KENYATTA UNIVERSITY
SCHOOL OF PUBLIC HEALTH
DEPARTMENT: HEALTH MAGEMENT AND
INFORMATICS
COURSE: HEALTH RECORDS AND INFORMATION
MANAGEMENT
UNIT CODE: PHI 404
UNIT TITLE: FIELD ATTACHMENT
NAME: MULUPI M. GERALD
REGISTRATION NO: Q124/4054/2013
FIELD OFFICER: MR. SOITA
SIGN:……………..
TITLE
FIELD ATTACHMENT AT KAKAMEGA COUNTY GENERAL HOSPITAL FROM APRIL 3RD
TO JULY 31ST
ACKNOWLEDGEMENTS
For the period I have been to kakamega general hospital, I would like the following individuals
and groups for the respective help they have done to me. The report is based on heavy inputs
from Health Records and Information Management professionals consultations. First I would
like to thank the Kakamega county general administration for allowing us undergo the field
attachment in their facility being led by medical superintendent, I would also the administration
for the recognition they have given to the students studying in the hospital. Secondly, I would
like to extent my sincere gratitude to the head of department Health Records and Information
Management Mr. Soita who is health records and information officer in charge for his
hospitality, his dedication to make sure that I have learnt in every department that I visited and
also providing me rules and regulations as a student to operate in. Furthermore I appreciate
the Records department staff for taking me different activities in different stations of records
that I went through to gain experience. Third, I would like to thank my colleague students who
acted as my peer educators who guided me and taught me where I didn’t understand,
especially those students from KMTC they had a positive impact on my study. Finally I would
like to acknowledge the support from my family especially my mother for her generous funding
to make sure am comfortable at the hospital at the time it was appropriate and her utmost
concern to make sure that the entire attachment was successful.
TABLE OF CONTENTS
ABBREVIATION USED
MOA- Mode of Admission
DOD-Date Of Discharge
RFA-Reason For Admission
IR- Interpersonal Relation
MDP- Manic Depression Psychosis
TLE-Temporal Lobe Epilepsy
S.V.D-Spontaneous Vertex Delivery
CS- caesarian delivery
DOA-Date Of Admission
OP-Outpatient
DBR-Daily Bed Return
HAS-Hospital Administration Statistics
DHIS-District Health Information System
ART- Antiretroviral Therapy
VCT- Voluntary Counseling And Testing
FP-Family Planning
CTX- Cortrimoxazole
PWP- Prevention With Positives
DAR- Daily Activity Register
BMI- Body Mass Index
ICD- International Classification of Diseases
ABSRACT
The main Aim of the attachment was to take as the really activities that are carried out in the
entire health records and information career together with ethical issues that are practiced
while in the field. My professional attachment I carried it out in Kakamega county general
hospital in the same department as my profession and it took me three month to learn and to
be competently doing several things as a health records and information manager.
We were taken through calculation of hospital administration statistics where we could deal
several arithmetic to come with solutions to bed occupancy, ALOS, T.O.I, average bed days,
occupied bed days and percentage occupancy.at the wards we used to fill DBR, calculate and
summarize the results on the summary sheet.
Coding and indexing, whereby we coded different conditions such as natural diseases, injuries
and accidents, abortion which entailed complete and incomplete abortions and births which
included S.V.D and C.S
1.0 INTRODUCTION
1.1 Historical Background of KCGH
KCGH was started way back in 1926 as a military camp dispensary with some of the buildings
that were initially used as barrack being turned into wards. Four of these buildings had a
capacity of forty patients on the total average. Due to rising demand, four additional wards
were constructed to ease congestion, currently the same are undergoing renovation as the
building were too old with poor sewage system.
Other units were set up under the support of Kenya Finland Primary Health Care project
namely; Inpatient department that houses MCH/FPS, Laboratory, Pharmacy, Radiology, Dental,
ENT departments and special clinics were constructed in the early eighties by MOH in the spirit
of integrating outpatient department services.
There is a psychiatric unit that serves the whole of western environs. Amenity section was later
put up and caters for NHIF holder and others. Mortuary has adequate space, the services are
fully utilized and include embalmment, post mortem and preservation.
KCGH is a level 5 hospital health facility and was formerly known as Kaka Mega Provincial
General Hospital. The hospital has a catchment population of 77306 with an estimated average
outpatient workload of 1700 monthly average inpatient of 1457 monthly. It has 500 beds
1.2 Hospital Location
It is located in Shieywe location, Lurambi kaka mega county and western part of Kenya.
1.3 Climate
The climate of KCGH is hot and wet and people plant maize and sugarcane as their staple food.
1.4 Vision
To be a leading regional center of excellence in hostalic health care delivery, medical research
and education
1.5 Mission
Provide accessible, affordable and sustainable quality, curative, preventive, promotive,
rehabilitative and educative health care service to client
1.6 Value
To develop, retain and motivate.
