Monday, May 11, 2015

Special Topic. Support Personnel for Acupuncture Providers

key words:  support personnel, special topic, hospital practice

Subject:  How to use Support Personnel for Acupuncture Providers

Details: 
If you could have support personnel assist you in your clinic (you are an L.Ac.), what would you have them do?  What kind of support would be best for you?  What does that look like (think ideal setting)?

Setting:  Hospital clinic, outpatient.  Imagine you and your clinic are preparing for a Joint Commission visit.  

Since the overall scenario is preparation for a Joint Commission visit, we will first include quality assurance factors and industry standards.
Second, (and mostly what I want to hear) is what your opinion and ideas or examples are of this.  The industry standards (or as much as I have been able to find so far--see below) are minimal.

Definitions
For purposes of this discussion “Acupuncture Providers” are defined as:

1.        Are the only personnel who use acupuncture needles or perform acupuncture procedures in the clinic

2.       Have the following industry standards in training:

a.       Licensed Acupuncturist.  Graduated from an ACAOM-accredited master’s or doctorate degree program.  NCCAOM board certified.
           

 Questions to contemplate and RESPOND to:

1.  What would an Acupuncturist’s support personnel be like?  What would be their minimum training?
What rules and standards currently govern this?  What are some useful examples?


Training:

I.  Medical assistant or nurse (RN, nursing assistant, Medic, Corpsman)

Acupuncture specific training needed?

No.  not trained in an ACAOM-accredited program (ie, not an Acupuncturist).  Staff is simply training in the usual medical assistant or related nursing program training in their field, standard.

Duties and/or tasks for being support personnel include:
(medics, corpsmen, nurses, nursing assistants, or medical assistant staff who help)

                                                               i.      Bring patient to treatment room

                                                             ii.      Take vitals

                                                            iii.      Record vitals in electronic health record (EHR)

                                                           iv.      Set up acupuncture tx room 

1.       This may include but is not limited to:  set up clean field, clean cupping supplies, set out and put away other equipment such as e-stim machines and heat lamps

                                                             v.      Stand in/chaperone for provider as needed

                                                           vi.      One-on-one care as needed (ex:  in high anxiety patients or some patients with post-traumatic stress symptoms often request to not be left alone in a room.   Other kinds of special cases.  Support personnel may stay/sit in room with patient while needles are retained during treatment.)

                                                          vii.      Clean up tx room post-procedure

As “support personnel”, these personnel would be subject to the following trainings that may be tied into competencies or SOPs, if your clinic feels it is necessary:

                                                        viii.      Standard precautions

                                                           ix.      Biohazard training

                                                             x.      Sharps training

                                                           xi.      How to set up a clean field (see CNT manual reference)

                                                          xii.      How to store acupuncture needles




II.  Acupuncture student (someone currently enrolled in an ACAOM-accredited program)

                Must have business associate agreement, etc, paperwork on file with appropriate hospital office for internship, externship, etc, with related school training program.

                Other rules or regulations that may apply?

What does your support personnel document in the electronic health record (EHR)? 

1.What should the support personnel document in the EHR before Acupuncturist arrives?  Talk with your Acupuncture providers about what they want.  Recommend a minimum of appropriate vitals such as:   height, weight, blood pressure, pain level, chief complaint

b.      Anything after visit?

Check with your Acupuncture provider.  He or she may want to check in on symptom progress, homework, etc.

2.  Should support personnel have competencies to assist in acupuncture?

No.  Support personnel should not be assisting with actual needling.  There currently is no standard that supports this.  Use of acupuncture needles must be by trained personnel.  Currently the industry standard for trained personnel is:  licensed acupuncturist or physician who has completed a medical acupuncture program

3.       What would be in a pre-procedure checklist?

I recommend the following resources to help you write this:  
latest version of the Clean Needle Technique Manual
local hospital policies on handwashing 

What other resources would you add?
4.       What would be in a post-procedure checklist?

I recommend the same resources as in #3.  
Please write in the comments section other resources you would recommend.

Resources/References
Applying Clean Needle Technique (CNT) in an Acupuncture Treatment*
CleanNeedle Technique Manual for Acupuncturists: Guidelines and Standards for theClean and Safe Clinical Practice of Acupuncture. 7th edition.  


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