details

Overview

Scope of Practice
Competence
Maintaining Competence
Consent
Record Keeping
Students/Occupational Therapist Assistants/Health Practitioners
Risk Management

Introduction

The College of Occupational Therapists of Ontario supports the use of acupuncture within occupational therapy practice. Since acupuncture is a procedure performed on tissue below the dermis it is considered a controlled act. Controlled acts are procedures or activities which pose a risk to the public if not performed by a qualified practitioner. Through a legislative exemption, occupational therapists are permitted to perform acupuncture without delegation (Ontario Regulation 107/96, Controlled Acts, s. 8(2), Regulated Health Professions Act,1991 (RHPA). The use of electrostimulation is a modality that can be used to augment regular acupuncture. Electrostimulation involves the passage of a small electric current between acupuncture needles. The use of electrostimulation does not fall under any of the prescribed forms of energy outlined in the Controlled Acts Regulation under the RHPA. OTs who wish to use electrostimulation as part of acupuncture treatment must be trained and have the knowledge, skill, and judgement to use this modality safely and provide a clinical rationale for its use. OTs are not permitted to delegate any parts of acupuncture.

Occupational therapists performing acupuncture are expected to practice within the scope of the profession. Occupational therapists must be aware of the minimum expectations for the performance of acupuncture as outlined in the Standards for Acupuncture.

Occupational therapists who use acupuncture are reminded that the use of the title acupuncturist or acupuncture practitioner, is restricted to members registered with the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario.

Application of the Standards for Acupuncture

The following Standards describe the minimum expectations for occupational therapists.
The performance indicators listed below each standard describe more specific behaviours that demonstrate the Standard has been met.
It is not expected that all performance indicators will be evident all the time. It is expected that the performance indicators could be demonstrated by the occupational therapist if requested.
There may be some situations where the occupational therapist determines that a particular performance indicator has less relevance due to client factors or environmental factors. Such situations may call for the occupational therapist to seek further clarification.
It is expected that occupational therapists will always use their clinical judgement to determine how to best meet client needs in accordance with the Standards of the profession.
It is expected that occupational therapists will be able to provide reasonable rationale for any variations from the Standard.

In the event of any conflict or inconsistency in these Standards for Acupuncture with any other College Standards, the Standards with the most recent issued or revised date prevail.

College publications contain practice parameters and Standards which all occupational therapists practising in Ontario should consider in the care of their clients and in the practice of the profession. College Standards are developed in consultation with occupational therapists and other stakeholders and describe current professional expectations. College Standards may be used by the College or other bodies in determining whether appropriate Standards of Practice and professional responsibilities have been maintained.

In accordance with the Regulated Health Professions Act, 1991 (RHPA), the College is authorized to make regulations in relation to professional practice. The College’s Professional Misconduct Regulation establishes that “contravening, by act or omission, a Standard of practice of the profession or failing to maintain a standard of the profession” constitutes grounds for professional misconduct.

Scope of Practice

Standard 1

The occupational therapist will perform the procedure of acupuncture within the scope of occupational therapy practice.

Performance Indicators

An occupational therapist will:

1.1

Perform acupuncture safely, effectively, and ethically in accordance with all the Standards of Practice, the Code of Ethics, scope of occupational therapy practice and relevant legislation;

1.2

Register with the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario if using the protected title Acupuncturist Practitioner or if performing acupuncture techniques outside the scope of occupational therapy practice;

1.3

Provide the clinical rationale for using the modality of acupuncture within the occupational therapy treatment plan;

1.4

Obtain appropriate delegation¹ if performing additional techniques of acupuncture that fall under other controlled acts (for example, medicinal application);

1.5

Refer clients to other qualified practitioners of acupuncture if the client requires treatment beyond the scope of occupational therapy practice and competence of the occupational therapist.

¹ Note: Delegation refers to the transfer of authority to perform a controlled act from one practitioner who has the authority to perform the controlled act to another practitioner who has the knowledge, skill, and judgement to perform the procedure safely and effectively.

Competence

Standard 2

The occupational therapist must have successfully completed formal training in acupuncture and demonstrate knowledge, skill, and judgement prior to performing acupuncture.

