‘SUPERSEDES: NEW CODE NO. 400.124 Jackson SECTION: 400.000 ~ CARE OF THE PATIENT ents ses SUBJECT: CLINICAL OBSERVER POLICY POLICY & PROCEDURE MANUAL poucy: It isthe policy of the Public Health Trust to accept physiclans, resident physicians, registored nurses, ether heath professionals or students desiring to particpate as an observer in clinical ‘areas al Jackson Heath System facilis. The indvidual desiring to participate must provide the ‘required documentation to the appropiate office for approval. This policy covers observership ‘requests for al inpaient and outpatient locations and other designated facities in the Jackson Heath system. PURPOSE ‘To define observer and length of an observership, ‘+ To caify the ole of an observer To describe necessary qualifications and requirements + To outline the application process for an observership DEFINITION ‘An observer isa health care professional or student who will not provide patient care or have direct pationt contact Observers difer from students in an academic program in that the ‘bservership is not an educational requirement of any academic program (see administrative policy 389 for students). Observerships may last up to 4 weeks (1 month, longer if witen ‘approval by he department is obtained. Observerships may be in an inpatient or cutpatiant ‘setting and must be approved by the Jackson Health Systom facility's departments) directors} of the area being observed. Fr physicians, approval is needed from the Associaie/Chiet Medical Officer. For residents, approval is needed from the GME offce, For nurses, approval readed from the Director of Patient Care Services andlor the Chief Nursing Officer. For all oher sludenis, approval is needed fiom the Associale/Chief Medical Ofcer. Helshe may be one ofthe fllowing: + Physicians (foreign or domestic) ‘+ Registered Nurses (foreign or domestic) ‘+ Other health professionals (e.g. Rasiology, Respiratory Therapy. Psychology, Pharmacy Technicians ele.) ‘= Students not covered under an existing afilation agreement ROLE OF AN OBSERVER ‘Subject tothe pationts permission, observers may watch procedures, surgeries, patent Interviews. Observers may altend patient rounds, teaching conferences, grand founds, and ‘non-confidential hospital committee meetings with advance permission fiom the committee DATE: 0472013 PAGE OF 5SUPERSEDES: NEW CODE NO, 400.124 Jackson vc SUBJECT: CLINICAL OBSERVER POLICY POLICY & PROCEDURE MANUAL s Heat ops chairperson. Observers may not pattcpate in any patient care actives or research Observers may not question or examine any patient. Observers may nol access or review a peaiants marca encord vathout the permission of ther sponsor. Observers may be permitted in the oporating room withthe permission of the servcelattending surgeon and subsequent approval othe Director of Perioperative Services andlor ACMO (refer to Perioperative poley 590 “Operating Room Vsllor/Observer Policy’). Requests must be made i advance of the surgery PROCEDURE: |. Aformat written request is required ofthe observer and if possible submitted onthe home insitation’s letterhead (not require of students), Tho request must identity the ‘objactves and length of visit, name ofthe observer, the unit(s) in which the observation vil occur and what Jackson Health System medical staff member or employee is the ‘sponsor. (addendum I). The appkcation is submited tothe appropriate department as, ‘described above I. Tre following documents are required Letter of good standing from home institution (f applicable) Letter of acceptance by the JHS dlnical sponsor Signed confidentially agreement Copy of valid driver's license Copy of medical icense (Ff appicable) Copy of passport and visa (f applicable) Proof of immunization (including Nepalis B) -IF OBSERVING MORE THAN 1 MONTH hh Proof of negative T8 test ~IF OBSERVING MORE THAN 1 MONTH @osee Upon approval of the application, alter of acceptance wil be sent tothe observer, clnical service and securily services, TV, Allobservers must wear a valid identification at al imes during the observershi. a. ifthe observership i less than 1 weok sihe must obtain a paper ID badge fom the