comments
Appendix 7
Checklist for the Review and Approval of Procedural Document
To be completed and attached to any procedural document that requires ratification
Title of document being reviewed:
1.
Yes/No
Comments
Title
Page 30 of 44
Title of document being reviewed:
2.
Is the title clear and unambiguous? It should not
start with the word policy.
Yes
Is it clear whether the document is a guideline,
policy, protocol or standard?
Yes
4.
5.
6.
7.
Comments
Rationale
Are reasons for development of the document
stated? This should be in the purpose section.
3.
Yes/No
Yes
Development Process
Is the method described in brief? This should be in
the introduction or purpose.
Yes
Are people involved in the development identified?
yes
Do you feel a reasonable attempt has been made to
ensure relevant expertise has been used?
Yes
Is there evidence of consultation with stakeholders
and users?
Yes
See metadata
Is the objective of the document clear?
Yes
See introduction
Is the target population clear and unambiguous?
Yes
Are the intended outcomes described?
Yes
Are the statements clear and unambiguous?
Yes
Content
Evidence Base
Is the type of evidence to support the document
identified explicitly?
Yes
Are key references cited?
Yes
Are the references cited in full?
Yes
Are supporting documents referenced?
Yes
See references
Does the document identify which
committee/group will approve it?
Yes
See metadata
If appropriate have the joint Human
Resources/staff side committee (or equivalent)
approved the document?
Yes
Approval
Dissemination and Implementation
Page 31 of 44
Title of document being reviewed:
8.
9.
10.
11.
Yes/No
Is there an outline/plan to identify how this will be
done?
Yes
Does the plan include the necessary
training/support to ensure compliance?
yes
Comments
See training
Document Control
Does the document identify where it will be held?
Yes
Have archiving arrangements for superseded
documents been addressed?
Yes
Process to Monitor Compliance and
Effectiveness
Are there measurable standards or KPIs to
support the monitoring of compliance with and
effectiveness of the document?
Yes
Is there a plan to review or audit compliance with
the document?
Yes
Yes – see monitoring
Is the review date identified?
Yes
April 2012
Is the frequency of review identified? If so is it
acceptable?
Yes
See metadata
Review Date
Overall Responsibility for the Document
Is it clear who will be responsible for co-ordinating
the dissemination, implementation and review of
the documentation?
Yes
Lead Director
If you are assured that the correct procedure has been followed for the consultation of this policy, sign and date it and
forward to the chair of the committee for ratification.
Name
Date
Signature
Ratification
Committee
Ratification Committee Approval
If the committee is in agreement to ratify this document, can the Chair sign and date it and forward to the \Head of
Assurance
Name
Date
Page 32 of 44
Signature
Appendix 10
Procedural Document
Registration Form
Page 33 of 44
To be completed by Lead Director
Document Title:
Name
Title
Extension No.
Lead Director or Manager
Lead Author
Committees/Groups/indivi
duals for consultation
Ratification
committee/group
To be completed by lead author
Does the document supersede another document?
No
Title and registration number of superseded document:
Outline of the document: include the purpose/aim of the document
To provide a coherent approach to the treatment of acupuncture in physiotherapy and podiatry
Evidence of best practice/standards (include National Guidelines, e.g. NICE or new legislation)
Reference
Title
1.AACP 2004
AACP guidelines for safe practice.
2.Nice guidelines Low back Early management of persistent non- specific low back pain
pain 2009
3.
Resource implications for implementation
Please indicate the methods that will be used to implement the procedural document i.e. training,
indicating that required resources have identified funding.
Time and funding for staff to be allowed to attend courses and update their CPD for maintenance of
membership of professional bodies.
Acupuncture guideline to be included in induction for relevant staff.
Relevant staff to be made aware of the guideline and how to access it.
Attendance at Acupuncture Interest Group meeting in house.
Acupuncture audit.
Procedural Document Review
It is the responsibility of the ratification group to agree the review period. The lead Director and the lead
author are responsible for ensuring that the procedural document is reviewed and updated in line with
emerging research evidence and local requirements when necessary and at least every three years.
Review period
Ratification group has agreed: 1 year, 2 years, 3 years
Lead Director Signature:
Date:
Page 34 of 44
Lead Author Signature:
Head of Assurance Signature:
Procedural Document Number and section i.e. HR 001
Date:
Date:
Equality Impact Assessment Tool
To be completed and attached to any procedural document when submitted to the appropriate committee for
consideration and approval.
Title of the policy/guidance:
Acupuncture clinical procedure guideline for physiotherapy and
podiatry.
Yes/No
Comments
1 Does the policy/guidance affect one group less or
more favourably than another on the basis of:
Race
Ethnic origins (including gypsies and travellers)
Nationality
Gender
Culture
Religion or belief
Sexual orientation including lesbian, gay and
bisexual people
Age
Disability - learning disabilities, physical disability,
sensory impairment and mental health problems
N
N
N
N
N
N
N
2 Is there any evidence that some groups are
affected differently?
3 If you have identified potential discrimination, are
any exceptions valid, legal and/or justifiable?
4 Is the impact of the policy/guidance likely to
be negative? (If no, please go to question 5.)
If so can the impact be avoided?
What alternatives are there to achieving the
policy/guidance without the impact?
Can we reduce the impact by taking different
action?
5 Health inequalities
6 Please consider the following questions
relating to Human Rights Act:
Will it affect a person’s right to life?
