WHITEHOUSE MEDICAL GROUP PRACTICE

CHAPERONE POLICY

 

 

Background

 

The Practice is committed to providing a safe, comfortable environment whereby the safety of patients and staff is of paramount importance. Patients experiencing consultations, examinations and/or investigations need to feel and be safe and experience as little discomfort/distress as possible.  Equally health professionals are at a potential risk of their actions being misconstrued or misrepresented if the conduct examinations where no third party is present.  Clinicians have a professional responsibility to minimise the risk of false accusations of inappropriate behaviour.

 

This policy presents principles and outlines the procedures that should be in place for appropriate use of chaperones for patients. It is largely based on the Model Chaperone Framework published by the NHS Clinical Governance Support Team in June 2005.

 

 

Responsibilities

 

Guidance on chaperoning is for the assistance and protection of both patients and healthcare professionals. Chaperoning may help reduce distress, but must be used in conjunction with respectful behaviour, explanation, informed consent and privacy.

 

 

Consent

 

In attending a consultation, it is assumed that a patient is seeking appropriate clinical assessment, diagnosis and treatment and therefore is granting implied consent to necessary physical examinations. However, before proceeding with a physical examination healthcare professionals should always seek to obtain, by word or gesture, some explicit indication that the patient understands the need for examination and agrees for it to take place.

 

 

Role of the Chaperone

There is no common definition of a chaperone and their role varies considerably depending on the needs of the patient, the healthcare professional and the examination or procedure being carried out. Broadly speaking their role can be considered in any of the following areas:

 

  • Providing emotional comfort and reassurance to patients
  • To assist in the examination, for example handing instruments during IUCD 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 rare circumstances to protect the clinician against an attack
  • An experienced chaperone will identify unusual or unacceptable behaviour on the part of the health care professional

 

A chaperone is present as a safeguard for all parties (patient and practitioners) and is a witness to continuing consent of the procedure.

 

 

There are 2 main types of Chaperone:

 

Informal Chaperone

 

Many patients feel reassured by the presence of a familiar person and this request in almost all cases should be accepted. A situation where this may not be appropriate is where a child is asked to act as a chaperone for a parent undergoing an intimate examination. They may not necessarily be relied upon to act as a witness to the conduct or continuing consent of the procedure.  However if the child is providing comfort to the parent and will not be exposed to unpleasant experiences it may be acceptable for them to be present. It is inappropriate to expect an informal chaperone to take an active part in the examination or to witness the procedure directly.

 

 

Formal Chaperone

 

A formal chaperone implies a clinical health professional, such as a nurse, or a specifically trained non-clinical staff member. This individual will have a specific role to play in terms of the consultation and this role should be made clear to both the patient and the person undertaking the chaperone role. This may include assisting with undressing or assisting in the procedure being carried out. In these situations staff should have had sufficient training to understand the role expected of them. Common sense would dictate that, in most cases, it is not appropriate for a non-clinical member of staff to comment on the appropriateness of the procedure or examination, nor would they feel able to do so.

 

Protecting the patient from vulnerability and embarrassment means that the chaperone would usually be of the same sex as the patient.

 

The patient should always have the opportunity to decline a particular person as chaperone if that person is not acceptable to them for any reason.  In all cases where the presence of a chaperone may intrude in a confidential

clinician-patient relationship their presence should be confined to the physical examination. One-to-one communication should take place before or after the examination when confidentiality is easier to maintain.

Training for Chaperones

 

Members of staff who undertake a formal chaperone role shall undergo relevant training for the role. These include an understanding of:

 

  • What is meant by the term chaperone
  • What is an “intimate examination”
  • Why chaperones need to be present
  • The rights of the patient
  • Their role and responsibility as a chaperone
  • Policy and mechanism for raising concerns

 

Induction of new clinical staff should include training on the appropriate conduct of intimate examination. Trainees should be observed and given feedback on their technique and communication skills in this aspect of care.

 

 

Offering a Chaperone

 

Patients should be routinely offered a chaperone during a consultation or procedure if they feel uneasy. This does not mean that every consultation needs to be interrupted in order to ask if the patient wants a third party present. The offer of chaperone should be made clear to the patient prior to any procedure, ideally at the time of booking the appointment. Most patients will not take up the offer of a chaperone, especially where a relationship of trust has been built up or where the examiner is the same gender as them.

