Raising the Bar: Medical Chaperones for Sensitive Health Examinations

Purpose: To establish a medical chaperone program in the ambulatory care setting and transform organizational culture where medical chaperones become a standard of care during a sensitive health examination.

Background/significance: A sensitive health examination involves the genitalia, rectum, or breast. It creates vulnerability for both the clinician and the patient. A review of literature confirms a medical chaperone should be present during a sensitive health; however, program implementation is poorly documented in the literature. Understanding how previous trauma may impact a patient’s experience during a sensitive health examination, the addition of trauma-informed care was included in education and training. Medical chaperones are trained members of the healthcare team who observe and assist during a sensitive health examination. Their presence improves patient safety and reduces vulnerability and risk.

Methods: Ambulatory care nursing leadership established a medical chaperone program with support from all levels of the organization utilizing the PDSA model to implement change. This involved policy development, staff and clinician training, patient education, and addressing workforce needs. Training included observation of the exam, the ability of the patient, clinician, or medical chaperone to stop the exam, education about trauma-informed care, consideration of gender preference, and the documentation of the presence or declination of a medical chaperone. Identifying diagnosis and procedural codes specific to sensitive health examination allowed for chart audits when monitoring for compliance. Audits identified vulnerabilities and the need for additional training.

Results: Patient-facing clinical staff completed a knowledge assessment survey prior to medical chaperone education and six months following implementation. There was substantial improvement in staff knowledge of trauma-informed care (36% increase) and staff knowledge of how to document medical chaperone presence or declination (38% increase). The results further indicated staff were less concerned about workflow issues (4% decrease) following education.

Conclusion: Medical chaperones are essential during a sensitive health examination and provide protection for patients and clinicians during vulnerable moments of care. Including medical chaperones during a sensitive health examination as a standard of care transforms culture and is achieved through acceptance and compliance of all members of the healthcare organization. This poster is an overview of the process that cultivates high reliability in an organization with the implementation of medical chaperones.