Dr Woodhouse & Partners

Chaperone Policy

INTRODUCTION

Dr Woodhouse & Partners is committed to providing a safe, comfortable environment where patients and staff can be confident that best practice is being followed at all times and the safety of everyone is of paramount importance.

This Chaperone Policy adheres to local and national guidance and policy –i.e.:-

‘NCGST Guidance on the role and effective use of chaperones in Primary and Community Care settings’.

The 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.

GUIDELINES

All patients are entitled to have a chaperone present for any consultation, examination or procedure where they consider one is required. The chaperone may be a family member or friend, but on occasions a formal chaperone may be preferred.

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.
• 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.  If necessary, where a chaperone is not available, the consultation/examination should be rearranged for a mutually convenient time when a chaperone can be present.

Complaints and claims have not been limited to male doctors with female patients – there are many examples of alleged homosexual assault by female and male doctors.  Consideration should also be given to the possibility of a malicious accusation by a patient. 

There may be rare occasions when a chaperone is needed for a home visit.  The procedure should still be followed. 

WHO CAN ACT AS A CHAPERONE?

A variety of people can act as a chaperone in the practice.  Staff acting as a chaperone should have been DBS checked by the Practice.  Where possible, it is strongly recommended that chaperones should be clinical staff familiar with procedural aspects of a personal examination.  Where suitable clinical staff members are not available the examination should be deferred.

Where the practice determine that non-clinical staff will act in this capacity the patient must agree to the presence of a non-clinician in the examination, and be at ease with this.  The staff member should be trained in the procedural aspects of personal examinations, comfortable in acting in the role of chaperone, and be confident in the scope and extent of their role. 

CONFIDENTIALITY

The chaperone should only be present for the examination itself, and most of the discussion with the patient should take place while the chaperone is not present.

Patients should be reassured that all practice staff understand their responsibility not to divulge confidential information.

The Chaperone Policy is clearly advertised through the website (when available) and can be read at the Practice upon request. A Poster is also displayed in the Practice Waiting Area.  A leaflet has been developed for patients and will be on display in the Practice Waiting Area.

PROCEDURE

• The clinician will contact reception to request a chaperone, or will ask a practice nurse if necessary.
• The clinician will record in the notes that the chaperone is present, and identify the chaperone
• Where no chaperone is available the examination will not take place – the patient should not normally be permitted to dispense with the chaperone once a desire to have one present has been expressed.
• The chaperone will enter the room discreetly and remain in the room until the clinician has finished the examination and has authorised the chaperone to leave.
• The chaperone will normally attend inside the curtain at the head of the examination couch to watch the procedure.
• To prevent embarrassment, the chaperone should not enter into conversation with the patient or GP unless requested to do so, or make any mention of the consultation afterwards.
• The chaperone will make a record in the patient’s notes after examination. The record will state that there were no concerns noted, or give details of any concerns.  The chaperone must record which GP they chaperoned for under their own password/entry i.e. “chaperoned in the present of, and enter which GP”.
• The patient can refuse a chaperone and if so this must be recorded in the patient’s medical record.

Checklist for consultations involving intimate examinations

• Chaperones are most often required or requested where a male examiner is carrying out an intimate examination or procedure on a female patient, but the designation of the chaperone will depend on the role expected of them, whether participating in the procedure or providing a supportive role.
• Establish there is a genuine need for an intimate examination and discuss this with the patient and whether a formal chaperone (such as a nurse) is needed.
• Explain to the patient why an examination is necessary and give the patient an opportunity to ask questions. The chaperone would normally be the same sex as the patient and the patient will have the opportunity to decline a particular person as a chaperone, if that person is considered not acceptable for any reason.
• 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 patient’s notes.
• Obtain the patient’s 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 patient’s notes.
• Once the chaperone has entered the room, they should be introduced by name and the patient allowed privacy to undress / dress. Use drapes / curtains where possible to maintain dignity. There should be no undue delay prior to examination once the patient has removed any clothing.
• Explain what is being done at each stage of the examination, the outcome when it is complete and what is proposed to be done next. Keep discussion relevant and avoid personal comment.
• If a chaperone has been present, record that fact and the identity of the chaperone in the patient’s notes.
• During the examination, the chaperone may be needed to offer reassurance, remain alert to any indication of distress but should be courteous at all times.
• Record any other relevant issues or concerns in the patient’s notes, immediately following the consultation.
• Chaperones should only attend the part of the consultation that is necessary – other verbal communication should be carried out when the chaperone has left.
• Any request that the examination be discontinued should be respected.
• Healthcare professionals should note that they are at an increased risk of their actions being misconstrued or misrepresented, if they conduct intimate examinations where no other person is present.

