STANDARDS FOR ACUPUNCTURE

STANDARDS
FOR ACUPUNCTURE

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j U N E 2 0 0 9
STANDARDS
FOR ACUPUNCTURE
Available on the College website in the Resource Room
Introduction
The Regulated Health Professions Act (1991), as amended, acknowledges occupational therapists as
autonomous practitioners. Regulation of the profession requires that occupational therapists practice
according to established standards and principles of practice, and apply these consistently in a
responsible and intentional manner within the health care environment.
Prior to the passing of the Traditional Chinese Medicine Act in December of 2006, acupuncture was
entirely exempt from the controlled act of “performing a procedure below the dermis” and anyone
was able to perform this activity. However, with the passing of the Traditional Chinese Medicine Act,
acupuncture is no longer entirely exempt from this controlled act.
A controlled act is any one of the actions/activities defined in Subsection 27(2) of the Regulated Health
Professions Act (RHPA, 1991) as amended.
Occupational therapists will continue to be exempt from the prohibition against performing the
controlled act of acupuncture, under an exemption for controlled acts contained in a regulation made
under the authority of the RHPA (Ontario Regulation 107/96, Controlled acts).
When College Registrants perform any controlled act, whether it is one directly authorized to them or one
permitted by another authorization method, it is to be performed in keeping with the requirements of the
law and standards of practice of the profession.
The College of Occupational Therapists of Ontario supports the use of acupuncture as a modality within
an occupational therapy practice by qualified occupational therapists.
Further, when performing the procedure of acupuncture, Registrants must ensure they are acting within
the scope of the profession of occupational therapy. Acting within the scope of occupational therapy is a
condition of using the controlled acts exemption. The legislated scope of practice of occupational therapy
from the Occupational Therapy Act (1991) reads:
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STANDARDS FOR ACUPUNCTURE
The practice of occupational therapy is the assessment of function and adaptive behaviour and the
treatment and prevention of disorders which affect function or adaptive behaviour to develop, maintain,
rehabilitate or augment function or adaptive behaviour in the areas of self-care, productivity and leisure.
(1991, c. 33, s. 3).
The purpose of this document is to ensure that occupational therapists in Ontario are aware of the
minimum expectations for performance of the procedure of acupuncture.
These Standards for Acupuncture are in force and approved for use by occupational therapists in Ontario.
These Standards are subject to review and revision based on future proclamation of legislation.
Definitions
Controlled Acts are those activities and procedures where risk of harm to the client is perceived to be
significant. The concept of controlled acts authorized to designated professions is linked to the RHPA’s
central goal of protecting the public by restricting performance of potentially harmful or high-risk acts.
A list of the 13 controlled acts is found in section 27(2) of the Regulated Health Professions Act (1991).
Delegation is a term that has been given specific meaning in the RHPA. It refers only to controlled acts
and speaks to the transfer of authority from one practitioner to another to perform the controlled act.
Application of the Standards of Practice for Acupuncture for Occupational Therapists
Performing acupuncture within the scope of practice is a condition of using the controlled acts
exemption.
• The following standards describe the minimum expectation 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 at all times, but could be demonstrated
if requested.
• There may be some situations where the occupational therapist determines that a particular
performance indicator has less relevance due to client factors and/or environmental factors.
Such situations may call for the occupational therapist to seek further clarification.
• It is expected that an occupational therapist will always use her/his clinical judgment to determine how
to best meet client needs in accordance with the standards of the profession.