Will someone be deprived of their liberty or have their
security threatened?
Could this result in a person being treated in a
N
N
Y
y
If a patient does not understand
the nature of acupuncture,
treatment will not be indicated for
patient safety.
See above
N
N
N
N
Page 35 of 44
degrading or inhuman manner?
Is there a possibility that a person will be prevented N
from exercising their beliefs?
Will anyone’s private and family life be interfered with? N
If you have identified a potential discriminatory impact of this procedural document, please complete Impact
Assessment Action Plan identifying the action required to avoid/reduce this impact.
For advice in respect of answering the above questions, please contact the Equality and Diversity Manager.
.
Is further detailed impact assessment required? No
If yes, please detail how this is to be processed and by whom
No
Details (names and roles) of staff involved in this impact assessment
Name
Role
Date completed
Susan Harvey BaL
ESP
1st June 2010
Outcome
No action required
Page 36 of 44
Impact Assessment Action Plan
Issue
Proposed Action
Rationale
Person
Responsible
Patients with learning disabilities, and mental Assess patient’s ability to understand If a patient does not understand the nature Individual
health issues
treatment.
of the treatment they are not able to say if therapists
there are any adverse effects etc. This
threatens patient safety. This is assessed as
part of normal practice, with every patient.
By When
Ongoing as part of
assessment.
Appendix 10
Walsall Health Inequalities Impact Assessment Screening Tool
Page 37 of 44
When completing a new project or making significant changes to existing services or policies, the planning process should take into account the health determinants and their effects
especially on disadvantaged groups. Services and amenities should be targeted according to need. Those that are most disadvantaged should be prioritised and protected from
negative health impact.
This tool focuses on vulnerable groups and completing it at an early stage in the planning process will assist planners to address the issues. If several negatives are highlighted it may
indicate a more detailed assessment is required.
Section 1
Project Title:
Acupuncture clinical procedure guideline for physiotherapy and podiatry
Date of assessment:1st June 2010
What ‘needs’ will the project address?(i.e. a specific group or area)
Information and resource tool for physiotherapists and podiatrists using acupuncture to provide a coherent approach to patient care.
What is the project designed to achieve? (project aims and outcomes)
A coherent approach to acupuncture practiced by physiotherapists and podiatrists, and to highlight where they differ.
Will the people who the project could potentially benefit have access problems? i.e. equality issues
No
Section 2 - Please describe the project’s potential impact on health inequalities as appropriate
Population Characteristics
Potential Impact on Health
Page 38 of 44
Positive
Accessibility - Have issues such as language, literacy
and hearing/visual impairment been considered when producing information?. Have
issues of location and transport, walking routes etc been considered?
Material disadvantage, i.e. low income, no car, poor housing unemployment
√
Minority culture or ethnic group, (culture religion, English as a second language)
√
Families with children (pregnant women, babies, children and teenagers)
√
Physical or mental frailty
(Learning or physical disability, carers
√
Gender/sexuality
(Access to services, issues of prejudice)
√
Negative
No change
√
Page 39 of 44
Determinants of Health
Understanding the factors that contribute to population health can help to plan projects so as to maximise their positive impact on health and on reducing health inequalities. A
multidisciplinary approach to this exercise will help to identify relevant health determinants and how they apply to the project.
Health Inequalities Impact Assessment Rapid Appraisal
Title of project…clinical procedure guideline for physiotherapy and podiatry………………………………………………………………
Geographical area…Walsall community health economy………………………………………………………….
Population group…Physiotherapist and podiatrists Walsall community health and their clients,………………………………………………………………….
Section 3 - Please consider the health determinants and the impact the project has on reducing health inequalities
Health Determinants
Project – Positive Impact
Project - Negative Impact on Health Inequalities
on Health Inequalities
Lifestyle – diet smoking, exercise, drugs Offers clients the option of acupuncture to augment treatment and
facilitate making lifestyle changes.
personal choice
Social community-culture/religion,
peer pressure, social isolation
Assists in enabling clients to integrate with the community by
providing pain relief as part of treatment.
Page 40 of 44
Home, Education, work - housing
services, amenities, schools and jobs
Acupuncture forms part of a treatment package designed around
client centred goals.
External environment –pollution,
hazardous waste,
Complies with existing policies in the trust for clinical waste
disposal, sharp’s policy
Economic factors- income, benefits,
economic situation
Acupuncture and treatment may assist in enabling clients to return
to work.
Section 4 - Please list Health Impacts and potential actions to reduce health inequalities within the project
Priority Health inequality Impacts identified from Previous List
Action Required to Maximise Positive Impact and Minimise Negative Impact
Page 41 of 44
5. Health Inequality Impact Assessment
Matrix Grading System to Prioritise your Actions
Action required
High
Likely impact
Med
Low
Short
Timescale for achieving change
Med
Long
1
2
3
4
Page 42 of 44
Which Health inequalities gap target will this service/policy contribute to and how?
6. Process evaluation and Monitoring
1. Which actions are to be included in the final project plan?
2. Which actions have been rejected from the project plan and why?
3. How will you monitor the impact on health inequalities as this project progresses?
If issues arise they can be raised at the Acupuncture interest group.
Page 43 of 44
Completed by;
Susan Harvey Bal
Organisation; Walsall Community Health
Date; 1st June 2010
Page 44 of 44