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3. Chaperones

3.1 The following advice is partly based on that written by the General Medical Council3 and sets out good practice principles that apply to all who work within diagnostic imaging and radiotherapy. Reference should also be made to local Trust, Health Board, Independent Provider and other employing authorities’ policies. These often provide detailed considerations with respect to chaperones that are tailored to suit local circumstances.

3.2 You should offer the patient the security of having an impartial observer of the same gender as the patient (a chaperone) present during an intimate examination and the patient has a right to request that one is present. For professional integrity and safety you should give equal consideration to your own need for a chaperone irrespective of the examination being undertaken or the gender of the patient. This applies whether or not you are the same gender as the patient. It is also good practice to be prepared to offer a chaperone even when the examination is not considered to be an intimate one.

3.3 A chaperone will ideally be:

i)  a member of staff

ii) the same gender as the patient

iii) someone who has had training for the role (training of chaperones is the responsibility of the healthcare provider)

iv) sensitive and respectful to the patient’s dignity and confidentiality

v)  prepared to reassure the patient if they show signs of distress or discomfort

 vi) familiar with the procedures involved in a routine intimate examination

vii) able to stay for the whole examination and see what the practitioner is doing, if practicable

 viii) prepared to raise concerns about a practitioner or patient if misconduct occurs.

3.4 If a chaperone is offered for an intimate examination but declined, local policies may allow the practitioner to proceed with the examination. However, having a chaperone present can strengthen a practitioner’s defence if an allegation of unprofessional behaviour is made.7

3.5 In some departments and circumstances, a member of staff with chaperone training may not be available and local policies may allow a relative or friend of the patient to be used as a comforter, carer or ‘informal chaperone’ if this is acceptable to both the patient and the practitioner involved. This may apply particularly to children. This practice may, however, make any allegation more difficult to defend as the relative or friend is not an impartial observer. When it is felt that the examination could be misinterpreted by the patient or the person accompanying them, it is always recommended to have an independent chaperone present. The 1999 Ionising Radiation Regulations11 describes the management of comforters and carers where the procedure utilises ionising radiation. For all other attendances where a patient requests a comforter or carer to remain with them, a local policy should be in place to support this. For further information please see the SCoR advice document at: https://www.sor.org/learning/document-library/ionising-radiations-regulations-1999-irr99-guidance-booklet-0

3.6 If the patient does not wish to proceed with the chaperone offered and no other suitable chaperones are available, the examination may have to be delayed to a later date when an alternative chaperone will be available, if this is compatible with the patients’ best interests.  Local protocols may also give advice on this situation which is unlikely to arise often. If any delay may be detrimental to the patient’s care or treatment, this must be made clear and the patient’s acceptance of this compromise recorded. The referring consultant/clinical team should be advised. All attempts should be made to resolve the situation within the resources available on the day. You should try and avoid making the patient feel under pressure to proceed against their wishes or to feel that they are inconveniencing you.7

3.7 A practitioner has a right to request that a chaperone is present during an intimate examination and may in any event normally be required to have one present under local policies which should always be consulted in addition to this guidance. These local policies often give advice on how to proceed if a patient refuses to have a chaperone present and the practitioner feels they may be at risk. The general principle would be that the practitioner should not carry out the procedure and explain to the patient that it will only be carried out in the presence of a chaperone. Attempts should be made to agree a suitable chaperone with the patient.

3.8 A notice should be placed in the waiting room stating that a chaperone may be requested for any examination.

3.9 You should record any discussion about chaperones and the outcome in the patient’s notes, electronic record or report.  If a chaperone is present you should record that fact and make a note of their identity. If the patient does not want a chaperone you should record that the offer was made and declined.

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