information desk at no charge. . Ifthe observership is to be more than 1 week a badge must be obtained from security services. The ID badge wil indicate OBSERVER status and inclide relevant Gates. A $10 processing fee will be charged. Upon completion ofthe ebservershp tne ID badge must be retumed to Security Services, “DATE: 042013 PAGE 2 OF 5SUPERSEDES: NEW CODE NO. 400.126 Jackson ‘SECTION: 400.000 — CARE OF THE PATIENT Henera serine SUBJECT: CLINICAL OBSERVER POLICY POLICY & PROCEDURE MANUAL \V. The depariment providing approval will maintain a tracking system of all observers with amas and dates of the observation, Vi. Allobservers must sign a contdentiaity agreement (atacnec), REQUIREMENTS, ‘An application must be submitted tothe sponsoring department head (addendum) ‘Al observers must wear val dentifcation badges at all imes during the observership in the ‘Jackson Health System, Observers must comply wth surgical attire policy while in the operating room. No photography s permitted at any ime. {All observers must sign and comply with the JH Confidentiality Agreement (addendum I}. Fallue to comply with these requirements wil result in an immediate end to the observership. APPROVED: Michael Butler, MD, EVP, CMO, Jackson Health System AUTHORIZATION: Carlos A. Migoya, President and CEO, Jackson Health System ‘ear013 PAGE 3 OF 8SUPERSEDES: NEW CODE NO. 400.124 Jackson Heater sysrTa ‘SUBJECT: CLINICAL OBSERVER POLICY POLICY & PROCEDURE MANUAL ADDENDUM Jackson ia ‘ear store APPLICATION rebethne teat rose rte One pete ean es ost requested information below, It takes 10 business days to process your application and supplemental materials Fret Nome LastName: Phone Number mat Address StarvEnd Date of Observation [ uonyry — MwDOYY ‘Area(s lo Be Observed Achieved Level of Education: [C]itah schoot [7] Bachelors [—] Masters [] Doctorate "What aretha goals and objectives for yaur observational experience? ‘SPONSORING INSTITUTION (IF APPLICABLE) Name Ares Contact Person ‘& phone umber DATE: 0407S PAGE 4 OF 5SUPERSEDES: NEW CODE NO, 400.124 Jackson See mecnisysrau SUBJECT: CLINICAL OBSERVER POLICY POLICY & PROCEDURE MANUAL ‘ADDENDUM I! Confidentiality Agreement | understand that this Confidentiality agreement shall cover any and all things observed or siscussed while |, ‘am on campus and inthe faclitias of Jackson Hain System (WAST. Tha purpose of my vis o participate in taining and education for professionals in my field. Confidential information may include, buts not limited to information on patients, employees, other workforce members, donors, research, and {inencal and business operations. Some ofthis information is made confidential by law (such as “protected health information” or PHI" under the federal Health Insurance Portability and ‘Accountability Act) or by Jackson Health System polices. o a a o Via a JHS official (undersigned), | have been given an overview of JHS policies and procedures, and understand mi role as a visitor with respect to patient privacy, securiy, ‘and confientiaty Confidentlat information may be in any form, i. written, electronic, oral, overheard or cbsened. | will not eisclose confidential information, including patient health information, to patients, fiends, relatives, or anyone else except as permited by JHS policies and applicable law. Atal times | wil protect the confidentiality of al protected information | may be exposed to, including patient neat informatio, while at JHS. ‘All confidential information remains the property of JHS and may not be removed or kept by me when | eave JHS except as permitted by JHS or required by law. I required by law, | wil provide the JHS Privacy Office with note in advance of any release of information. | wll provide immediate notice tothe JHS Privacy office if there ‘or disclosure of protected healt nfermalon, {1 violate this agreement, I may be subject to criminal or civil penalties. ny Inappropriate use ‘This agreement survives the end of my time as a visor at JHS. | have read and understand the above and agree to be bound by the terms of this agreement Print Name: Signature (Visto, at Signature (JHS Officia) Date: DATE: 0472013 PAGE OFS