This Protocol is designed to assist staff with an understanding of their role of chaperone and associated responsibilities.
Introduction
This policy is designed to protect both patients and staff from abuse or allegations of abuse and to assist patients to make an informed choice about their examinations and consultations.
The Practice is committed to providing a safe and comfortable environment where patients and staff can be confident that best practice is being followed at all times. The safety of everyone is of paramount importance.
Definition of a Formal Chaperone
In clinical medicine, a formal chaperone is a person who serves as a witness for both a patient and a medical practitioner as a safeguard for both parties during a medical examination or procedure and is a witness to continuing consent of the procedure. Family members or friend may be present but they cannot act as a formal chaperone.
Why are Chaperones needed
There are two considerations involved in having a chaperone to assist during intimate examinations; namely for the comfort of the patient and the protection of the doctor/nurse from allegations of impropriety.
Intimate Examination
Examples of an intimate examination include examinations of the breasts, genitalia and the rectum but it also extends to any examination where it is necessary to touch or be close to the patient for example conducting eye examinations in dimmed lighting, taking the blood pressure or palpating the apex beat.
The Rights of the Patient
All patients are entitled to have a chaperone present for any consultation, examination or procedure where they feel one is required. Patients have the right to decline the offer of a chaperone. However, the clinician may feel that it would be wise to have a chaperone present for their mutual protection for example, an intimate examination on a young adult of the opposite gender. If the patient continues to decline the doctor will need to decide whether or not they are happy to proceed in the absence of a chaperone. This will be a decision based on both clinical need and the requirement for protection against any potential allegations of improper conduct.
Appropriately Trained Chaperone
An appropriately trained chaperone is defined as a member of staff who has completed training and who has been assessed as competent by a member of the Practice clinical team. All clinical staff who act as a chaperone have a documented Disclosure and Barring Service check kept on record.
Reception/Admin staff are not routinely DBS checked. They are suitably trained so they develop the competencies required. The surgery has an appropriate risk assessment in place providing a clear rationale as to why. Staff who are not DBS checked, are at no time left alone with a patient and do not look after a child while the patient is being examined.
Consultations Involving Intimate Examinations – If an intimate examination is required, the clinician will:
- Establish there is a need for an intimate examination and discuss this with the patient
- Give the patient the opportunity to ask questions
- Obtain and record the patient’s consent
- Offer a chaperone to all patients for intimate examinations (or examinations which may be construed as such) -Documentation should reflect this. It should document who provided the chaperoning and also say what part of the consultation they were present for.
Guidelines:
Clinicians (male and female) should consider whether an intimate or personal examination of the patient (either male or female) is justified, or whether the nature of the consultation poses a risk of misunderstanding.
- The clinician should give the patient a clear explanation of what the examination will involve and what the chaperone will be doing and where they will be in the room.
- Always adopt a professional and considerate manner – be careful with humour as a way of relaxing a nervous situation as it can easily be misinterpreted.
- Always ensure that the patient is provided with adequate privacy to undress and dress.
- Ensure that a suitable sign is clearly on display in each consulting or treatment room offering the chaperone service if required.
This should remove the potential for misunderstanding. However, there will still be times when either the clinician, or the patient, feels uncomfortable, and it would be appropriate to consider using a chaperone. Patients who request a chaperone should never be examined without a chaperone being present
The Patient can expect the Chaperone to be:
- Available if requested
- Sensitive and respect the patient’s dignity and confidentiality
- Reassure the patient if they show signs of distress or discomfort
- Be familiar with the procedure involved in a routine intimate examination.
- Stay for the whole examination and be able to see what the doctor is doing, if practical
- Be prepared to raise any concerns if they are concerned about the doctor’s behaviour or actions.
The Position of the Chaperone
The positioning of the chaperone will depend on several factors for example the nature of the examination and whether or not the chaperone has to help the clinician with the procedure.
When a Chaperone is not available
There may be occasions when a chaperone is unavailable (for example on a home visit or when no trained chaperone of the appropriate sex is in the building). In such circumstances the doctor will assess the circumstances and decide if it is appropriate to go ahead. If necessary, the consultation / examination should be rearranged for the patient to a mutually convenient time when a chaperone can be present.
Patients should raise any concerns/make any complaint via the practice’s usual comments/complaints procedure.
Read Codes to be recorded by staff when Chaperoning
Staff must record in the patient record that they have acted as Chaperone and use an appropriate code from the list below:
| Name | Code |
|---|---|
| Chaperone offered | XaEiq |
| Chaperone present | XaEir |
| Chaperone refused | XaEis |
| Chaperone not available | XaMe5 |
| Nurse chaperone | XaF0C |
| Presence of chaperone | XaEip |