GUIDELINES FOR CHAPERONES

INTRODUCTION

These guidelines should be read in conjunction with the Chaperone Policy.  They are intended as an information resource for staff who may be asked to become chaperones, either on a casual (one-off) basis or as a routine role.

All examinations will place patients in a situation in which they may feel uncomfortable, and this may be compounded further by the need to undress, consent to intimate touching or intrusive examination.  The presence of a third party may alleviate some of these concerns and provide protection for both patient and clinician.

It is often not known prior to an examination commencing whether a chaperone will be desirable.  Often staff may be called upon to undertake this role without prior warning, enabling them to prepare.  It is essential therefore that chaperones are trained in their role, familiar with what is expected of them in carrying this out, and understand the support aspects of the role for the patient.

Ideally, the clinician will have explained the nature of the examination, the reasons for it and what is involved prior to it commencing, and will have given the patient the opportunity to have a chaperone present.  Alternatively, the clinician may themselves have elected to have a chaperone present for their own security.  Either way, it is important for at least one of the persons present that the third party is also there.

ROLE

This will vary a great deal, and may be passive (simply a presence in the room) or active (assisting with patient preparation or the procedure itself).  It may involve:

• Providing patient reassurance
• Helping the patient to undress or prepare, or helping with clothing or covers
• Assist with the procedure (if a nurse or healthcare assistant)
• Help with instruments
• Witnessing a procedure
• Protecting a clinician
• Being able to identify unusual or unacceptable behaviour relating to a procedure of the consultation
• Being able to identify whether the implied or implicit consent given at the start of the procedure remains valid throughout, and determine whether the attitude of the patient or the clinician has changed.

It is expected that, in general practice, you will be specially and formally trained in your role, either through professional competencies (e.g. nurses) or through formal training courses delivered either internally or externally.  It is essential that you thoroughly understand what is expected from you, not only what the practice/GP expects, but also what a patient may reasonably expect by virtue of your presence.

Clinical staff acting as chaperones may be the most appropriate staff group to undertake this role, and they may be able to interpret the procedure/examination, and for a judgement as to whether the actions are appropriate to the investigation or not.  This is a fundamental part of the ability to reassure the patient.  For this reason you, as a chaperone, should always be of the same sex as the patient.

As a chaperone, you should bear in mind that the patient may decline to have you present (as an individual) while still requiring a chaperone generally.  This is within the rights of the patient and should be considered as usual and not personal slight on your abilities.

COMPETENCIES

You should be comfortable in your role across a range of examination type, and if you do not feel confident in what you are being asked to observe, or how to do it, ask for guidance or further training.

• Understand your duties
• Understand where you are expected to be at each stage of the examination, and what you are expected to hear, and observe
• Understand the rights of the patient relating to your presence, and their ability to halt an examination
• Understand how to identify concerns and raise them within the practice so that they are given a fair hearing in an objective manner, perhaps with other clinicians without causing offence. This should be done immediately following the consultation.

CONSIDERATIONS

In some cultures, examinations by men (on women) may be unacceptable.  Some patients may be unwilling to undress, or raise concerns related to a culture.  These concerns should be respected and recorded, and in a similar way, if there is a language difficulty, it may be best to defer an examination until an interpreter is available. 

Where mental health patients are concerned, or those who may have difficulty in understanding the implications or an examination, it may be inappropriate to proceed until more secure arrangements can be made.

There may be instances, where, as a chaperone, you may be required to act in this capacity outside the practice (e.g. on a home visit).  Where a GP wishes to examine a patient in their own home, where another family member may not be present, it may be more important that a chaperone is present, and you need to be aware of your responsibilities in these circumstances.

You may be required to act as a chaperone for a member of staff where they feel uncomfortable being alone with a patient i.e. where a male or female patient can be acting in a very familiar and ‘touchy’ manner.