Sustainable quality improvement interventions to ensure adequate physician documentation of chaperone presence in breast clinic: a multicycle clinical audit.

Abstract

Introduction: Current best practice guidelines recommend chaperone presence during intimate clinical examination. Achieving guideline standards of documentation regarding chaperone presence has important implications from both clinical governance and medicolegal perspectives. This multicycle clinical audit provides insight into quality improvement interventions relevant to chaperone utilization and achieving guideline documentation standards.

Materials and methods: This single-centre, multicycle quality improvement audit was performed in the setting of a tertiary breast referral clinic at Beaumont Hospital, Dublin, Ireland. The quality improvement audit consisted of three audit cycles with two distinct interventions employed. Firstly, a 'chaperone stamp' was entered into the clinical notes prior to consultation to serve as a memory aid for physicians. Secondly, following transfer of clinical notes from paper-based to electronic records, a mandatory check field was introduced ensuring adequate documentation.

Results: A total of 388 female patients underwent breast examination at our centre. Despite levels of chaperone presence being directly observed at 100% in clinical consultations, chaperone documentation rates were poor (7.6%). Introduction of a chaperone stamp resulted in a 51.1% improvement in chaperone documentation. This intervention demonstrated poor sustainability as documentation standards declined by 13.6% at 6 months postintervention. Introduction of a mandatory check field using electronic patient records generated the most significant improvement in documentation standards, with 100% of clinical notes recording chaperone presence to reference standard.

Conclusion: Accurate documentation of chaperone presence or decline thereof is of relevance from clinical governance and medicolegal perspectives. Simple, resource-efficient interventions such as the 'chaperone stamp' demonstrate significant quality improvement potential but with questionable long-term efficacy. Electronic records present a viable opportunity for units to achieve guideline standards in a time and resource-efficient manner.