Performance Indicators

An occupational therapist will:

2.1

Have formal acupuncture training that includes instructional, theoretical, and practical components by a qualified acupuncture practitioner;

The course will include the following components:

Introduction to the theories, philosophy, and principles of acupuncture
Acupuncture points:
- anatomy, acupuncture points, acupuncture meridians
Applications of acupuncture in modern Western medicine:
- clinical conditions in which acupuncture has been shown to be beneficial
- selection of patients, planning of treatment, and evaluation of progress/benefit;
- hands on practice of point location, safe needle insertion and removal
- Practical evaluation as part of the program
Infection, prevention, control, and safety procedures in acupuncture
Treatment techniques:
- common principles, and techniques;
- specific clinical conditions;

2.2

Provide verifiable documentation of the completion of an educational program in acupuncture upon request;

2.3

Assess client(s) as candidates for acupuncture based on current evidence and effectiveness of the acupuncture treatment;

2.4

Understand the indications, contraindications, benefits, and limitations of the acupuncture techniques;

2.5

Not perform any acupuncture technique that is outside the occupational therapist’s training, knowledge, skills, and judgement.

Maintaining Competence

Standard 3

The occupational therapist will maintain competence by engaging in ongoing acupuncture specific learning activities.

Performance Indicators

An occupational therapist will:

3.1

Participate in regular and as needed professional development activities to ensure ongoing competence to perform acupuncture safely and effectively;

Some examples can include:

recognized acupuncture education and training programs,
workshops,
conferences,
learning modules.

Consent

Standard 4

The occupational therapist will ensure that informed and ongoing consent is obtained from the client/Substitute Decision Maker (SDM) to perform acupuncture, in accordance with the Standards for Consent

Performance Indicators

An occupational therapist will:

4.1

Obtain informed consent for acupuncture as outlined in the Standards for Consent ensuring the client/SDM understands that the modality of acupuncture is being used within the occupational therapy scope of practice:

The nature of the proposed acupuncture procedure
Disclose benefits, risks, limitations and side-effects and adverse reactions of acupuncture to the client
Alternative treatments
The option of the client to withdraw consent at any time during the process
Disclose any fees associated with the treatment prior to performing acupuncture;

4.2

Respect the client’s choice not to proceed with acupuncture; and offer alternative treatment options.

Record Keeping

Standard 5

The occupational therapist will document the performance of acupuncture in accordance with the Standards for Record Keeping.

Performance Indicators

An occupational therapist will:

5.1

Document relevant details about the performance of acupuncture (for example record keeping may include but not limited to needle points used, length of needle, depth, direction, and any stimulation or manipulation) and the outcome and effectiveness of the procedure.

Students/Occupational Therapist Assistants/Health Practitioners

Standard 6

The occupational therapist will not delegate or assign any part of the controlled act pertaining to acupuncture.

Performance Indicators

An occupational therapist will:

6.1

Not delegate or assign any part of acupuncture to students, occupational therapist assistants or any other health practitioner.

Risk Management

Standard 7

The occupational therapist will be responsible for minimizing the risks to the client, self and others associated with the performance of acupuncture before, during and after the procedure.

Performance Indicators

An occupational therapist will:

7.1

Comply with the Standards for Infection Prevention and Control:

7.1.1

Maintain required standards of cleanliness, skin disinfection technique, needling technique;

7.1.2

Ensure needles used for treatment are single-use, pre-packaged, pre-sterilized, unexpired, manufactured for use in acupuncture, intended for the specific kind of acupuncture being performed, and disposed of properly at the end of the treatment;

7.2

Establish policies and implement precautions necessary to prevent adverse events or injury when performing acupuncture (for example, ensure the number of needles inserted into the client reconciles with the number of needles removed from the client, disposing of needles in accordance with public health guidelines for sharps safety);

7.3

Recognize and manage adverse client reactions or complications during, or as a result of, acupuncture treatment;

7.4

Have written procedures and protocols to manage emergency situations, and processes to track adverse incidents, to inform quality improvement.

Reference

College of Occupational Therapists of Ontario. (2016). Standards for Record Keeping.
College of Occupational Therapists of Ontario. (2017). Standards for Consent.
College of Occupational Therapists of Ontario. (2020). Guide to Controlled Acts and Delegation.
College of Occupational Therapists of Ontario. (2019). Standards for Infection, Prevention and Control.
Occupational Therapy Act, 199. https://www.ontario.ca/laws/statute/91o33
Regulated Health Professions Act, 1991. https://www.ontario.ca/laws/statute/91r18

Details

Downloads

Overview

Introduction

Application of the Standards for Acupuncture

Scope of Practice

Competence

Maintaining Competence

Consent

Record Keeping

Students/Occupational Therapist Assistants/Health Practitioners

Risk Management

Reference