Key Message
Brunton Park Health Centre 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.
Our Chaperone Policy is clearly advertised on the practice website, displayed in the practice waiting room and a copy can be provided upon request.
All patients are entitled to have a chaperone present for any consultation, examination or procedure where they consider one is required.
Patients are advised to ask for a chaperone if required, at the time of booking an appointment, if possible, so that arrangements can be made and the appointment is not delayed in any way. The Healthcare Professional may also require a chaperone to be present for certain consultations.
All staff are aware of and have received appropriate information in relation to this Chaperone Policy.
All trained chaperones understand their role and responsibilities and are competent to perform that role.
All staff that chaperone have been DBS checked.
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 under 2 headings:
Primary roles:
- Providing emotional comfort and reassurance to patients
- Providing protection to healthcare professionals against unfounded allegations of improper behaviour
- Protecting the clinician against an attack
- Identifying unusual or unacceptable behaviour on the part of the health care professional
Who can act as a Chaperone?
A variety of people can act as a chaperone in the practice, but staff undertaking a formal chaperone role will have been trained in the competencies required. Where possible, chaperones will be clinical staff familiar with procedural aspects of personal examination.
Where the Practice determines that non-clinical staff will act in this capacity, the patient will be asked to agree to the presence of a non-clinician in the examination, and for confirmation that they are at ease with this. The staff member will be trained in the procedural aspects of personal examinations, be comfortable acting in the role of chaperone, and be confident in the scope and extent of their role. They will also have received instruction on where to sit/stand and what to watch and listen for. A chaperone will document in the patient notes that they were present, and detail any issues arising
Offering a Chaperone
All patients should be made aware a chaperone can be made available for any consultation or procedure involving a health professional.
It is not always clear ahead of the consultation that an intimate examination or procedure is required. It is therefore prudent to offer a chaperone at the time of the examination or treatment.
In every case, the health professional should be able to demonstrate, if challenged, that they have taken all reasonable steps to protect themselves and the patient from allegations of improper behaviour.
Many 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 this in their health record, that the offer was made and declined.
Examination or procedure
- The clinician will contact reception to request a chaperone
- Where no chaperone is available, a clinician may offer to delay the examination to a date when one will be available, as long as the delay would not have an adverse effect on the patient’s health
- If a clinician wishes to conduct an examination with a chaperone present but the patient does not agree to this, the clinician will explain clearly why they want a chaperone to be present. The clinician may choose 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 have an adverse effect on the patient’s health
- Examinations should take place in a closed room or well-screened bay that cannot be entered while the examination is in progress
- Facilities should be available for patients to undress in a private, undisturbed area. There should be no undue delay prior to examination once the patient has removed any clothing
- The patient should be offered a gown or some sort of cover for themselves
- The clinician will record in the notes that the chaperone is present, and identify the chaperone
- The chaperone will enter the room discreetly and remain in the room until the clinician has finished the examination
- A chaperone will attend inside the curtain/screened-off area at the head of the examination couch and observe the procedure
- To prevent embarrassment, the chaperone will not enter into conversation with the patient or GP unless requested to do so, or make any mention of the consultation afterwards
- The patient can refuse a chaperone, and if so this must be recorded in the patient’s medical record.
- During an intimate examination
Offer reassurance
Be courteous
Keep discussion relevant
Avoid unnecessary personal comments
Encourage questions and discussion
Remain alert to verbal and non-verbal indications of distress
- Any requests that the examination be discontinued should be respected.
Where a Chaperone is Requested 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.
If the seriousness of the condition means 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.
It is acceptable for a health 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 be recorded in the patients’ health record.
Consent
Before proceeding with an examination, healthcare professionals should always obtain some explicit indication that the patient understands the need for examination and agrees to it being carried out.
There may be special situations where more explicit consent is required prior to intimate examinations or procedures, such as where the individual concerned is a minor or has special educational needs.
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.
Children have the right to confidential advice on contraception, pregnancy and abortion. However, the younger the person, the greater the concern about abuse or exploitation.
In situations where abuse is suspected, great care and sensitivity must be used to allay fears of repeat abuse. Healthcare professionals should refer to the local guidance “Framework for good practice in working with families and children”
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 examination. In these cases, it would be advisable for consent to be secured and a formal chaperone to be present for any intimate examinations.
Vulnerable Adults
For vulnerable adults, 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.
Vulnerable adults who resist any intimate examination or procedure must be interpreted as refusing to give consent and the procedure must be abandoned.
Lone working
Health care professionals are at an increased risk of their actions being misconstrued or misrepresented if they conduct intimate examinations where no other person is present.
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.
Where it is appropriate, family members/friends may take on the role of informal chaperone. In cases where a formal chaperone would be appropriate, i.e. intimate examinations, the healthcare professional would be advised to reschedule the examination to a more convenient location.
Where this is not an option, for example due to the urgency of the situation or because the practitioner is community based, then good communication and record keeping are paramount.
Communication and Record Keeping
A cause of patient complaints is sometimes a misunderstanding of what the practitioner was doing. It is essential that the healthcare professional explains in a format that the patient can understand, 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.
Details of the examination including presence/absence of chaperone and information given must be documented in the patient’s health records.
If the patient expresses any doubts or reservations about the procedure and the healthcare professional feels the need to reassure them before continuing then it would be good practice to record this in the patient’s health record.
In any situation where concerns are raised or an incident has occurred, a report should be completed immediately after the consultation.
Training for chaperones
Staff who undertake a formal chaperone role have undergone training such that they develop the competencies required for this role.
These include an understanding of:
- Equity and diversity issues when chaperoning
- 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
- Guidelines 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.
Training is not specialised and can usually be done ‘in-house’. It would not be expected to take longer than 30-40 minutes. It can often be usefully linked to other aspects of professional practice.
Not all chaperones fulfil the same role. Training should be customised to the expected role of the chaperone in any particular situation.