 

If the patient is offered and does not want a chaperone it is important to record that the offer was made and declined. If a chaperone is refused a healthcare professional cannot usually insist that one is present and many will

examine the patient without one. However, there may be cases where the practitioner makes a professional judgement that they cannot conduct the examination or procedure without a chaperone present and they therefore may decline to proceed without a chaperone. 

 

Patients decline the offer of a chaperone for a number of reasons: because they trust the clinician, think it unnecessary, require privacy, or are too embarrassed.

 

 

Where a Chaperone is Needed but not Available

 

If the patient has requested a chaperone and none is available at that time the patient must be given the opportunity to reschedule their appointment within a reasonable timeframe. If the seriousness of the condition would dictate that a delay is inappropriate then this should be explained to the patient and recorded in their notes. A decision to continue or otherwise should be jointly reached.

 

In cases where the patient is not competent to make an informed decision then the healthcare professional must use their own clinical judgement and record and be able to justify this course of action.

 

It is acceptable for a healthcare professional to perform an intimate examination without a chaperone if the situation is life threatening or speed is essential in the care or treatment of the patient. The rationale for any such examination should be recorded on the patient’s notes.

 

 

Issues Specific to Religion/Ethnicity or Culture

 

The ethnic, religious and cultural background of some women can make intimate examinations particularly difficult, for example, Muslim and Hindu women have a strong cultural aversion to being touched by men other than

their husbands. Patients undergoing examinations should be allowed the opportunity to limit the degree of nudity by, for example, uncovering only that part of the anatomy that requires investigation or imaging. Wherever possible,

particularly in these circumstances, a female healthcare practitioner should perform the procedure.

 

It would be unwise to proceed with any examination if the healthcare professional is unsure that the patient understands due to a language barrier.

 

If an interpreter is available, they may be able to double as an informal chaperone. In life saving situations every effort should be made to communicate with the patient by whatever means available before proceeding

with the examination.

 

The patients beliefs, attitudes and concerns will not be presumed and will be discussed with the patient and taken into account. Each individual has very different needs and before the procedure is carried out, these should be mutually agreed with the healthcare professional.  The healthcare professional however will not collude with patients who are practising discrimination.

 

 

Issues Specific to Learning Difficulties/Mental Health Problems

 

For patients with learning difficulties or mental health problems that affect capacity; a familiar individual such as a family member or carer may be the best chaperone. A careful, simple and sensitive explanation of the technique is

vital.

 

Adult patients with learning difficulties or mental health problems who resist any intimate examination or procedure must be interpreted as refusing to give consent and the procedure should be abandoned and an assessment should be made of whether the patient can be considered competent or not. If the patient is competent, despite learning difficulties or mental health problems, the investigation or treatment cannot proceed.

 

In lifesaving situations the healthcare professional should use professional judgement and must fully record their rationale in the patients notes. Advice and assistance is available from a member of the Mental Health Care Team.

 

 

Lone Working

Where a health care professional is working in a situation away from other colleagues e.g. home visit, out-of-hours centre, the same principles for offering and use of chaperones should apply. The healthcare professional may be required to risk assess the need for a formal chaperone and should not be deterred by the inconvenience or complexity of making the necessary arrangements. In all instances the outcome must be documented.

 

 

Communication and Record Keeping

 

The most common cause of patient complaints is a failure on the patient’s part to understand what the practitioner was doing in the process of treating them.  It is essential that the healthcare professional explains the nature of the

examination to the patient and offers them a choice whether to proceed with that examination at that time. The patient will then be able to give an informed consent to continue with the consultation. Chaperoning in no way removes or reduces this responsibility.

 

 

Recording in Patients’ notes

 

Details of the examination including presence/absence of chaperone and information given must be documented in the patient’s medical records. The records should make clear from the history that the examination was necessary.

 

In any situation where concerns are raised or an incident has occurred this should be dealt with immediately in accordance with the Incident Reporting Procedure.