TCM: Count 'Em In, Count 'Em Out
Practice acupuncture for a while and you’ll hear the story of how a practitioner stuck themselves with a used needle.
Stick around a little longer (acupuncture pun) and you’ll hear stories from your patients how so-and-so chiropractor, physiotherapist, and even acupuncturist, sent them home with needles still in their body. I know it can happen. Heck, I’ve heard two separate stories of two different practitioners of acupuncture leaving their patients in the treatment room with needles while they went home for the day. The receptionist had to pull out all the needles.
While I have absolutely no suggestions for how not to leave patients on the table while going home for the day, I do have some solid recommendations to help remember where all those little pieces of sterile stainless steel were placed.
Charting isn’t just about writing down the chief concerns or SOAP notes. Charting can be tailored to our own needs as practitioners. I use the margins to make notes on what I would like to work on next time. I write down when a patient is going on vacation so I can continue the conversation when they return. I also write down every single acupoint I use. If it’s an Ashi point I like to use Dr. Tan’s method of charting by writing down the nearest neighbouring acupoint, or if it’s on a channel I write down an approximation of where it is between two acupoints (eg: SP2.5 - halfway between SP2 and SP3).
There are two very important protocols I follow when it comes to charting:
If I change, add, or take away an acupuncture point, I immediately write down the change.
I write how many needles I have used in a point prescription. If the number changes because I add or take away an acupoint, I immediately write down the change.
Breaking this protocol is disastrous, and it is especially important when running multiple rooms.
Writing the number of acupoints used is extremely useful for finding hidden needles. What are hidden needles? DU20 can get lost in the hair. REN15 or UB13 can get lost if the patient’s shirt covers them. Basically, anything not visible in plain sight can get lost and patients either find them when they start to dress, when their car seat pushes into them, or they’ll take them all the way home.
Angle and Depth
Nobody wants that phone call where a patient tells them they found a needle in their head after they got home. However, adhering to proper needling angle and depth, while leaving a good amount of space between the root of the needle and the skin, can keep the patient safe in the event an accident occurs. Shirts and pants often ride down during treatment. I do believe patients should disrobe or a clip of some sort should be used if a practitioner is fighting with clothing. However, even in the clinic it is very important to make sure the angle and depth are correct so that a needle accidentally pushed all the way to the root causes no damage.
I always double check. Using positive language in the clinic, I don’t tell my patients I am looking for blood. Instead, I tell them I am looking for leaks. They usually laugh, but what I am doing is recounting the number of acupoints while checking for any ‘late bleeding acupoints’ with cotton ball in hand.
Safety is the first of my three kings of the clinic. Safety isn’t just about our patients, it’s about keeping ourselves safe, our families safe, our careers safe and our profession safe. I have all these in mind every time I administer acupuncture.