CORE CHAPERONING GUIDELINES

Version / 2
Name of responsible (ratifying) committee / Nursing and Midwifery Advisory Committee
Date ratified / 14.04.2011
Document Manager (job title) / Matron - Main Outpatients
Date issued / 19.04.2011
Review date / April 2012
Electronic location / Corporate Clinical Guidelines
Related Procedural Documents / Mental Capacity Act and Deprivation of Liberty Safeguarding Policy.
Safeguarding Adults – policy and procedure guidance.
Key Words (to aid with searching) / Chaperone; Formal Informal Chaperone; Lone Worker Policy

CONTENTS

QUICK REFERENCE GUIDE

1.INTRODUCTION

2.PURPOSE

3.SCOPE

4.DEFINITIONS

5.DUTIES AND RESPONSIBILITIES

6.PROCESS

7.TRAINING REQUIREMENTS

8.REFERENCES AND ASSOCIATED DOCUMENTATION

9.MONITORING COMPLIANCE WITH, AND THE EFFECTIVENESS OF, PROCEDURAL DOCUMENTS

QUICK REFERENCE GUIDE

For quick reference the guide below is a summary of actions required. This does not negate the need for the document author and others involved in the process to be aware of and follow the detail of this policy.

  1. The examining healthcare professional must ensure there is: a genuine need for the examination; a chaperone is routinely offered; and any refusal of a chaperone is recorded in the patient’s notes
  1. Whilst exercising clinical judgment, clinicians are advised that they should always consider being accompanied by a formal chaperone when the patient:
Requires intimate examination, treatment or care
  • Is semiconscious or unconscious
  • Is intoxicated with alcohol or has taken anxiolytics, hypnotics, and opioid analgesics or any drug or substances known to have an hallucinogenic effect.
  • Is confused/disorientated
  • Does not use English as their first language. Intimate examinations should never be carried out for non-english speaking patients (except in an emergency) without an interpreter/advocate (taking account of gender) being present
  • Has hearing, visual or speech difficulties
  • Is a vulnerable adult e.g. an older person or a patient with a learning disability or any cognitive impairment. For these patients, 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.
  • Has a history of abuse, or where abuse is suspected. Great care and sensitivity must be used to allay fears of repeated abuse.woo
  1. Once the formal chaperone has entered the room or area, the patient must be given privacy to undress, using curtains or other means to maintain dignity.
  1. If a chaperone has been present, the name, nature and status of the chaperone should be recorded in the clinical notes.
  1. For patients who request a formal chaperone but none is available a decision to continue or otherwise should be jointly reached
  1. If a chaperone is declined, a healthcare professional cannot insist that one is present. If the clinician is unhappy to proceed without a chaperone it may be possible to arrange for the patient to see another healthcare professional
  1. Specific issues must be taken into account when considering the use of chaperones when the examination of children is involved
  1. The ethnic, religious and cultural background of patients must be taken into account
  1. Specific issues must be taken into account when considering the use of chaperones for vulnerable adults in general, patients with learning difficulties and mental health problems
  1. Any issues relating to the use or non-use of chaperones must be documented in the patient’s notes

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1.INTRODUCTION

It is best practice, particularly in an outpatient setting, that a trusted adult is present whilst any consultation, examination, care or treatment takes place, although within an in-patient setting it is acknowledged this is often not possible. For most patients, respect, explanation, consent and privacy take precedence over the need for a chaperone, and the presence of a third party does not negate the need for this.

All clinical staff are in a vulnerable position at some stage during consultation, examination, treatment or care of patients. The process of chaperoning is designed to protect the patient and can also allow medical and nursing staff to safeguard themselves from any accusation of improper conduct. The presence of a third party cannot provide full assurance that the procedure or examination is conducted appropriately.

Chaperones are most often required or requested where a male examiner is carrying out on intimate examination or procedure on a female patient. However, the Hospital Trust considers it good practice to offer all patients a chaperone for any examination or procedure where the patient feels one is required; regardless of the gender of the examiner or patient.

2.PURPOSE

This policy is intended to provide advice on the use of chaperones in order to safeguard the position of patients and staff.

3.SCOPE

This guideline applies to all staff who have contact with patients in the Trust, including medical staff, nursing and midwifery staff, allied health professionals, medical students, nursing and midwifery students, radiographers, and other members of the multidisciplinary team working with individual patients in wards, outpatient clinics and departments.

‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises that it may not be possible to adhere to all aspects of this document. In such circumstances, staff should take advice from their manager and all possible action must be taken to maintain ongoing patient and staff safety’

4.DEFINITIONS

Clinician: the Healthcare Professional responsible for a patient’s care.

Intimate examination: an examination, investigation or photography involving the breasts, genitalia or rectum. It also includes supporting mothers with breast feeding.

Informal chaperone:a person who is familiar to the patient, which includes family members, friends and non-clinical staff. This may not be appropriate for a child to act as an informal chaperone for a parent.

Formal chaperone:a Trust employee with a designated specific role. Protecting the patient from vulnerability and embarrassment means that the formal chaperone would usually be of the same gender as the patient. Medical and nursing students can be used as formal chaperones, provided that the patient is aware of their role.

5.DUTIES AND RESPONSIBILITIES

Examining healthcare professional: it is the responsibility of the examining healthcare professional to:

  • Ensure there is a genuine need for the examination/intervention and to discuss this with the patient.
  • Routinely offer a chaperone prior to any examination or procedure.
  • Document in the patient’s notes if the offer of a chaperone is refused

Chaperone: it is the responsibility of the chaperone to:

  • Actas a safeguard for all parties and be witness to the continuing consent to the procedure.
  • Support the provision of privacy and dignity for the patient

Medical or Nursing Students: any student undertaking the role of chaperone must be aware of their role responsibilities in this regard together with their duty of confidentiality

Detail the duties, accountabilities and responsibilities (including level) of Directors, individuals, specialist staff, departments and committees.

Privacy and Dignity Working Group: the responsibilities of the group include

  • Raising awareness of all issues relating to privacy and dignity
  • Ensuring staff are aware of initiatives and are using them appropriately
  • Producing a Dignity Charter
  • Ensuring staff are appropriately trained
  • Undertaking audit

Safeguarding

The care of vulnerable adults is of particular importance when they are receiving any kind of examination or treatment and it is relevant for all staff acting as a chaperone to be also aware of the PHT Safeguarding Adults: Policy and Practice Guidance

6.PROCESS

6.1Establish that there is a genuine need for an examination/ intervention and discuss this with the patient. Adequate information and explanation prior to an examination or procedure should be provided to the patient, and where necessary, easily understood literature and diagrams to support the verbal information.

6.2 By attending a consultation it is assumed by implied consent that a patient is seeking treatment, and the basic assumption is made that every adult has the capacity to consent to, or refuse, proposed healthcare intervention (Please refer to the Trust’s Mental Capacity Act and Deprivation of Liberty Safeguarding Policy). However, careful and sympathetic explanation of the examination technique should be provided by the healthcare professional intending to carry out the examination, and risks/ benefits should be given to ensure informed consent is gained. For example, patients need to be told why both breasts are examined when they may complain of a lump in only one, or why a vaginal examination may be necessary if a female patient complains of abdominal pain, or why the testes may be examined in a male patient with abdominal pain.

6.3Once consent has been given it must recorded in the patient’s notes before the examination and the examining healthcare professional must be prepared to discontinue the examination at any stage at the patient’s request.

6.4It is best practice, and the responsibility of the professional undertaking the procedure to routinely offer a chaperone prior to any examination or procedure. The offer of an informal/ formal chaperone could be made prior to the examination or should be made at the time of the care intervention and discussed with the patient.

If the patient declines the offer of a chaperone, this must be documented in the patient’s clinical notes. If a chaperone is declined, a healthcare professional cannot insist that one is present. If the clinician is unhappy to proceed without a chaperone arrangements should be made for the patient to be seen by another healthcare professional.

6.5 For patients who request a formal chaperone but none is available a decision to continue or otherwise should be jointly reached. The patient should be given the opportunity to reschedule the appointment should that be the preferred option. In cases where the patient lacks capacity to make an informed decision then clinicians must use their own clinical judgment, record and be able to justify this course of action. A trusted relative or friend should always be considered in preference to no chaperone at all.

6.6 Once a chaperone has entered the room,or a patient has refused the presence of a chaperone, they must be givenprivacy to undress and dress and be allowed the opportunity to limit the degree of nudity.

6.7 If a chaperone has been present, the name, nature and status of the chaperone should be recorded in the clinical notes by the healthcare professional responsible for the examination.

