Code of Safe Practice

SAFE NEEDLE PUNCTURE

All members of The Acupuncture Society must follow this code:
Only use Pre-sterilised disposable needles .
Always clean the skin with anti-bacterial wipes prior to and after needling if the skin does not appear clean or you are aware that the patient suffers from a skin disease.
Wear sterile vinyl or latex gloves if you have a skin disease, have sweaty fingers, cuts, abrasions, lesions or suffer from an infectious disease.
You can choose whether or not to use guide tubes, as aseptic puncture is possible by holding the handle of the needles. Never allow your fingers to touch the needle shank.
Needles must be used directly from the sterile pack and not placed on non-sterile surfaces prior to use. Where the point of an unused needle comes in contact with the skin, nail or any non sterile surface it must not be used and be discarded in a yellow sharps container.
All used needles must be placed in a yellow sharps container and disposed of correctly by incineration. Used cotton wool wipes and couch roll can be disposed of in the normal rubbish collection


PERSONAL HYGIENE

Hands and finger nails must be scrubbed clean with antibacterial soaps between each patient. Paper masks must be used when in close contact with patients and whilst administering non smokeless moxibustion. If you are not using a guide tube and cannot effectively insert the needle using the handle, you must use sterilised vinyl or latex disposable gloves during normal standard needle insertion and withdrawal or sterilised cotton wool technique as appropriate. Never allow your fingers to touch the needle shank.. Always clean the skin areas to be puncture with Hibiscrub 10% dilution or similar antibacterial cleanser. Disposable hand towels are recommended. Plastic gloves must be worn when examining skin disease. Refrain from smoking or consuming food in the treatment area.

Needlestick injuries should be logged and a blood test taken by a registered medical practitioner, where the needle had penetrated the dermal layers. We recommend a Hepatitis B vaccination to protect you and your clients from exposure to this highly infectious desease and clients must be asked about their exposure to Hep B and all other infectious diseases prior to treatment. Treatment must be declined where infectious risk is perceived to be likely to be present.


PATIENT CHECK LIST TO BE FILLED IN PRIOR TO TREATMENT

Practitioners must ask patients to fill in this or a similar check list before administering treatments:

If you suffer from any of the conditions listed below or other conditions which have not been included that you feel are relevant, please inform us prior to treatments so that we can assess your suitability for such treatment.
Where there is any doubt please consult your GP.
- A recent operation
- An untreated medical condition
- Severe bone or joint disorders (Rheumatoid/Osteo arthritis, osteoporosis)
- Cardiovascular disorders (high blood pressure, heart / circulatory desease, thrombosis)
- Diabetes
- Endocrine disorders
- Epilepsy
- Drug addiction or recent use of recreational and/or prescribed drugs and or exessive alcohol consumption
- Medication
- Pregnancy (or post natal within the last 6 months)
- Severe skin disorders
- Severe mental illness
- Spinal injuries
- Prone to fainting
- If you suffer from infectious deseases like hepatitis B or HIV
You must also have eaten within 2 hours prior to treatment (please inform practitioner if you haven’t)
- Is there anything else we should know about your health?


HERBAL MEDICINE

The EU laws concerning Herbal medicine came into force in April 2011, which only apply to patent medicines and preparations made up in factories for thirds parties. Those practitioners and retail outlets who are trading in patent medicines will be able to apply for a licence to continue to supply these patent or factory prepared formulations from the HPC (see the written ministerial statement below published 16 February 2011).
UK legislation due in early 2013 is likely to require registration of Herbal Practitioners with the HPC, it’s anticipated that this will greatly increase our acceptance within the orthodox medical community. There will be a consultion process begining in late 2012 leading to legislation expected in 2013, there will be grandparenting arrangements for all those qualified prior to the legislation becoming active. Until the White Paper is published it is not yet clear what exactly it will contain, but its expected to follow simillar processes that occured when previous aspirant therapies attained registration to the HPC in the past. The Acupuncture Society is seeking to attain automatic grandparenting for all its Herbal Members.

