AERD Report 2023 Q2
As promised, here’s our quarterly review of AERD reports! From 4/1/23 through 7/5/23, we had thirteen completed reports submitted to the AERD. You will note that those dates don’t track exactly with the end of the quarter, but I promise I have a good reason for that which I’ll get to in a minute. Thank you everyone who took the time to share your experiences!
This batch of AERD reports was juicy and might deserve the title of “Why We Do This, Part 3”. Let’s start with AERD Greatest Hits. In that category we have:
2 reports of bruising
1 report of swelling and pain at a needle site which felt worse for 7 days
1 report of a migraine occurring immediately after a treatment (an interesting aspect of this report is that the treatment in question was a Korean 4 Point treatment in a POCA Tech student clinic, and it involved no head points at all).
1 report of dizziness and 1 report of fainting. (For more on why we need to take dizziness and fainting seriously, and a story about how dizziness was responsible for one of the highest payouts ever from a malpractice insurance company for an acupuncture claim, please see the post Four Stages and Safety)
In the case of the patient who fainted, the practitioner reported that the patient was very nervous about receiving acupuncture and fainted after two needles were inserted. The patient also reported that they had low blood pressure. The treatment was on a table. In the case of the report about dizziness, the patient “called the clinic several hours after her appointment describing symptoms of unpleasant floating/dizziness sensations. She stated that several head needles were especially intense today (one had to be removed during treatment) and wondered if that had anything to do with it?”
We wonder too, but we have to be honest that we don’t know for sure, because it’s not always clear exactly what causes an acupuncture adverse event.
On that note, let’s revisit the category of Things Got Weird.
I appreciate very much the practitioner who submitted 2 reports of patients feeling needle sensations in places where there weren’t actually needles, to the point that they complained about discomfort. The practitioner wrote, “I never considered reporting this to AERD until I read the quarterly report for April 2023.”
Patients feeling needles where there aren’t needles is something I think of as a common phenomenon; when I was working in a busy clinic it happened to me regularly. But I’ve never seen it addressed anywhere else as part of patient safety communication and I think it really needs to be! It highlights the difference between how patients experience receiving a treatment vs. how practitioners experience giving a treatment, and SO many safety issues arise in that gap. It also highlights how little we really understand about how acupuncture works in the body. Reports like this make some of the more extreme incidents understandable, like a patient believing a needle has broken off in their body (sometimes in a place where there wasn’t a needle to begin with) -- it seems like there’s a continuum of mysterious perceptions and practitioners should expect things to happen along that continuum.
For the remaining five reports in this batch of AERD Data, I’m creating two additional categories: How We Think About Safety and New Information, Please Share!
How We Think About Safety
In this category we have:
1 report of a practitioner not doing a great job responding to a patient’s concerns. “The patient reported that the practitioner needles more deeply and stimulated the needles in a way she was not used to. Patient told the practitioner that the needles in her neck “felt weird.” The practitioner told the patient that “weird is good” and left the room.” If there’s one thing I’ve learned from the AERD it’s that weird is not necessarily good, weird is just weird, and the correct response to a patient saying that something feels weird is “Tell me more about that.” So let’s call this a practitioner error, because it sounds like nothing bad happened as a result (fortunately).
2 reports from student interns in school clinics on their experiences as patients, which we appreciate very much! The first one reports bruising, bleeding, redness and soreness at needle sites, and psycho emotional triggers, related to more than one experience as a patient in a student clinic. This student noted, “Being left alone in a medical room for an intern or supervisor to come back, or with painful needles, is so unpleasant...It's hard for clinic interns with a trauma informed approach to create safety when supervisors don't collaborate.”
The second report is from a student who developed a headache during a treatment that lasted several hours afterwards. This was another Korean 4 Point treatment in a POCA Tech student clinic. The student wondered if maybe the intern misdiagnosed the imbalance, thus causing the headache? I think this is an example of the need to draw a line between adverse events and errors. A headache represents an adverse event but we don’t know that it represents an error in this case, because we don’t know that the intern chose the wrong points for this treatment. A headache (adverse event) isn’t proof of an error, just like needle shock/dizziness/fainting isn’t proof of an error. We don't know why people get headaches during or after acupuncture.
(To reiterate: An acupuncture adverse event is a negative consequence or injury to a patient because of treatment and not necessarily because of error. An acupuncture error (like forgetting to remove a needle) is an incorrect action or plan that may or may not cause harm to a patient. There may be overlap between adverse events and errors, but they shouldn’t be confused, because the remedies are often different.)
New Information, Please Share!
This is one of the reports that came in after June 30 but I didn’t want to wait months to blog about it. The category in the AERD is “other”. The patient was wearing an Apple Watch, sometimes referred to as a smart watch, the kind that collects data and gives notifications. The acupuncturist inserted a needle at PC 6 on the same arm as the Apple Watch. The needle placement and the insertion were no problem. Shortly afterwards, the Apple Watch “went off” -- it did its thing and pinged a notification, and the patient immediately received an intense, painful electric shock down her arm into her hand.
While PC 6 is known for the possibility of electric shocks and unpleasant nervy feelings, this incident was a different order of magnitude. (It happened at WCA and the practitioner talked to me about it after they submitted the report.) This is not something we want to happen again, and I don’t think we know from this report that the risk is limited to PC 6. Maybe TW 5 or SI 3 could have the same effect? Or for that matter ANY point on the arm? I think we need to consider that smart watches and acupuncture are potentially a problematic combination, and either avoiding needles in proximity or asking the patient to remove the watch might be a good idea.
This incident is a perfect example of why the acupuncture profession needs some kind of safety reporting mechanism that updates information faster than the Clean Needle Technique Manual, which depends on adverse events data published in academic journals. It’s also an example of how not every safety problem is a result of practitioner error or “undertrained practitioners”. Technology is evolving rapidly, especially the kind of technology that interfaces with the human body in novel ways, and I’m going to take this report as the first sign that we need to pay attention to how that evolution might create acupuncture safety issues.
Until there’s another way to share information about safety issues, we’re it, folks. Thanks again for sharing your data! Talking about safety helps make acupuncture safer!