Florence House Medical Practice 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 policy aims to provide support and protection of both patients and staff during episodes of care within the community, to prevent misinterpretations of actions during consultations, examination and investigations and to assist patients to make an informed choice about their examinations and consultations.
Protocol
Doctors and nurses (both male and female) should consider whether an intimate or personal examination of the person (either male or female) is justified, or whether the nature of the consultation poses a risk of misunderstanding. There may be a rare occasion when an independent witness to a consultation may be prudent.
If so, the doctor or nurse should explain the examination, procedure or consultation and the patient must be offered the choice to have a chaperone present in the room during the examination or consultation. A suitable sign should clearly be on display in each consulting room, treatment room and at reception offering chaperone service if required.
If either the clinician or the patient does not want the examination to go ahead without a chaperone present, or if either of them is uncomfortable with the choice of chaperone, the examination should be postponed to a later date when a suitable chaperone will be available, as long as the delay would not adversely affect the patient’s health.
If the clinician doesn’t want to go ahead without a chaperone present but the patient has said no to having one, the clinician must clearly explain why he/she wants a chaperone present. Ultimately the patient’s clinical needs must take precedence. The clinician must wish to consider referring the patient to a colleague who would be willing to examine them without a chaperone, as long as the delay would not adversely affect the patient’s health.
When a patient refuses a chaperone, this must be recorded in the patient’s medical record.
Any member of staff who does not wish to be a chaperone at the surgery or accompany a doctor or nurse on any or a particular home visit has the right to decline without prejudice, and alternative arrangements will be made.
Definition of a Chaperone
A chaperone is an impartial observer and is present to safeguard for all parties (patients and healthcare professionals) and to witness to continuing consent of the procedure. It is either a health professional or a specifically trained non-clinical staff member such as a receptionist.
A relative or a friend of the patient is not an impartial observer and so would not usually be a suitable chaperone. But the practice should comply with a reasonable request to have such a person present as well as a chaperone
Confidentiality
- The chaperone should only be present for the examination/procedure 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 contact reception to request a chaperone.
- The clinician will record in the notes that a chaperone was offered and if the offer was accepted/refused, the details of the chaperone and the nature of the examination/procedure.
- 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, introduce themselves and confirm with the patient that their attendance is acceptable. The chaperone will remain in the room until the clinician has finished the examination and the patient is dressed.
- The chaperone will normally attend inside the curtain at the head of the examination couch and watch the procedure.
- To prevent embarrassment, the chaperone should not enter into conversation with the patient or clinician 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 that there were no problems, or details of any concerns or incidents that occurred.
- The clinician should record whether there were any problems, or give details of any concerns or incidents that occurred.
- Any concerns raised by a healthcare professional, patient, carer following episode of care must be documented in the patient’s records as a Significant Event (9g0) and an SAE form completed.
- The patient can refuse a chaperone, and if so this must be recorded in the patient’s medical record.
NB: there may be rare occasions when a chaperone is needed for home visit. The above procedure should still be followed.
Special Cases
Issues Specific to Children
In the case of children, a chaperone would normally be a parent or carer or alternatively someone known and trusted or chosen by the child. Patients may be accompanied by another minor of the same age. Children and their parents or guardians must receive an appropriate explanation of the procedure in order to obtain their co-operation and understanding.
The age of consent is 16 years. A child under 16 who is being assessed as Gillick Competent (Fraser Guidelines) and therefore has sufficient understanding and intelligence to enable him/her to understand fully what is proposed, can accept an examination. If a Gillick Competent child presents in the absence of a parent or guardian or refuses parental presence, the healthcare professional must ascertain if they are capable of understanding the need for examination. In these cases consent should be secured and a formal chaperone should be present for any intimate examinations.
For competent young adults the guidance relating to adults is applicable.
Issues Specific to Ethnicity and Culture
The ethnic, religious and cultural background of some women can make intimate examinations particularly difficult, for example, some patients may have strong cultural or religious beliefs that restrict being touched by others. Patients undergoing examination should be allowed the opportunity to limit the degree of nudity, 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.
Issues Specific to Patients with Mental Health Problems and Learning Difficulties
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 an intimate examination or procedure must be interpreted as refusing to give consent and the procedure must be abandoned, unless the patient has been sectioned. In life-saving situations, the healthcare professional should use professional judgement and where possible discuss with a member of the Mental Health Care Team.