Follow this link to the hpc website page on herbal regulation http://www.hpc-uk.org/aboutregistration/ aspirantgroups/aspirantgroups/

Herbalist’s mush not use endangered species animal and mineral substances in their formulae nor use patient medicines nor ask third parties to prepare them or their insurance may be void.


List of Banned Herbs and legal implications of new EU herbal regulation

A: RESTRICTED UNDER THE CONVENTION ON INTERNATIONAL TRADE IN ENDANGERED SPECIES (CITES) Herbs which are endangered in the wild are restricted but may be traded with the appropriate CITES certification. In the case of Appendix I this is normally only permitted for scientific purposes if at all. Suppliers can trade in herbs listed in Appendix II but only when obtained from an authenticated cultivated supply. An example of this is XI YANG SHEN which is available from farmed sources.

APPENDIX I
HU GU (Os tigris)
SHE XIANG (Secreto Moschus)
XI JIAO (Cornu Rhinoceri)
XIONG DAN (Vesica Fellea Ursi)
BAO GU (Os Leopardis)
DAI MAO (Carapax Ertmochelydis)
MU XIANG (Saussurea lappa) NOTE: Vladimira species are permitted as a substitute herb.

APPENDIX II
CHUAN SHAN JIA (Squama Mantis Pentadactylae)
HOU ZAO (Calculus Macacae)
LING YANG JIAO (Cornu Antelopis)
GUI BAN (Chinemys reevesii)
SHI HU (Dendrobium species)
BAI JI (Bletilla striata)
TIAN MA (Gastrodia elata)
GOU JI (Cibotium barometz)
LU HUI (Aloe ferox)
XIAO YE LIAN (Podophyllum emodii)
ROU CONG RONG (Cistanches deserticola)
XI YANG SHEN (Panax quinquefolius) NOTE: Only applies to the whole and sliced root.
HU HUANG LIAN (Picrorrhiza kurroa)

B: RESTRICTIONS UNDER STATUTORY INSTRUMENTS

SI 2130 1997 These herbs were listed as an in addition to those listed in the Medicines Act 1968 as being potent and hence in need of dosage regulation. In some cases they are forbidden at any level of internal dosage.

MD= Maximum single dose MDD=Maximum Daily Dose

FU ZI/CAO WU (Aconitum species) NOTE: Permitted to use externally at a dose of 1.3% or below. Internal use prohibited.
SHI LIU PI (Punica granitum). Internal use prohibited.
BING LANG (Areca catechu) Pharmacy use only.
DA FU PI (Areca catechu) Pharmacy use only
MA HUANG (Ephedra sinica). MDD: 1800 mg. MD: 600 mg.
YANG JIN HUA (Datura stramonium). MDD: 150 mg. MD: 50 mg.
YANG JIN HUA (Datura stramonium). MDD: 150 mg. MD: 50 mg.
DIAN QIE CAO (Atropa belladona). MDD: 150 mg. MD: 50 mg.
TIAN XIAN ZI (Hyocyamus niger). MDD: 300 mg. MD: 100 mg.

NOTE: SI 2130 also applies to other herbs not employed in Chinese medicine. S1 1841 2002
This ban relates to all Aristolochia species and also includes herbs which have been confused with Aristolochic species due to poor quality assurance.

The sale, supply and importation of the following is banned:
MU TONG (Aristolochia manshuriensis). NOTE: this ban also applies to Akebia quinata, Akebia trifoliata, Clematis montana and Clematis armandii.
FANG JI (Aristolochia fangji). NOTE: this ban also applies to Stephania tetrandra, Cocculus laurifolius, Cocculus orbiculatus and Cocculus Trilobus
MA DOU LING (Aristolochia contorta, Aristolochia debilis)
TIAN XIAN TENG (Aristolochia contorta, Aristolochia debilis)
QING MU XIANG (Aristolochia debilis)

SI 548 2008
All species of Senecio are prohibited for internal use due to the presence of toxic pyrrolizidine alkaloids
(PA). This mainly applies to the use of Senecio scandens QIAN LI GUANG

C: VOLUNTARY RESTRICTION Due the presence of Aristolochic Acid in Asarum species there is a voluntary ban on the use of: XI XIN (Asarum species)

D: RESTRICTIONS UNDER THE MEDICINES ACT 1968 Under Section 12(1) of the 1968 Medicines Act 1968, herbal remedies which are administered after a one-to-one consultation with a practitioner do not require a medicines licence (marketing authorisation). This legislation was enacted before traditional medicines from non-European cultures, which use non-plant substances, had any significant presence in the UK. Since the term ‘herbal remedies’ refers to plant materials, the MHRA has stated in its guidance on medicines law that the use of mineral and animal substances, which do not have a marketing authorisation, is illegal.

