Chaperones

INTRODUCTION

This policy is designed to protect both patients and staff from abuse or allegations of abuse and to assist patients in making an informed choice about their examinations and consultations.

Respect, explanation, consent and privacy take precedence over the need for a chaperone.  The presence of a chaperone does not remove the need for adequate explanation and courtesy.  Neither can it provide full reassurance that any examination is conducted appropriately.

The GMC has published guidance on intimate examinations and chaperones. This sets out the details of circumstances when and why a patient may require a chaperone and considerations that should be given:
https://www.gmc-uk.org/professional-standards/the-professional-standards/intimate-examinations-and-chaperones  

EXAMINATION GUIDELINES

Clinicians (male and female) should carefully consider during each consultation whether an intimate or personal examination of the patient (either male or female) is justified.  All consultations, examinations, and investigations have the potential to cause distress. 

Patients with additional needs, such as communication difficulties or learning disabilities, should be identified and reasonable adjustments made to ensure that the patient understands the nature of the examination, and that they feel sufficiently supported.

• The clinician should always give the patient a clear explanation of what any physical examination will involve in a way the patient can understand.
• The patient should be given an opportunity to ask questions about the proposed examination. 
• The patient’s permission should always be sought for the examination to proceed, and the patient’s consent must be recorded.
• Always ensure that the patient is provided with adequate privacy to undress and dress.  Do not help the patient to remove clothing unless they have given permission to do so.
• Stop the examination if the patient requests this. 
• Keep discussion relevant to the procedure and do not make unnecessary personal comments.
• Ensure that a suitable sign is clearly displayed in each consulting or treatment room advertising the services of a chaperone on request.

Patients who request a chaperone, or who have accepted the offer of a chaperone, should never be examined without a suitably qualified chaperone being present.

If necessary, in cases when no chaperone is available, the consultation / examination should be rearranged for a mutually convenient time when a chaperone can be present (taking into account the urgency of the clinical need).

There may be rare occasions when a chaperone is needed for a home visit.  The principles outlined in this policy should still be followed whenever possible.  In such situations clear communication and thorough documentation explaining the absence of a chaperone is essential if the patient agrees to proceed with examination. 

WHAT IS AN INTIMATE EXAMINATION?

Intimate examinations can be embarrassing or distressing for patients.  When examining a patient always be sensitive to what might be considered as intimate.  This is likely to include examinations of breasts, genitalia and rectum, but could also include any examination where it is necessary to touch the patient.

WHO CAN ACT AS A CHAPERONE?

An appropriately trained member of staff may act as a chaperone. Usually this will be a clinical health professional such as a nurse or health care assistant. Non-clinical members of staff acting as a chaperone should be trained in the following competencies:

• What is meant by the term “chaperone”
• What constitutes an “intimate examination”
• Why chaperones need to be present
• The rights of the patient
• Roles and responsibilities of a chaperone (see below)
• How to raise any concerns (usually via line manager or Adult Safeguarding lead)
  All staff acting as chaperones are required to have had a DBS check.

If non-clinical staff are acting as chaperone the patient must be in agreement with this. The staff member should be trained in the procedural aspects of personal examinations, comfortable with acting in the role of chaperone, and be confident in the scope and extent of their role. They will have received instruction on where to stand and how to observe the examination.

A relative or friend of the patient is not an impartial observer and so would not usually be a suitable chaperone.  At the patient’s request it would be permissible to have such a person present as well as a chaperone.  The patient may wish to decline the offer of a chaperone if they feel that their friend or family member is able to provide the support they require. 

CONFIDENTIALITY

• The chaperone should only be present for the examination itself, and most 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.

PROCEDURE

• The clinician will make contact with Treatment Room staff or Reception to request a chaperone.
• The clinician will record in the notes that a chaperone is present, and will record the identity of the chaperone (make sure that an appropriate code is applied, see below).
• If no chaperone is available the examination will not take place if the patient has already expressed a preference for a chaperone to be present. 
• The chaperone will enter the room discreetly and remain in room until the clinician has finished the examination.  The GP should introduce the chaperone to the patient and seek verbal confirmation from the patient that they consent for the chaperone to remain present.
• The chaperone will always attend inside the curtain at the head of the examination couch and watch the procedure.  In the case of a breast examination the chaperone should stand the opposite side to the GP or, if the couch is against a wall, in such a position that they can observe the procedure.
• The chaperone is available to act as an advocate and to support the patient and to offer reassurance if the patient shows any signs of distress or discomfort.
• Chaperones should be sensitive to the patient’s needs and act so as to respect and maintain their privacy and dignity.
• 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.
• Once the examination is complete, the chaperone should exit the curtain into the consultation room with the GP and wait until the patient is dressed.
• The chaperone will document their presence in the patient’s clinical record after examination. The record will state the nature of the observed examination or procedure, and that there were no problems, or give details of any concerns or incidents that occurred.
• The patient may decline the offer of a chaperone, and if so this must be recorded in the patient’s medical record.

ASSESSMENT OF CAPACITY

It is not within the scope of this policy document to provide full clinical guidance on the assessment of capacity.  The following general considerations will be applied.

The Official Code of Practice provides for a two-stage question test:

1. Is there an impairment of, or disturbance in, the functioning of the person’s mind or brain?
2. If so, is the impairment or disturbance sufficient that the person lacks the capacity to make that particular decision?

This test must be used and the records must record this and the response.

Consideration must be given to:

• Whether the patient is able to understand the information given to them.
• Whether the patient is able to retain this information.
• Whether the patient is able to assess this information whilst reaching a decision.
• Whether the patient is able to communicate their decision (using any effective means).

Where the person is unable to do any one of the above they are unable to make the decision themselves.  If the patient is unable to make an informed decision then the healthcare professional should use their clinical judgement and be able to justify their course of action.  Reasonable adjustments should be made for vulnerable patients and decisions made in their best interests if necessary – thorough documentation is essential.

Recording / Coding

Within SystmOne, the Ardens Chaperone Template should be used to facilitate application of the appropriate clinical codes.

NB. The clinician should record the identity of the attending chaperone within the patient’s record.

Executive Accountability

As CQC Registered Manager and Adult Safeguarding Lead Dr Alistair Smith is responsible for ensuring implementation of this Policy and for assuring quality and safety governance.

Regular audit is undertaken to remind staff of their obligations regarding the offer of a suitably qualified chaperone and the requirement for clear and well-implemented record keeping procedures. 

Reference

GMC: Professional Standards: “Intimate Examinations and Chaperones”: https://www.gmc-uk.org/cdn/documents/intimate-examinations-and-chaperones_pdf-58835231.pdf