MANAGEMENT IN THE HEALTH RECORDS AND INFORMATION DEPARTMENT
Below is the Health Records and Information hierarchical organogram showing the flow of
information across the entire department from the top management of the facility. The topdown mode of communication is usually used during the giving of instruction from senior
management of the hospital. While the bottom-up type of communication which is used mainly
in the time of report submission at the end of each month.
MEDICAL SUPRITENDANT
HEALTH RECORDS OFFICER
DEPUTY HEALTH RECORDS OFFICER INCHARGE
MATERNITY
OPD
CENTRAL
RECORDS
CASUALTY
CONSULTANT
CLINIC
PSYCHIATRIC
CCC
DATA
CENTER
STUDENTS
Psychiatric department
This is the station of records I attended to in the hospital; it deals with treatment of mental
illness. Mental illness is the diseases that affect the mind and the way those individuals think
and behave. Throughout the period I got to know dangers and signs of mental ill patient. Some
of the causes of mental illness include social stress or trauma. There are offensive words that
are used to describe mentally sick person are; mad, lunatic, crazy and insane instead of
mentally disturbed, unstable, mentally sick and mentally ill. There are several reasons that
might suggest the admission of a given patient in psychiatric ward which may include general
violence and poor IR, depression, refusing food and even not wearing clothes. Some of
psychiatric conditions include; APE, TLE, MDP, ABS. At the D.O.D the patient is passed through
Mental Status Assessment (MSA) wherein case of NAD the patient is allowed to go back home.
While registering psychiatric patients, care should be taken to obtain enough identification
information about the patient. This helps in caseof follow up is needed at any particular time.
Its in this section that I did analytical hospital statistics. There calculation;
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Average length of stay
Excess patient days
Percentage occupancy
Average daily population
Average bed days
Occupied bed days
Turn over per bed
Functions of health records and information
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Receiving and registering ne patients who are admitted in the psychiatric ward.
Provide legal admissions when they are needed whereby we have different MOA due to
different RFA.
Receive patient file and parole
Do coding of diseases
Indexing of the coded files
Retrieve patient files when they are needed
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Filing of the patient files
Compiling of monthly, quarterly and annually statistics
Provide data for research when they are needed.
Teaching students on attachment.
Creation of master ndex cards
Designing of medical forms
Activities done at psychiatric ward
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Registration of new patients
Reception of patients
Coding
Tracing of patient files.
Indexing of coded files
Booking of patients
Clinical preparation
Filing of patient files
Retrieving of patient files
Data center department
Here is where reports are generated. Reports from all departments are collected from all
departments and wards to be combined and reported to the next level. The next levels include;
health information unit, district medical records office and county medical records office.
Functions of health records officer in data Centre
1.) Compilation of DBR from wards.
2.) Calculating HAS.
3.) Aggregation of all data and information for various departments and sections.
4.) Compilation and analysis of reports i.e. monthly, quarterly and annually.
5.) Upload of reports to the DHIS system timely, accurate and complete.
6.) Presentation and dissemination of health information.
7.) Participate in development of AWPS or service delivery indicators.
8.) Maintaining security of health records equipment.
9.) Designing medical forms
10.)
Preparing section unit health record budget
11.)
Attend Health Records meeting as delegated to the HRIO
Reporting tools found in Data Centre
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MOH 717- monthly workload
MOH 710- immunization and vitamin A summary sheet
MOH 705A- under 5 daily outpatient morbidity summary sheety
MOH 705A –over 5 daily outpatient morbidity summary sheet
MOH 713- nutrition monthly reporting
MOH 515- community health extension workers summary sheet
MOH 105- service delivery report.
MOH 731- Comprehensive HIV/Aids facility reporting form.
MOH 718- inpatient morbidity and mortality summary sheet.
MOH 711- An integrated tool for reproductive
MOH 708- environmental health service.
MOH 734- CDRR for HIV nutrition commodities
MOH 706- laboratory summary report.
MOH 364-sexual based gender violence summary form.
MOH 643- CDRR laboratory commodities
Ways in which Data is submitted to the next level
There are two ways in which data is submitted to the next level;
(a) Through DHIS
Here computers are involved in keying in the information.
(b) The second way is through hardcopy e.g. tallying
The information is distributed in four copies in the following order;
1.)
2.)
3.)
4.)