• It is also expected that an occupational therapist will be able to provide a reasonable rationale for any
variations from the standard.
Pursuant to the Regulated Health Professions Act (1991), the College of Occupational Therapists of Ontario
is authorized to make regulations in relation to professional practice. The College’s Professional Misconduct
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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.
College publications contain practice parameters and standards which should be considered by all
Ontario occupational therapists in the care of clients and in the practice of the profession. College
publications are developed in consultation with occupational therapists and describe current professional
expectations. It is important to note that these College publications may be used by the Colleges of other
bodies in determining whether appropriate standards of practice and professional responsibilities have
been maintained.
OVERVIEW OF THE STANDARDS FOR ACUPUNCTURE
1. Scope of Practice
2. Competency Attainment
3. Continuing Competency
4. Evidence-Based Practice
5. Informed Consent
6. Safety Considerations
7. Record Keeping
8. Delegation of Components of Acupuncture to Support Personnel or Others
9. Accountability
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STANDARDS FOR ACUPUNCTURE
1. SCOPE OF PRACTICE d 1
Occupational therapists have been given access to perform the procedure of acupuncture according to
the standard of practice of the profession through an exemption in the RHPA. In order to perform
acupuncture outside the scope of occupational therapy practice and use the title acupuncturist/
acupuncture practitioner, one must register with the College of Traditional Chinese Medicine
Practitioners and Acupuncturists.
Standard 1
The occupational therapist will perform the procedure of acupuncture within the scope of practice of
the profession of occupational therapy, and will have the knowledge, skill and judgment to perform the
procedure safely, effectively and ethically.
Performance Indicators
An occupational therapist will:
1.1 Determine how the use of the modality of acupuncture practice fits within her/his scope of
practice of occupational therapy;
1.2 Practice within the parameters of professional and personal competence (knowledge, skill and
judgment), including any limitations to perform acupuncture safely, effectively and ethically;
1.3 Perform acupuncture in accordance with the standards of practice and the code of ethics
for the profession;
1.4 Obtain Registrant status with the College of Traditional Chinese Medicine Practitioners and
Acupuncturists of Ontario if one wishes to perform acupuncture outside the scope of
occupational therapy practice and/or use the title acupuncturist/acupuncture practitioner;
1.5 Only perform adjunctive techniques of acupuncture that are controlled acts (e.g. electric
stimulation of needles, medicinal application, e.g. the use of analgesics) with appropriate
delegation;* and
1.6 Refer to other providers of acupuncture if the client requires treatment beyond the scope of
practice of occupational therapy and/or beyond the limits of the clinician’s knowledge and skill.
*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 judgment to perform the procedure safely and effectively.
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2. COmPETENCy ATTAINmENT d 1
Occupational therapists have education and training in anatomy, physiology and pathophysiology.
These baseline educational components are necessary to perform acupuncture safely and effectively.
Occupational therapists wishing to perform the controlled act of acupuncture are expected to ensure
they have adequate background knowledge, skills, abilities and specific training to perform this
procedure safely and effectively. The specific acupuncture educational program should be taught by
someone who is legally able to perform acupuncture, and should test individuals on both theoretical
and practical components of the procedure of acupuncture. While programs that are provided by an
accredited educational program may have more merit, there is no accreditation system in place in
Ontario for education in acupuncture at the time of development of these Standards that is officially
recognized by any regulatory authority or ministry.

