Adverse Events and Errors

What is a reportable event?


If a patient complains about it or it is in the Clean Needle Technique manual, please report it.

The next two F.A.Q.'s answer this question in greater detail. Please read on for more information.

What do you mean by an Adverse Event? / What are the practical goals of this database?

These two questions are very closely related.

The U.S. Department of Health and Human Services defines an adverse event as: An event, preventable or non preventable, that caused harm to a patient as a result of medical care. This includes never events; hospital-acquired conditions; events that required life-sustaining intervention; and events that caused prolonged hospital stays, permanent harm, or death.

By this definition, the practice of acupuncture very rarely involves adverse events. This is one reason that no database has previously been created to track them.

However, the Clean Needle Technique manual contains a list of “adverse events”, both serious and less so, which reflects a much broader definition:

  • Bruising and Bleeding
  • Needle Site Pain/Sensation
  • Fainting
  • Failure to Remove Needle
  • Stuck Needle
  • Aggravation of Symptoms

Rare but serious AEs: pneumothorax, injury to other organs and/or central nervous system, injury to tissue, nerves, and/or blood vessels, infection, and broken needle.

The Current Clean Needle Technique Manual

A major goal of this database is to support a culture of safety in the practice of acupuncture. Part of creating a culture of safety is making it easier and more comfortable for both practitioners and patients to communicate about safety issues. We believe that better, more cooperative communication around even minor “adverse events” can help prevent, and/or improve the management of, adverse events in general

What kind of adverse events should I report? (How minor is too minor?)

Considering the goal of creating a culture of safety, which includes improving cooperation both among practitioners who are peers and/or colleagues AND improving cooperation between practitioners and patients around safety issues, the working definition of an adverse event is:

  • Anything that a patient complains about with regard to treatment, including but not limited to the list of events from the CNT manual.
  • Anything that happens in your clinic, related to treatment, that you don’t want to happen again.

Obviously this will involve some judgement calls, and since not everyone will make the same judgement calls, this means our data will not be perfect. However, our data doesn’t have to be perfect in order to contribute to a culture of safety.

For example, bruising and/or bleeding is relatively common in acupuncture. Some patients will be unconcerned when this happens, whereas some patients will be very concerned. Histamine reactions to acupuncture, up to and including hives, are less common, but have a similar dynamic: some patients might be indifferent to major redness and swelling -- if they are accustomed to having hives -- while others will be very worried, even about minor flushing. It is helpful for practitioners to have an idea about how often patients might feel concerned about these kinds of events, regardless of how minor they are, because it helps practitioners know what to expect from their clinical experience, and it also helps them to communicate with patients.

So if a patient states they are concerned about a bruise, regardless of the size of the bruise itself, it’s worth filing a report in our database. Eventually, we’ll have an idea of how often patients are likely to be concerned about bruises -- and that will be valuable in terms of both patients and practitioners knowing what to expect from acupuncture.

Many acupuncturists, especially relatively new practitioners, struggle with knowing how to respond supportively to patients’ concerns. We hope this database will help with that.

Why should I report Adverse Events and Errors?

If you provide acupuncture services, you should anonymously report adverse events and errors because reporting errors is fundamental to preventing errors. Many medical errors are a function of systems and practices as opposed to a failure of individual vigilance, and the only way to improve systems is to gather data about problems from many different perspectives. All healthcare providers have to contend with adverse events and errors; the only way to decrease them across the board is to gather data and analyze it. We encourage you to look at reporting adverse events and errors as simply being a part of the safe practice of acupuncture.

If you are a patient, you should report any acupuncture adverse events and/or errors you have experienced because your information may be able to help prevent similar problems in the future. Your information is valuable to understanding and improving safety practices.

What is an Adverse Event? What is an Error? Are they Different?

An acupuncture adverse event is a negative consequence or injury to a patient because of treatment and not necessarily because of error. Most acupuncture adverse events are minor, such as local bruising or temporary dizziness or nausea (“needle shock”). More serious acupuncture adverse events can include nerve damage or organ puncture.

An acupuncture error is an incorrect action or plan that may or may not cause harm to a patient. A common acupuncture error is failing to remove a needle after treatment, especially if the needle is in an area such as the head and is hidden by hair. In many cases in which an acupuncturist forgets or overlooks a needle, this represents an action in which no harm is caused to the patient. However, there are variants of acupuncture in which needles are intentionally retained permanently (representing a plan), and there have been reports of intentionally retained needles migrating elsewhere in the body and causing harm.

An example of an adverse event combined with an error would be an acupuncturist inserting a needle too deeply in an area too near to the lungs, resulting in a pneumothorax. Awareness of the possibility of organ puncture has resulted in acupuncture safety practices that discourage deep needling in certain areas.

A less serious example of an adverse event combined with an error would be an acupuncturist providing treatment to a patient who reported that they had skipped lunch and were feeling light-headed, and as a result, the patient faints during treatment ("needle shock").

Can I report by mail?

Sure, we love getting mail!

Just download a copy of the error/adverse event reporting forms fill them out and mail them to us at:

Acupuncture Adverse Events and Errors Reporting
c/o POCA
3526 NE 57th Ave
Portland, OR 97213

The Data

Why are you collecting this information?

Although voluntary Adverse Event Reporting Databases are a fixture in many areas of health care, there has not yet been a voluntary Adverse Event Reporting Database for acupuncture. Although acupuncture is a very safe practice already, we feel that collecting this type of safety data is simply a part of providing health care in the 21st century. Acupuncture has standard safety practices, but without a feedback loop of voluntary reporting, these practices miss an opportunity for validation and improvement.

What will you do with my report?

Your report will be logged and analyzed in the context of other patient safety reports. If we notice emerging trends that indicate a safety issue, we will make a recommendation for change of practice methods on this website.

Will you share the collected data analysis? Can I view the reports?

Yes. Collected data will be analyzed and summaries will be published on this site, along with suggestions for possible improvements to safety practices.

The Researchers

Who are you to create an Adverse Events Reporting System?

The POCA Cooperative is a multi-stakeholder or “solidarity” cooperative that represents both patients and practitioners. As a result, POCA works on projects where the interests of “consumers” and “producers” overlap. Improving the collection of acupuncture safety data is one of those areas.

I have more questions how can I contact you?

Send an email to aerd@pocacoop.com

Security & Privacy

Is this website secure?

Yes. All requests sent to and from this website are sent over industry standard encrypted connections to our host. The survey used to collect Adverse Event and Error reports is hosted and secured by SurveyMonkey. We selected SurveyMonkey because of their good security practices, you may read their security statement and privacy policy for more information.

How will you protect my privacy?

We understand that adverse event reporting presents the possibility of disclosure of potentially sensitive information and interception of a report could de-anonymize the reporting party. For this reason this website is secured using the strongest encryption methods currently available to protect your report from prying eyes while in transmission. We consciously selected a survey provider with strong security practices and good track record to collect and store any report you may submit. We do not automatically store any identifying information from your computer, such as IP address.

At the end of this report you will have the option of identifying yourself for follow up contact if you chose. Providing this information is voluntary and not required to submit a report. While filling out this report please respect the privacy of others and do not identify anyone but yourself. Information that identifies others will be stricken from the report and will not be used.

If you choose to share your contact information: we will not share it with anyone who is not a part of our research team and it will not be used for any purpose except to contact you for follow up.