6.8 Whilst exercising their clinical judgment, clinicians are advised that they should always consider being accompanied by a formal chaperone when the patient:

Requires intimate examination, treatment or care
  • Is semiconscious or unconscious
  • Is intoxicated with alcohol or has taken anxiolytics, hypnotics, and opioid analgesics or any drug or substances known to have an hallucinogenic effect.
  • Is confused/disorientated
  • Does not use English as their first language. Intimate examinations should never be carried out for non-english speaking patients (except in an emergency) without an interpreter/advocate (taking account of gender) being present
  • Has hearing, visual or speech difficulties
  • Is a vulnerable adult e.g. an older person or a patient with learning disability or other cognitive impairment. For these patients, 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.
  • Has a history of abuse, or where abuse is suspected. Great care and sensitivity must be used to allay fears of repeated abuse.

6.9 Issues specific to the care of children and adolescents:

  • When undergoing examination for child protection procedures, the individual with parental responsibility may not be appropriate as an informal chaperone
  • There are specific concerns when the patient is pubertal or post-pubertal
  • When children/adolescents are not accompanied by an individual with parental responsibility.

6.10Issues specific to Religion, Ethnicity or Culture

  • The ethnic, religious and cultural background of some women can make intimate examinations particularly difficult.
  • Whilst all patients undergoing examinations should be allowed the opportunity to limit the degree of nudity, this may be of particular importance for religious, ethnic or cultural reasons.
  • Wherever possible, particularly in these circumstances, a trained female healthcare practitioner should perform the procedure.

6.11Issues specific to Learning Difficulties, Mental Health problems and Vulnerable Adults

  • Staff must consider that for this group of patients, their capacity may be affected.
  • A familiar individual such as a family member or carer may be the best chaperone and be able to act as an advocate for the patient.
  • Adult patients who resist any intimate examination or procedure must be interpreted as refusing to give consent, and the procedure must be abandoned.

7.TRAINING REQUIREMENTS

All staff members who act as formal chaperones must have had sufficient training to understand the role expected of them and the procedure/examination to be undertaken. It is expected that it will be the line manager’s responsibility to ensure that any staff acting as a chaperone are fully aware of their responsibilities as outlined in this document.

8.REFERENCES AND ASSOCIATED DOCUMENTATION

Internal

Lone Worker Guideline

Consent Policy

External

  1. Chesterfield Royal Hospital NHS Foundation Trust. Chaperoning Guideline. (2005)
  2. Chesterfield Royal Hospital NHS Foundation Trust. Chaperoning Policy. (2007)
  3. Department of Health. Clinical Governance Support Team NHS. Guidance on the Role and Effective Use of Chaperones in Primary and Community Care Settings. (2005)
  4. Isle of Wight Healthcare NHS/PCT. Chaperone Policy (2006)
  5. Royal College of Obstetricians and Gynaecologists. Guidelines on intimate examinations. (1997)
  6. Committee of Inquiry – Independent Investigation into how the NHS handled allegations about the conduct of Clifford Ayling.

7.Committee of Inquiry to investigate how the NHS handled allegations about the performance and conduct of Richard Neale

8.

  1. GMC GMC | Maintaining boundaries - guidance for doctors
  2. Royal College of Nursing: Chaperoning; The role of the nurse and the rights of patients, Guidance for nursing staff, July 2002 Publication code 001 446
  3. Chaperones for intimate examinations: cross sectional survey of attitudes and practices of general practitioners, 3/12/04
  4. Use and offering of chaperones by general practitioners: postal survey in Norfolk, 16/12/04
  5. Attitudes of patients towards the use of chaperones in Primary care – Whitford DL, Karin M, Thompson G. British Journal of General Practice 2001; 51:381-3
  6. Guidelines in Practice, July 2002 Vol 5 (7), 52-53
  7. Virtual chaperone enhances patient records 18 July 2003
  8. Big Sister is watching you, The Economist 18 Nov 2004
  9. Black Box – Lachlan Clark
  10. Primary Care Training Centre, Bradford Tel: 01274 617617 Chaperone study day
  11. Mental Capacity Act Mental Capacity Act 2005 : Department of Health - Policy and guidance

9.MONITORING COMPLIANCE WITH, AND THE EFFECTIVENESS OF, PROCEDURAL DOCUMENTS

This policy will be audited as part of the annual Privacy and Dignity Audit

The audit consists of 10 questionnaires being distributed to each ward.

Completion of the audit is supported by the Clinical Audit Department.

The results of the audit will be presented to the Privacy and Dignity Working Group, which will also be responsible for taking any actions in the light of the outcome of the audit

Core Chaperoning Guidelines. Issue 2. 19.04.2011 (Review date: April 2012)Page 1 of 8