NeedleWhy do missed needle removals keep happening?
The root cause of missed needle removals is not inattention — it is verification workflows that rely on human memory and paper, which is precisely the pain point hospitals have been addressing digitally in recent years. During acupuncture, needles stay in place on the patient for a period of time, and removal is often handled by a different staff member after the retention period ends. To remove every needle, someone first has to remember where the needles are and how many were inserted — a task that has long depended on memory and paper cross-checks. A study by the Department of Chinese Medicine of Taipei City Hospital, published in the international journal Medicine, lists missed needle removals among the common medical errors of acupuncture.
In practice several factors stack up: retention times differ from patient to patient, handovers are frequent during busy clinic hours, and multi-region treatments require counting needle by needle. When counting relies entirely on human memory and paper cross-checks, a breakdown at any point can lead to something being missed. As acupuncture visit volumes grow, the risk of "remembering to count" grows with them — which is why hospitals have started handing verification to systems.
What are hospitals doing? Three public cases
The Department of Chinese Medicine of Taipei City Hospital digitized its acupuncture workflow: after the physician records the needle count for each body region, the system automatically marks the insertion completion time; when a nurse removes needles, selecting "complete" records the time automatically. The system uses this to calculate needle retention time and automatically totals the per-region needle counts for verification. The team published an analysis of 13,920 inpatient acupuncture treatment courses from 2018 to 2021 in the international journal Medicine (February 2025): after the new digital workflow was introduced, missed needle removal events per 1,000 treatments fell from 6.8 to 2.2 — a reduction of more than 60%. Dalin Tzu Chi Hospital worked with National Chung Cheng University to develop a smart acupuncture system: as the physician inserts needles and speaks the acupoint names, the system records the acupoint locations in sync and logs the insertion and removal process, so records are created in real time as the procedure happens.
In an innovation project, the Department of Traditional Medicine of Taipei Veterans General Hospital developed a "smart cloud-based needle insertion/removal counting system": tri-axial accelerometer and gyroscope sensors are worn on the physician's wrist and finger with elastic bands, collecting vibration and acceleration data during insertion; machine learning then identifies valid insertion waveforms and automatically counts the needles inserted. The project documentation also notes that counting accuracy still requires calibration with more cases. What the three cases share is turning "remembering to count" into "system verification" — records are produced by the system as the procedure happens, and counting is compared by the system rather than relying on memory. These are all in-house hospital projects, however; what most TCM clinics need is a solution they can adopt directly, without building their own R&D team.
Workable approaches for clinics and hospital TCM departments
Verification workflows fall broadly into three stages. Stage one is paper cross-checking: ticking off insertion regions and needle counts item by item on a treatment sheet. Setup cost is low, but both recording and verification depend on manual work; items are easily missed when things get busy, and retrospective review is limited. Stage two is digital forms: a tablet or online form records insertion regions, counts and times, leaving a searchable electronic record. Handovers and retrospection are more reliable than paper, but staff still have to enter each item. Stage three is automatic recording and verification: electronic tags or sensing devices create records at the moment of insertion and removal, the system compares counts and provides reminders, and the counting work is handed to the system.
The trade-off across the three stages is the balance between labor cost and system cost: paper has almost no setup cost, but the whole verification burden falls on people; digital forms need equipment and data-entry labor; automatic recording and verification involves hardware, deployment and training, in exchange for system-executed verification and traceable records. For clinics and hospital TCM departments, a pragmatic starting point is to take stock of the current situation: how records are kept today, daily acupuncture visit volume, how often counting happens and who is responsible — first make counting a fixed step. Once visit volumes and needle counts grow until manual counting becomes a burden, then evaluate digital forms or automatic recording options. Adoption scope and costs are assessed per site.
How electronic tags assist verification
Needle acupuncture e-tags integrate electronic identification into the needle handle: a record is created at insertion, and at removal the system verifies the count and provides reminders, reducing repeated copy-work and manual counting. Reminders assist care workflows and do not replace the clinical judgment or verification responsibilities of clinical staff; adoption scope, identification methods and frontline operation are confirmed item by item during the assessment stage.
The tag technology was filed for and is held under patent by our partner RFID Integrated Marketing Co., Ltd., including Taiwan invention patent TWI840156B and European patent EP4427720B1; the technical scope and latest legal status follow the patent publications. ProgramWorld is responsible for the Needle application solutions, system integration and site adoption. The actual operation is demonstrated on site during the adoption assessment, and how it connects with the facility's existing workflow can be confirmed then.
Three assessment questions before adoption
Three things can be reviewed before an assessment. First, what are the current recording and counting workflows? Who keeps the records, where, and how are counts verified before removal? Second, how often is counting done, and who is responsible? Does anyone confirm counts during handovers? Third, if a needle really is left behind, how is it remedied and reported? Is there a record that can be traced afterwards? Answering these three questions clearly shows where the risks in the current workflow sit.
If the assessment suggests verification should be strengthened, share your facility type (TCM clinic or hospital TCM department) and your current insertion and recording workflow, and request an adoption assessment through the website; an assessment will then be arranged for your site, covering feasible options, adoption scope and costs.
Frequently asked questions
At which step are missed needle removals most likely?
The count after the retention period ends: many insertion regions, clothing obscuring the needles, and handovers during busy hours — both human memory and paper cross-checks are prone to missing something. Digital records turn "remembering to count" into "system verification".
Do electronic tags change the insertion workflow?
The tag and the acupuncture needle are integrated as one unit (the patent is held by our partner RFID Integrated Marketing); by design, the existing insertion workflow does not need to change. Actual operation is demonstrated on site during the adoption assessment.
Does a small clinic need a system too?
If daily acupuncture visits make manual counting a burden, or counting discrepancies have occurred, an assessment is worthwhile. Adoption scope and costs are assessed per site, and it can start with the verification reminder feature.
Sources
Related product
Acupuncture e-tag system
Needle acupuncture e-tags integrate electronic identification into the needle handle, helping TCM clinics and hospital TCM departments record insertions, verify removal counts and keep treatment records for traceability.
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