Hurley Group Chaperone Policy

Hurley Group Chaperone Policy
Reviewed November 2010 – Jo Betterton

A chaperone is a third party, present during a consultation, as a safeguard for all parties (patients and practitioners) who is a witness to continuing consent of the procedure being carried out. In the majority of cases chaperones are requested by female patients undergoing an intimate examination by a male doctor but all patients are entitled to ask for a chaperone to be present.

Evidence shows that very few patients are offered a chaperone and, of those who are, very few accept.

The GMC “Good Medical Practice” makes the following recommendations
Chaperones
 Wherever possible, you should offer the patient the security of having an impartial observer (a ‘chaperone’) present during an intimate examination. This applies whether or not you are the same gender as the patient.
 A chaperone does not have to be medically qualified but will ideally:
o be sensitive, and respectful of the patient’s dignity and confidentiality
o be prepared to reassure the patient if they show signs of distress or discomfort
o be familiar with the procedures involved in a routine intimate examination
o be prepared to raise concerns about a doctor if misconduct occurs.
In some circumstances, a member of practice staff, or a relative or friend of the patient may be an acceptable chaperone.
 If either you or the patient does not wish the examination to proceed without a chaperone present , or if either of you is uncomfortable with the choice of chaperone, you may offer to delay the examination to a later date when a chaperone (or an alternative chaperone) will be available, if this is compatible with the patients best interests.
 You should record any discussion about chaperones and its outcome. If a chaperone is present, you should record that fact and make a note of their identity. If the patient does not want a chaperone, you should record that the offer was made and declined.
http://www.gmc-k.org/guidance/ethical_guidance/maintaining_boundaries.asp

What does a Chaperone do?

The “Guidance on the roles and effective use of chaperones in primary and community care settings” (Clinical Governance Support Team – June 2005) describes the role of a chaperone as

 Providing emotional comfort and reassurance to patients
 To assist in the examination, for example handling instruments during ICUD insertion
 To assist with undressing patients
 To act as an interpreter
 To provide protection to healthcare professionals against unfounded allegations of improper behaviour
 In very occasional circumstances to protect against an attack
 An experienced chaperone can identify unusual or unacceptable behaviour on the part of the health care professionals

Who can be a Chaperone?

Any member of the practice team ,a patient’s friend or a family member can act as a chaperone as requested.

To ensure that the patient is protected from embarrassment or vulnerability the chaperone should be the same sex as the patient and the patient should be given the opportunity to decline a particular person.

An Informal chaperone – is when another person is present in the room to reassure the patient. It would not be appropriate for a child to act as a witness for an intimate examination on a parent and an informal chaperone could not be expected to take an active part in the examination or witness the procedure directly

A Formal chaperone – implies a member of the clinical team or a trained non-clinical member of staff who may be required to participate in the examination e.g. assist patient with undressing

A chaperone only needs to be present for the physical examination and should leave afterwards to allow one to one communication with the clinician, unless the patient specifically requests them to remain.

Offering a Chaperone

The practice should display clear information for patients about chaperones (see appendix one for example of notice for waiting area) to ensure that they are aware that they have the option to have one present.

Checklist for consultations involving intimate examinations

 Establish there is a genuine need for an intimate examination and discuss this with the patient.

 Explain to the patient why an examination is necessary and give the patient an opportunity to ask questions

 Offer a chaperone or invite the patient to have a family member/friend present. If the patient does not want a chaperone, record that the offer was made and declined in the patients notes.

 Obtain the patients consent before the examination and be prepared to discontinue the examination at any stage at the patient’s request.

 Record that permission has been obtained in the patients notes.

 Once chaperone has entered the room give the patient privacy to undress and dress. Use drapes where possible to maintain dignity.

 Explain what you are doing at each stage of the examination, the outcome when it is complete and what you propose to do next. Keep discussion relevant and avoid personal comments.

 If a chaperone has been present record that fact and the identity of the chaperone in the patients notes.

 Record any other relevant issues or concerns immediately following the consultation.

Procedure during the examination/procedure

There should be facilities for patients to undress in a private and undisturbed area, and once the patient has undressed the examination/procedure should be carried out promptly.

During the examination the chaperone should:

 Take up a position in the room which is most acceptable to the patient

 Offer reassurance

 Be courteous

 Keep discussion relevant

 Avoid un necessary personal comments

 Encourage questions and discussion

 Remain alert to verbal and non-verbal indications of distress from the patient

 Ensure that if the patient requests that the examination be discontinue that is respected

Communication during the procedure and record keeping

The most common cause of complaint is that patients did not understand the procedure that was being carried out in the process of treating them.

In is essential that the procedure is clearly explained to the patient to enable to them to give informed consent for it to proceed.

Once completed the examination, and presence of a chaperone should be clearly recorded in the patients notes. If a chaperone was offered and declined this should also be recorded in the records.

Further information

1. Reference Guide to Consent for Examination or Treatment, Dept of Health
http://www.dh.gov.uk/assetRoot/04/01/90/79/04019079.pdf

2. GMC: Intimate examinations
http://www.gmc-uk.org/standards/intimate.htm

3. Royal College of Nursing: The role of the nurse and the rights of patients, Guidance for nursing staff, July 2002
Publication code 001 446 www.rcn.org.uk

4. Guidance on the role and effective use of Chaperones in primary and community care setting – Model Chaperone Framework, Clinical Governance Support Team , June 2005 http://www.lmc.org.uk/guidance/default.aspx?s=C