New Wokingham Road Surgery is committed to providing a safe, comfortable environment where the safety of patients and staff is of paramount importance. This policy is designed to protect patients and staff from abuse or allegations of abuse and to assist patients to make an informed choice about their examinations and consultations.
This policy presents principles and outlines the procedures that should be in place for appropriately chaperoning patients during examinations, investigations and care. This policy adheres to the Model Chaperone Framework published by the NHS Clinical Governance Support Team (June 2005).
The chaperone policy is clearly advertised through patient leaflets, the website and on the waiting room television screen Patients are encouraged to ask for a chaperone if required at the time of booking their appointment wherever possible.
All staff should be aware of and have received appropriate information in relation to this chaperone policy.
Training for chaperones
Members of staff who undertake a formal chaperone role should undergo training every 3 years. This should include an understanding of:
- What is meant by the term chaperone
- The specific details of different types of intimate examinations
- The rights of the patient
- Their role and responsibility
- Policy and mechanism for raising concerns
Guidelines for consultations involving intimate examinations
A chaperone is present as a safeguard for both parties (patient and healthcare professionals) and is a witness to the conduct and the continuing consent of the procedure. All formal chaperones should understand their role and responsibilities and are competent to perform their role. Patients may find any examination distressing, particularly if these involve the breasts, genitalia or rectum (known as “intimate examinations”). Also consultations involving dimmed lights, close proximity to patients, the need for patients to undress and being touched may make a patient feel vulnerable. All clinicians and others working on their behalf have a duty to consider chaperoning issues as they relate to their work and to work in accordance with the following guidelines.
- 1. Establish there is a genuine need for an intimate examination and discuss this with the patient.
- 2. Explain to the patient why an examination is necessary and give the patient an opportunity to ask questions.
- 3. Offer a chaperone. If the patient does not want a chaperone, record that the offer was made and declined in the patients notes.
- 4. Obtain the patients consent before the examination and be prepared to discontinue the examination at any stage at the patient’s request.
- 5. Record that permission has been obtained in the patients notes.
- 6. Once the chaperone has entered the room, give the patient privacy to undress and dress. Use drapes where possible to maintain dignity.
- 7. 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 the discussion relevant and avoid personal comments.
- 8. If a chaperone has been present, record that fact and the identity of the chaperone in the patient’s notes.
- 9. Record any other relevant issues or concerns immediately following the consultation.
Where a chaperone is needed but not available
If the patient has requested a chaperone and none are available at that time the patient must be given the opportunity to reschedule their appointment within a reasonable timeframe (this may include simple waiting in the practice until a member of staff is available). 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 must 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 be able to justify this course of action. The decision and rationale should be documented in the patient’s notes.
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. This should also be recorded in the patient’s notes.
Where a healthcare professional is working in a situation away from other colleagues, for example during a home visit, 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.
Issues specific to children
Children and their parents or guardians must receive an explanation of the procedure in order to obtain their co-operation and understanding. If a minor presents in the absence of a parent or guardian the healthcare professional must ascertain if they are capable of understanding the need for an examination.
In these cases it is advisable for a formal chaperone to be present for any intimate examinations. In situations where abuse is suspected great care and sensitivity must be used to allay fears of repeat abuse. In these situations healthcare professionals should refer to the local child protection policies and seek advice from the Child Protection Lead/Team as necessary.
Issues specific to religion, ethnicity, culture and sexual orientation
All 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. Some patient’s ethnic, religious, cultural background and sexual orientation can make intimate examinations particularly difficult. It should be recognised that each individual has very different needs and before the procedure these should be mutually agreed with the healthcare professional.
Issues specific to people with learning difficulties and 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 simple and sensitive explanation of the technique is vital. This patient group is a vulnerable one and issues may arise with physical examination.
Adult patients with learning difficulties or mental health problems who resist an examination or procedure must be interpreted as refusing to give consent and the procedure must be abandoned. In life-saving situations the healthcare professional should use their clinical judgement. Where possible the matter should be discussed with a member of the Mental Health Care Team.
Non English speaking patients
In the situation of a non English speaking patient being examined the use of an independent interpreter should be enlisted. The use of a formal chaperone may still be appropriate with the interpreter in the room. A family member or interpreter should not be used as a formal chaperone.
Date published: June 2012
For Annual Review