Standard 2
The occupational therapist will, prior to performing acupuncture, successfully complete a rigorous
educational program.
Performance Indicators
An occupational therapist will:
2.1 Ensure that her/his background knowledge in anatomy, physiology and pathophysiology is current
and sufficient;
2.2 Prior to performing acupuncture, complete an educational program in acupuncture that consists
of the following components:

2.2.1 Is taught by someone legally authorized to perform acupuncture,

2.2.2 Tests individuals on both the theoretical components and practical components
of acupuncture,
2.3 Retain documents which reflect her/his competency to perform acupuncture in accordance with
the College of Occupational Therapists of Ontario educational requirements, such that she/he is
able to present these to the College of Occupational Therapists of Ontario upon request; and
2.4 Meet all the educational requirements, as well as any other statutory, regulatory and professional
obligations that apply.
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STANDARDS FOR ACUPUNCTURE
3. CONTINUINg COmPETENCy
Standard 3
The occupational therapist will maintain ongoing competency by engaging in professional
development, including updating her/his knowledge of currently accepted practice with regards
to acupuncture.

Performance Indicators
An occupational therapist will:
3.1 Participate in regular and systemic professional development activities that ensure current
ongoing knowledge, skill, ability and judgment to perform the procedure of acupuncture;
3.2 Demonstrate her/his competency to perform acupuncture in accordance with current
best practice;
3.3 Assume full responsibility to seek out and utilize support and resources as required to maintain
competency;
3.4 Be able to provide the rationale and intent behind her/his actions with respect to using the
modality of acupuncture;
3.5 Maintain the knowledge and skill required to continue to provide quality care if continuing to
provide acupuncture as part of occupational therapy services; and
3.6 Decline to perform acupuncture if the performance of the procedure is outside of her/his
current professional knowledge, skill and judgment.
4. EvIDENCE-BASED PRACTICE
Evidence-based practice reflects the use of best research evidence in conjunction with clinical expertise,
and knowledge of client status, preferences and values in evaluating ongoing decisions about whether
acupuncture is appropriate for a specific client.
Standard 4
The occupational therapist will be accountable for determining that the client’s condition warrants the
use of acupuncture and for assessing the clinical results/outcomes of the procedure. The occupational
therapist will make decisions about the performance of the procedure of acupuncture based on client
preference and status, clinical expertise, and research evidence.
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Performance Indicators
An occupational therapist will:
4.1 Critically appraise literature and supporting scientific evidence to make informed decisions
about performing the procedure of acupuncture;
4.2 Engage the client and other stakeholders, if applicable, in a collaborative approach;
4.3 Consider the information known about the client (e.g. desired outcomes/goals, cultural,
environmental, socio-economic, ethnic, health and/or disability related factors) to make
informed decisions about performing the procedure of acupuncture;
4.4 Determine a reasonable rationale for all decisions about performing acupuncture on a
specific client; and
4.5 Determine the need for acupuncture using reliable and valid assessment methods as
relevant to the practice of occupational therapy.

5. INFORmED CONSENT
Standard 5
The occupational therapist will ensure there is informed and ongoing consent from the client to
perform acupuncture, as per the Standards for Consent (COTO, 2008) which will include a discussion
of the following:
a) The nature of the proposed procedure;
b) The benefits, risks, limitations and side-effects of acupuncture to the client;
c) Alternative treatments, including no treatment; and
d) The option of the client to withdraw consent at any time during the process.

Performance Indicators
An occupational therapist will:
5.1 Present the occupational therapist’s role in the provision of acupuncture in relation to other
services provided by the occupational therapist and the team;
5.2 Comply with the Standards for Consent (COTO, 2008);
5.3 Consider and discuss alternative treatment(s) with the client and provide other suitable options; and
5.4 Respect the client’s choice to be the final decision-maker in treatment options and refuse
the procedure.
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STANDARDS FOR ACUPUNCTURE
6. SAFETy CONSIDERATIONS d 1
When performed by a competent practitioner, acupuncture is generally a safe treatment (World
Health Organization, 1999; 2002). Occupational therapists should practice within the guidelines that
minimize the risk of infection and accidents, be alert to contraindications, and be able to manage
complications occurring during treatment. The importance of clinical safety in the procedure of
acupuncture is evidenced in the literature. Inappropriate practice may lead to adverse effects that
can be severe and life threatening. The following standard is consistent with the College’s Standards
for Infection Control (2006).
Standard 6
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.
The occupational therapist will appropriately manage any adverse reactions or complications
arising during or after the procedure.
Performance Indicators
An occupational therapist will:
6.1 For every individual client who may be interested in acupuncture, assess the risk of performing
the procedure of acupuncture, including a consideration of contraindications for this procedure;
6.2 Discuss any risks and/or contraindications involved with performing acupuncture with each
individual client;
6.3 Establish and/or apply policies and procedures for recognizing and managing adverse reactions or
complications during, or as a result of, acupuncture treatment;
6.4 Maintain current certification in a First Aid and CPR course to assist in managing any adverse
reactions or complications;
6.5 Comply with the Standards of Infection Control (COTO, 2008);
6.6 Develop and apply current evidence-based infection control protocols to minimize risk factors for
infection when performing the procedure of acupuncture; and
6.7 Develop and maintain a risk management process to assist with tracking incidents, identifying
trends, and implementing quality improvement processes.
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