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��1 Recent studies have indicated insufficient use of chaperones across primary as well as secondary care.5�C8 Previous studies have highlighted how doctors�� attitudes to intimate examination may influence their use of chaperones.9 10 Studies have also shown that many patients see the offer of a chaperone as a sign of respect from their doctor and helps build a good patient�Cdoctor relationship.5 6 In this project, the authors aimed to investigate current offer, documentation and, thus, use of chaperones, within a major breast service unit. It then explored the use of a ��note stamp�� to improve adherence to professional guidelines concerning chaperones. Methods This single centre quality improvement project included three audit cycles (figure 1). All patients attending a breast service department outpatient appointment were included. It is important to note that this does not include patients attending routine breast screening. Figure?1 Study timeline. Sample size was calculated based on an estimated average number of clinical encounters per week within the department; population number 250. At 95% confidence levels and an interval of ��5, the sample size needed was 152. This was achieved across all cycles. An PDE4B initial retrospective analysis of all available outpatient notes after clinical completion was performed. In all three cycles, patient gender was recorded but further demographic analysis was not. The authors audited four initial questions to determine full adherence to professional guidelines. Full guideline adherence is defined as documentation of chaperone being offered, documentation of patient preference for chaperone and chaperone identifier (name or signature of chaperone) present.1 Was an examination documented? Was offer of chaperone documented in the notes? Was documentation of chaperone preference indicated in the notes��declined/accepted? Was the attending doctor male or female? First postintervention cycle The following interventions were completed and the department was re-audited. Interventions Discussion of findings in the weekly multi-disciplinary team (MDT) meeting and recent GMC guidelines regarding ��intimate exams and chaperone�� were highlighted. Additionally, data from a freedom of information request to the Medical Protection Society (MPS) quoted were ��at least twelve cases in 2012, where criminal investigations were instigated against doctors around sexual assault.�� (Godeseth C, personal communication October 2013). Introduction of a ��chaperone stamp�� into the outpatient notes (figure 2). Figure?2 Initial Chaperone Stamp. Memo pamphlets placed in clinic rooms (see online supplementary appendix 1). The same questions plus an additional two questions were then re-audited.