Aim: Inconsistent needle count is a common clinical problem in acupuncture. The purpose of this study was to use healthcare failure mode and effect analysis (HFMEA) to improve acupuncture safety and needle count accuracy. Materials and Methods: In accordance with the HFMEA method, we reviewed the acupuncture procedure with hazard analysis to identify potential failure modes and causes of inconsistent needle counts. We used descriptive statistics to compare differences before and after HFMEA. Results: The hazard index of “nursing assistant failed to properly assist patients in preparing for acupuncture stance and exposing the naked needle” dropped from 9 to 4 points, with a 55.6% improvement rate. Another hazard index of “physician incorrectly calculating the number of needles” reduced from 12 to 4 points, with an improvement rate of 66.7%. The hazard index of “needle missing from nurses picking operation”decreased from 9 to 6 points, with an improvement rate of 33.3%. The mismatch rate of acupuncture needles in outpatients decreased from 0.231% to 0.16%.