The importance of a medical chaperone: a quality improvement study exploring the use of a note stamp in a tertiary breast surgery unit

Objectives :The project aim was to determine current use and documentation of medical chaperones within a major breast service unit. It explored ways of improving adherence to professional guidelines concerning chaperones. Setting: The single centre quality improvement project was completed in a tertiary breast service unit in North West London. It was a three-stage project with initial audit in October 2013, 1st postintervention cycle in November 2013 and 2nd postintervention cycle in October 2014. Participants: In each study cycle, data were collected from entries in clinic notes until at least 155 encounters with documented clinical examination were analysed. All notes were of female patients. Interventions: (1) Intervention 1st cycle: presentation and discussion of chaperone guidelines alongside reminder posters and introduction of note stamp. (2) Intervention 2nd cycle: note stamp alone. Primary and secondary outcome measures: Documentation of chaperone offer, documentation of patient preference regarding chaperone, identifier (name or signature) of chaperone present and gender of examining clinician. Results: In the 1st postintervention cycle, 69.95% documentation of chaperone offer was recorded, p<0.001, CI (59.04% to 80.76%). This result was replicated in the 2nd postintervention cycle a year later with 74.86% documentation of chaperone offer recorded, p<0.001, CI (66.41% to 83.31%). The 4.91% difference was insignificant; p=0.294, CI (14.03% to 4.21%). Conclusions: The authors suggest that a proforma approach to medical chaperones is an effective means of ensuring adherence to best practice guidelines. A stamp, or similar, that can be embedded into documentation structure is an effective example of such an approach. Improved documentation allows any problems with adherence to guidelines to be more easily identified, helping to ensure the safeguarding of patients and staff involved in intimate examinations.

研究目标：本项目旨在明确某大型乳腺诊疗单元内医疗陪同人员（medical chaperones）的当前使用情况与记录规范，并探索提升医疗陪同人员相关专业指南依从性的可行路径。
研究实施概况：本单中心质量改进项目于伦敦西北部的三级转诊乳腺诊疗中心完成，整体分为三个阶段：2013年10月开展初始审核，2013年11月实施首轮干预后周期，2014年10月实施第二轮干预后周期。
研究对象：各研究周期均从门诊病历记录中提取数据，直至完成至少155例有明确临床检查记录的就诊人次分析；所有病历均来自女性患者。
干预措施：（1）首轮干预：开展医疗陪同人员相关指南的宣讲与讨论，配套张贴提醒海报，并引入病历盖章流程。（2）第二轮干预：仅采用病历盖章流程。
主要与次要结局指标：医疗陪同人员告知情况的记录、患者关于医疗陪同人员的偏好记录、在场陪同人员的标识（姓名或签名）以及检查医师的性别。
研究结果：在首轮干预后周期中，医疗陪同人员告知情况的记录率达69.95%（p<0.001，置信区间：59.04%~80.76%）。该结果在一年后的第二轮干预后周期中得到复现，医疗陪同人员告知情况的记录率为74.86%（p<0.001，置信区间：66.41%~83.31%）。两个周期的记录率相差4.91%，差异无统计学意义（p=0.294，置信区间：14.03%~4.21%）。
研究结论：作者提出，采用标准化流程管理医疗陪同人员是确保遵循最佳实践指南的有效手段。可嵌入病历记录流程的盖章或同类工具，便是此类流程的有效范例。完善的病历记录可更便捷地识别指南依从性方面存在的问题，有助于保障参与私密检查的患者及医护人员的安全。