Section 12(1) is currently under review and the RCHM is working to re-establish the use of animal and mineral products. It is also expected that this redefinition of what constitutes a ‘herb’ will be clarified in European and UK legislation in the near future to include non-plant medicines.

In the meantime, members are warned that the use of these products may result in legal action by the MHRA and absence of insurance cover in the case of a claim. Hence all animal and mineral products should not be used until otherwise informed.

Whatever the outcome of this process, the following must never be used in any form:
ZHU SHA (Mercuric sulphide) Cinnabar
QING FEN (Mercuric chloride) Calomel
HONG FEN (Mercuric oxide) Realgar
HEI XI Lead

PRESCRIPTION ONLY MEDICINES (POM)
It is strictly prohibited to include any drug which is made available only through prescription by a registered medical doctor.
This includes the following:
YING SU KE (Papaver somnifera)
MA QIAN ZI (Strychnos nux vomica)
STEROIDS Including external use in creams such as PI YAN PING or 999 SKIN CREAMS.
FU ZI Internal use

E: PATENT FORMULAE
It should be noted that several patent formulae traditionally contain some of the above restricted herbs and toxic minerals, and recently some have been found to contain drugs. These include the following, which may present a health risk if used as a patent:

NIU HUANG JIE DU PIAN (May contain arsenic) TIAN WANG BU XIN DAN (May contain mercuric salts)

It is the responsibility of the practitioner to ensure that all patent formulae are obtained from ‘bonafide’ suppliers. In practice this means that all ingredients are listed and none of the above are included in the formula.


TREATMENT PROHIBITIONS

Patients should not be treated if they have consumed alcohol or combinations of alcohol, prescribed or recreational drugs or if they haven’t eaten two to three hours prior to treatment. They should have also taken their prescribed medicine to the prescribed dose prior to treatment. Patients should be treated whilst they are lying on the treatment couch and not whilst sitting on a chair as this will reduce the risk of syncope.


PROHIBITED TREATMENTS

Abortion.Pregnancy related symptoms against the advice of a midwife or a medical doctor. Controlled infectious disease which require hospitalization in isolation. Treatment for cancer and other serious diseases like diabetes, high cholesterol, blood pressure, thyroid or any other conditions requiring medication must not be offered as a replacement to conventional medical treatment.


ORIENTAL MASSAGE SAFE PRACTICE STANDARDS (INCLUDING TUINA, THAI, ACUPRESSURE AND CHINESE MASSAGE)

An Oriental Massage Practitioner members will be able to demonstrate that they:

1. know and comply with their Professional the Acupuncture Society’s Code of Professional Conduct and Ethics.
2. keep clear and appropriate records.
3. understand cautionary techniques, and conditions requiring special consideration.
4. can offer appropriate lifestyle recommendations.
5. follow an accurate and appropriate assessment procedure.
6. use appropriate and accurate techniques.
7. can demonstrate reflective practice.
9. are working within the scope of practice of thier training.
10. have certificate or diploma qualification recognised by the Acupucture Society.
11. carry upto date professional indemnity/ public liability insurance cover.
12. have a minimum of anatomy and physiology qualification equivalent to the national standards of level 3.
13. hold a currant a first aid certificate.
14. can refer clients to a more approriate practitioner or a doctor when out of thier scope of practice.
15. can refer clients to their GP if any symptoms presented are not understood, are potentially dangerous or may require further investigation or medical treatment.
16. have undertaken the required annual CPD course hours and submitted them on the Society’s log.

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