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Governance — DFSRH MCQ

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EasyGovernanceDFSRH

A 32-year-old woman attends a community sexual and reproductive health clinic for planned interval insertion of a levonorgestrel intrauterine device. Pregnancy has been reasonably excluded, she has capacity and valid consent has been obtained. She declines a formal chaperone because she prefers as few people as possible in the room, but asks for her sister to remain. The accredited fitter is working without another clinician. A receptionist who has completed chaperone training, but has not been trained to assist with cervical instrumentation, is available. The procedure is not clinically urgent. What is the most appropriate governance action?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Defer insertion and rebook when an appropriately trained assistant is available, documenting the chaperone discussion

Explanation lettering: B = shown as A · E = shown as B · A = shown as D · D = shown as E

FSRH distinguishes the supportive chaperone role from the safety-critical assistant role during intrauterine procedures. A chaperone should be offered for an intimate examination, but a capacitous adult may decline. That decision and the discussion should be documented. However, FSRH states that an appropriately trained assistant should be present during all cervical instrumentation procedures because they may need to provide equipment, monitor the patient, summon further help or perform basic life support. As this insertion is not urgent, it should be deferred until such an assistant is available (B). A is incorrect because documenting refusal of a chaperone does not remove the separate requirement for a trained procedural assistant. C is incorrect because chaperone training alone does not demonstrate competence to undertake the assistant's clinical safety functions. D is incorrect because the patient need not accept a separate formal chaperone; the appropriately trained assistant will usually also fulfil the chaperone role if the patient accepts their presence. E is incorrect because a relative may provide emotional support but cannot substitute for an appropriately trained assistant. The assistant's role should be explained clearly when rebooking, since insertion cannot proceed if the patient does not consent to the presence of the personnel required for safe cervical instrumentation.

Reference: FSRH Guideline: Intrauterine Contraception (March 2023, amended January 2025) — https://www.fsrh.org/Common/Uploaded%20files/documents/fsrh-clinical-guideline-intrauterine-contraception-mar-23-amended.pdf Improving chaperoning practice in the NHS: key principles and guidance (5 December 2025) — https://www.england.nhs.uk/long-read/improving-chaperoning-practice-in-the-nhs-key-principles-and-guidance/