General Surgery Department, North Bristol NHS Trust, Bristol, UK.
Int J Risk Saf Med. 2022;33(S1):S91-S95. doi: 10.3233/JRS-227031.
The General Medical Council (GMC) states that all intimate examinations should have a chaperone offered. Documentation of chaperone identity, or patient's refusal, is essential.
This project aimed to improve documentation of chaperones during intimate examination of patients based in a Surgical Admissions Unit (SAU) within a large tertiary hospital in the Southwest of the UK.
A Plan-Do-Study-Act (PDSA) cycle structure was used. Initial data collection and planning occurred in December 2019. Intervention implementation and analysis occurred from January 2020 to March 2021. Intervention 1 involved presenting results at a clinical governance meeting. Intervention 2 was information posters in the SAU and intervention 3 involved training sessions for nursing staff. Intervention 4 was editing the surgical clerking proforma.
Prior to interventions, chaperone identity or patient's refusal was correctly documented only 9.7% (N = 7 out of 72) of the time. Intervention 1 increased this to 34.6%. Following interventions 3 and 4, correct documentation was 25.0% and 28.6% respectively. After intervention 4 correct documentation was at 59.1%.
Initial documentation of chaperones was poor. Interventions 1 to 3 were successful in educating clinicians how to document accurately, but engaging individuals in person was more successful than passive education through posters. Changing the proforma structure was the most successful intervention. This suggests a visual reminder for clinicians at the point of contact with the patient is the most effective way to encourage correct documentation of chaperones, improving patient care and clinical practice.
英国总医学理事会（GMC）规定，所有亲密检查都应提供一名陪护。陪护人员的身份或患者的拒绝记录是必不可少的。
本项目旨在改善英国西南部一家大型教学医院的外科入院部（SAU）中对患者进行亲密检查时的陪护记录。
采用计划-实施-研究-行动（PDSA）循环结构。最初的数据收集和计划于 2019 年 12 月进行。干预实施和分析于 2020 年 1 月至 2021 年 3 月进行。干预 1 包括在临床治理会议上展示结果。干预 2 是在 SAU 张贴信息海报，干预 3 是对护理人员进行培训。干预 4 是编辑外科记录表单。
在干预之前，陪护人员的身份或患者的拒绝记录只有 9.7%（N=7/72）是正确的。干预 1 将这一比例提高到 34.6%。在干预 3 和 4 之后，正确记录的比例分别为 25.0%和 28.6%。干预 4 后，正确记录的比例为 59.1%。
最初的陪护记录很差。干预 1 到 3 成功地教育了临床医生如何准确记录，但与个人接触比通过海报进行被动教育更成功。改变表单结构是最成功的干预措施。这表明，在与患者接触的点为临床医生提供视觉提示是鼓励正确记录陪护人员的最有效方法，从而改善患者护理和临床实践。
