Identification and evaluation of risk factors
associated with acupuncture practice
A thesis submitted in fulfilment of the requirements for the degree
of Master of Applied Science (Chinese Medicine)
Suzi S. Y. Mansu
BAppSc (ChinMed), BHSc (Acup)
Division of Chinese Medicine
School of Health Sciences
RMIT UNIVERSITY
August 2007
I
DECLARATION
I certify that except where due acknowledgement has been made, the work is that of
the author alone; the work has not been submitted previously, in whole or in part, to
qualify for any other academic award; the content of the thesis is the result of work
which has been carried out since the official commencement date of the approved
research program; and, any editorial work, paid or unpaid, carried out by a third party
is acknowledged.
Suzi (Shu Yi) Mansu BAppSc (ChinMed), BHSc (Acup)
_________________________
Date:_____________________
II
ACKNOWLEDGEMENTS
I would like to thank my supervisors Professor Charlie Changli Xue and Associate
Professor Chun Guang Li for their guidance, encouragement and patience
throughout my study for this research degree. Without their support, the completion
of this degree study would not have been possible.
I am indebted to my consultants, Associate Professor Cliff DaCosta and Dr Anthony
Lin Zhang, for their invaluable statistical support. I am also grateful to my colleagues,
Dr Angela Weihong Yang and Mrs Sandy Ebell, in taking up the extra workload whilst
I took leave to finalise this thesis. I would also like to express my gratitude to the
other staff in the Division of Chinese Medicine for assisting in the teaching and clinic
duties whilst studying.
Last but not least, to my husband Michael for all the domestic duties I couldn’t help
with, for his caring, encouragement and love and daughter Olivia for those beautiful
smiles and cheekiness keeping my motivation going. I am also ever thankful to my
other family members for their encouragement.
III
PUBLICATIONS
Conference Proceedings/Presentations
Mansu S, Li CG, DaCosta C, Yang AWH, Zhang AL, Story DF and Xue CCL. A
Retrospective Survey on Adverse Events Associated with Acupuncture Practice by
Registered Practitioners. Sixth Meeting of the Consortium for Globalization of
Chinese Medicine. Beijing, China – August 29-30, 2007.
Mansu S, Li CG, DaCosta C, Yang AWH, Zhang AL, Story DF and Xue CCL. A
Retrospective Survey on Adverse Events Associated with Acupuncture Practice by
Registered Practitioners. The 3rd World Integrative Medicine Congress. Guangzhou,
China – 22-24 September 2007.
Mansu S, Li CG, DaCosta C, Yang AWH, Zhang AL, Story DF and Xue CCL. A
Retrospective Survey on Adverse Events Associated with Acupuncture Practice by
Registered Practitioners. Society For Acupuncture Research Conference: The Status
and Future of Acupuncture Research: 10 Years Post-NIH Consensus Conference.
University of Maryland, Baltimore, MD, November 8-11, 2007.
i
TABLE OF CONTENTS
DECLARATION ....................................................................................................................................... I
ACKNOWLEDGEMENTS....................................................................................................................... II
PUBLICATIONS..................................................................................................................................... III
TABLE OF CONTENTS........................................................................................................................... I
LIST OF TABLES .................................................................................................................................. III
LIST OF FIGURES................................................................................................................................. IV
LIST OF APPENDICES .......................................................................................................................... V
ABBREVIATIONS.................................................................................................................................. VI
SUMMARY .............................................................................................................................................. 1
CHAPTER 1: INTRODUCTION .............................................................................................................. 4
1.1 BACKGROUND & DEFINITIONS .......................................................................................... 4
1.1.1 Acupuncture....................................................................................................................... 4
1.1.2 Adverse Events.................................................................................................................. 5
1.1.3 Medical Error ..................................................................................................................... 6
1.1.4 Error Management............................................................................................................. 8
1.2 THE RATIONALE AND THE SIGNIFICANCE OF THIS STUDY.......................................... 12
1.3 OBJECTIVES & RESEARCH QUESTIONS ........................................................................ 13
1.4 METHODOLOGY................................................................................................................. 15
1.4.1 The Literature Review...................................................................................................... 15
1.4.2 The Survey Design .......................................................................................................... 15
1.4.3 Implementation of the Survey.......................................................................................... 15
1.4.4 Statistical Analyses.......................................................................................................... 16
1.5 THESIS ORGANISATION.................................................................................................... 16
CHAPTER 2: ERROR AND RISK ........................................................................................................ 18
2.1 INTRODUCTION.................................................................................................................. 18
2.2 SKILL BASED ERRORS (SLIPS AND LAPSES) ................................................................. 19
2.3 RULE BASED ERRORS (MISTAKES)................................................................................. 20
2.4 KNOWLEDGE BASED ERRORS (MISTAKES)................................................................... 20
2.5 ACTIVE VERSES LATENT FAILURES ............................................................................... 21
2.6 ERRORS VERSUS VIOLATIONS........................................................................................ 22
2.7 RISK ANALYSIS .................................................................................................................. 22
2.8 CLINICAL RISK MANAGEMENT......................................................................................... 24
2.9 SUMMARY........................................................................................................................... 25
CHAPTER 3: LITERATURE REVIEW ON MEDICAL ERROR............................................................ 27
3.1 INTRODUCTION.................................................................................................................. 27
3.2 MEDICAL ERROR RESEARCH .......................................................................................... 27
3.2.1 Summary .........................................................................................................................27
3.2.2 Criteria for Literature Review........................................................................................... 27
3.3 STUDIES OF PATIENTS EXPERIENCING ADVERSE EVENTS IN HOSPITALS .............. 28
3.3.1 The Literature ..................................................................................................................28
3.4 STUDIES OF PATIENTS EXPERIENCING ADVERSE EVENTS IN GENERAL PRACTICE
36
3.4.1 Introduction ...................................................................................................................... 36
3.4.2 The Literature ..................................................................................................................37
3.5 CRITICAL REVIEW OF MEDICAL ERROR AND SAFETY LITERATURE .......................... 39
3.6 RISK ASSESSMENT / ANALYSIS ....................................................................................... 63
3.7 CLINICAL RISK MANAGEMENT......................................................................................... 63
CHAPTER 4: LITERATURE REVIEW ON ADVERSE EVENTS IN ACUPUNCTURE........................ 65
4.1 INTRODUCTION.................................................................................................................. 65