Phase 1: Exploration

Identifying human factors and environmental factors before implementing acupuncture or acupressure in a hospital setting.

Bottom Line Before launching any hospital acupuncture programme, you must understand the internal need, the available intervention options, your team composition, staff and patient attitudes, organisational readiness, and funding landscape. Skipping this phase is the most common reason implementations fail.

Prior to implementation, it is necessary to establish a good understanding of the human factors and environmental factors within which the implementation will happen. Factors to be considered are:

Does an internal need for change exist?
What intervention types are available?
Who should be on the implementation team?
What are staff perspectives on the proposed changes?
What are patient requirements?
Is funding necessary and available?
Is the organisation ready for change?

Identify Internal Needs

Using PONV (postoperative nausea and vomiting) as example:

How is PONV prevented and managed locally?

Review hospital practice guidelines for PONV management

Is PONV incidence charted?

Check observation charts in Recovery, ward, and pre-discharge phases
Verify documentation across all care settings

What is current PONV incidence and rescue antiemetic usage?

Track current incident rates
Monitor rescue medication administration
Note: "rescue anti-emetic use is not equivalent to PONV"
Resource: PONV study data extraction template provided

Is PONV risk assessed?

"PONV risk assessment is the first recommendation for PONV management" (Gan 2014). Four primary risk factors identified:

Female gender
Non-smoker status
Previous PONV or motion sickness history
Post-operative opioid use

Risk increases 20% per additional factor (Apfel et al., 1999). Patient self-assessment checklist available.

Intervention

Compare the main acupuncture and acupressure modalities below. Expand any row for detailed effectiveness data, advantages, disadvantages, and implementation notes recovered from the legacy POPA4Ease site.

Overview of acupuncture and acupressure modalities — Legacy POPA4Ease overview graphic retained as supporting context, not as the primary interaction.

Modality	Invasiveness	Evidence Snapshot	Cost / Equipment	Training	Details
Manual Acupressure	Non-invasive	Practical low-cost option with reduced nausea and vomiting in the legacy source.	No equipment	Low	View details Effectiveness Lee et al., 2015: nausea reduced from 45% to 30% (RR 0.71, 95% CI 0.62-0.81). Lee et al., 2015: vomiting reduced from 30% to 18% (RR 0.60, 95% CI 0.50-0.73). Advantages Avoids needles Requires no equipment Easily trained staff Disadvantages Effectiveness varies by practitioner skill Legacy source offered less detail than other modalities
Transcutaneous Electrostimulation	Non-invasive	Strong non-invasive option with adjustable stimulation and extended-use potential.	$40-$200 equipment	Moderate	View details Effectiveness Legacy source describes it as the strongest non-invasive stimulation option. Lee et al., 2015 pooled PC6 evidence: nausea reduced from 45% to 30% and vomiting reduced from 30% to 18%. Advantages Can be used over extended periods Adjustable intensity Avoids needles Disadvantages Requires equipment Requires staff training
Auricular Acupuncture	Needle-based	Procedure-specific evidence in gynaecological surgery and laparoscopic cholecystectomy.	Few cents per needle or bead	Moderate	View details Effectiveness Huang et al., 2005: effective following gynaecological surgery. Kim et al., 2003: effective following gynaecological surgery. Sahmeddini and Fazelzadeh, 2008: effective following laparoscopic cholecystectomy. Advantages Economical Individualized point selection Low risk of misplaced needles Remote from most surgical sites Disadvantages Requires staff training or a qualified acupuncturist
Body Acupuncture	Needle-based	Direct body acupuncture with clear reductions in nausea, vomiting, and total PONV.	$0.05 per needle	Moderate	View details Effectiveness Lee et al., 2015: nausea reduced from 54% to 29% (RR 0.56, 95% CI 0.39-0.80). Lee et al., 2015: vomiting reduced from 41% to 20% (RR 0.51, 95% CI 0.34-0.76). Cheong et al., 2013: PC6 plus other acupoints reduced PONV from 21% to 6% (RR 0.29, 95% CI 0.17-0.49). Advantages Economical Individualized point selection Strong reduction when PC6 is paired with additional points Disadvantages Requires staff training or a qualified acupuncturist Requires monitoring for misplaced needles
Electroacupuncture	Needle-based	Body acupuncture with adjustable electrical stimulus and reusable stimulation units.	$200-$800 equipment plus needles	Moderate	View details Effectiveness Legacy source describes outcomes as equivalent to body acupuncture with easier stimulus control. Cheong et al., 2013 combined-point evidence: PONV reduced from 21% to 6% (RR 0.29, 95% CI 0.17-0.49). Advantages Reusable stimulation units Adjustable intensity Individualized point selection Strong combined-point evidence Disadvantages Requires staff training or a qualified acupuncturist Requires equipment purchase Requires monitoring for misplaced needles
Acupressure Band or Patch	Non-invasive	Improves nausea, vomiting, and rescue antiemetic use with low training burden.	About $5 AUD	Low	View details Effectiveness Shiao and Dune, 2006: nausea reduced from 36% to 24%. Shiao and Dune, 2006: vomiting reduced from 20% to 15%. Shiao and Dune, 2006: rescue antiemetics reduced from 22% to 13%. Advantages Extended use No infection risk Flexible delivery Can continue at home Disadvantages Not suitable for some wrist sizes or injuries Can be awkward with multiple IV or arterial lines
PC6 Acupoint Stimulation (All Modalities)	Mixed	Strong pooled effect across modalities with mild transient side effects.	Varies by modality	Moderate	View details Effectiveness Lee et al., 2015: nausea reduced from 47% to 31%. Lee et al., 2015: vomiting reduced from 33% to 19%. Lee et al., 2015: rescue antiemetics reduced from 33% to 20%. Advantages Equivalent effectiveness to common antiemetics Mild transient side effects Can be combined with antiemetics for additional benefit Disadvantages Requires staff training or a qualified acupuncturist

The Team

The Implementation Team

Team composition should include:

Opinion Leaders / Facilitators

"Individuals in an organization who have formal or informal influence on attitudes and beliefs regarding intervention implementation."

Champions

Individuals who "drive through an implementation, overcoming indifference or resistance."

External Change Agents

External individuals who "formally influence or facilitate intervention decisions."

Key principle: Early users should share professional, educational, cultural, or socioeconomic backgrounds with leadership for successful implementation.

Staff

Staff Groups Requiring Involvement

Anaesthetists
Nurses
Midwives
Gynaecologists / Obstetricians
Surgeons
Administrative clerks
Interpreters

USA Survey Results (Faircloth, 2014)

Respondents: 292 from 1,728 anaesthesia staff across 96 departments.

Composition: 54% anaesthesiologists, 44% nurses, 2% aides.

Prior use with positive outcomes: 27%
Willing to consider use: 54%
Willing to pursue education: 74%

Main barriers:

"Lack of scientific evidence" (79%)
"Unavailability of credentialed providers" (71%)
"Lack of equipment" (49%)

Time concern: Only 38% viewed acupuncture as too time-consuming.

Australian Hospital Survey Results

Respondents: 165 doctors, nurses, midwives, obstetricians.

Believed effective for PONV: 42%
Would encourage patients after education: 81%
Wanted further education: 88%

Australian General Practice Context

National survey of 544 GPs: ~85% considered acupuncture effective and safe for primary care (Cohen et al., 2005)
GP referral rate: 80% have referred patients (Wardle et al., 2013)
Medical school integration: Some Australian schools teach acupuncture as electives

Readiness for Change

Organizational Readiness Assessment

Tool: Modified Checklist to Assess Organization Readiness (CARI) (Barwick, 2011)

Evaluates:

System readiness
Senior leadership support
Staff capability
Implementation plan maturity
Training requirements

Scoring: Total possible = 100 points. Readiness threshold: 80+ points (minimum 15 points per category).

Funding

Cost and Funding Considerations

Cost Assessment Framework (Myle, 2016):

Costs to Track:

Device cost per patient
Staff time for intervention delivery
Staff time for intervention monitoring
Prevention antiemetic medications and costs
Rescue antiemetic medications and costs
Intra-operative and post-operative pain medications and costs

Assessment Methods:

Track intervention delivery time (minutes)
Document medication type and dosage
Calculate pharmaceutical costs
Calculate device costs
Compare cost-effectiveness against alternatives

Cost Comparison

Acupressure wristbands: ~$5 AUD per unit (reusable)
Acupuncture needles: ~$0.05 per needle
Electroacupressure units: $40–$200
Electroacupuncture units: $200–$800

Patient

Patient Perspectives

Patient Survey Results (Weeks et al., 2017):

Sample: 160 surgical patients (Australian).

Pre-education willingness: 65% would use acupuncture for PONV
Baseline knowledge: Only 15% knew acupuncture could treat nausea/vomiting
Post-education willingness: 87% (22-percentage-point increase)

PONV Management Guideline Recommendation: Interventions should consider patient preferences when selecting treatment approaches.

Phase 1 Resources

Last reviewed: April 2026

Phase 1: Exploration

Identify Internal Needs

Intervention

Effectiveness

Advantages

Disadvantages

Effectiveness

Advantages

Disadvantages

Effectiveness

Advantages

Disadvantages

Effectiveness

Advantages

Disadvantages

Effectiveness

Advantages

Disadvantages

Effectiveness

Advantages

Disadvantages

Effectiveness

Advantages

Disadvantages

The Team

Opinion Leaders / Facilitators

Champions

External Change Agents

Staff

Readiness for Change

Funding

Cost Comparison

Patient

Phase 1 Resources