The original copy should be sent to the health information unit
First duplicate copy should be sent to the district medical record office
Second duplicate should be sent to the provincial medical record office
Third duplicate should be maintained by the hospital medical records
Uses of service delivery and workload reports
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Hospital budgeting
Planning
Monitoring and evaluation
They are used as communication tools
Casualty/emergency department
At this station, it acts as the reception for the people who are in emergency conditions. It also
acts as the reception for the inpatient clients. The registration and admissions of the patients is
the main activities that takes place here. The admission is done using EMR for the new
admissions and readmissions. Readmission is done for those given patients have come for
another admission and that means previously have been admitted in the same facility. The
software used in the EMR in admission is called Check Health Information System(CHIS).
When admitting a patient, the details of the patient are captured into the Inpatient Register
(MOH 305). The details include the patient number, full names, residents, the person who
brought the patient and the ward admitted.
The patient is generated by numerical way of listing patients as the way they get admitted, the
patient being admitted is given a unique identifying number to the next previous patient in the
ascending order. The patient there for is given the Inpatient Card, whereby in case of a
readmission, the particular patient should show the card the Health Records officer to avoid
forgetting in case it happens.
Duties of health records officers at casualty include
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Teaching students on attachment
Filing patients notes
Issuing of files to patients
Registering patients
Retrieving and tracing of patient files
Birth notification
Filing back patient files
Doing file search for research
The standard operating procedures for registering patients
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DATE- the actual date the patient seen at the facility
OPD No- A unique identification number given to a new patient annually
REVIST-OPD number of the patients who return to the facility for services during the
calendar year
FULL NAMES-At least three names of the patient
SEX-Should be recorded as M for male and F for female
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AGE IN YEARS-Actual stated age of the patient expressed in figures/numbers and NOT A
or C
ADDRESS-Physical, land marks or telephone number of the patient and the next of kin
Outpatient department
It acts as the reception for outpatient patients. The outpatient department deals with those
patients who come treatment for just a while and go back home. Here the patient is received
and given the direction on how he is going to receive the treatment
Outpatient management
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Patient registration and billing for:
Special clinics
X-ray
Medical examination
Eye and simple extraction of teeth
Procedure for billing
Click on GOK, revenue code its records department to specify where you are billing from for
accountability. Enter the patient OP number on the receipt that has been registered with…..
then get charges on either request form that has been given by the doctor or prescription that
has been written on the paper that the patient has just come with, click on the search services
and enter the request services.
At a time when the doctor sends the charges and it reflects immediately the patient no is
entered… you click on the respective services and you bill as you give the receipt out.
Patient registration
There is creating new patient file- for the first visit and here the patient has to pay ksh.70 for
the registration. This is for the first time for the patient’s name to be entered into the system.
The information about the patient is entered into the system and the receipt printed out. The
information about the payments reflects to the doctor’s systems.
Revisit
For those who have ever come to the facility and their names are reflecting in the system. Here
the patient only pays ksh.50 for the visit. All his or her information is captured from the system
and is displayed.
Registers that are found in outpatient department
a) Outpatient (over 5) Register MOH 204B – this register is for registering all patient over 5
years who visit the hospital through the section. Their number is generated separately.
b) Outpatient (under 5) Register MOH 204A- this register is for registering all patients who
are less than 5 years of age. There outpatient numbers are generated separately.
The registers are not commonly used nowadays due to electronic registration using EMR. The
system has all information required from the patient captured and the patient given an
outpatient appointment card which carries the OP number of the patient, names and location.
The card helps the patient in case of revisit to be traced in the system easily.
COMPREHENSIVE CARE CENTRE (CCC)
CCC is a clinic on its on and is managed as any health facility. At this station. Clients are received
from different entries after having been diagnosed or tested positive. These entries include;
PMTCT, IPAD, TB clinic, OPD, VCT, IPDCh. There are several clients who are also tranfered in
from different facilities in the count. The patients at this station they are enrolled onto either
CTX or ARVs as per the level of CD4 counts in the body. The type of filing system that is used in
this section is straight numerical for the patients who started ART with the facility, for the
transferred in they are filed alphanumerically.
Ethics practiced in records
Health records that work in the CCC must operate under bound laws to make sure the
information about any patient cannot be exposed to any outsider. This laws of conduct include;
1) Confidentiality- it involves the privacy of the clients and the information they having.
2) Discipline- this is a code of conduct of behaving well before other staff, patients and to
other students.
3) Communication- it refers to the transmission of information from one person to
another. It can be within the department or from the top management and it carries
different information as per to the chain of command.
4) Security- the information about the patient should be handled under a high security, the
information should never be interfered with in any manner.
5) Disclosure- the patient of the patient is not supposed to be disclosed to any person
since it can be used as a weapon against that person. But due some curcumstances the
information is disclosed out;
 By court order
 Patient’s consent
 Safeguard the interest of the hospital or for the doctor
 Transfer of information between authorized health agencies
 Disclosure for higher duties of outbreak of diseases or side effect.
6) Ownership- the records used belong to the hospital but they normally carried by
patients during every time of revisit.
Heath Management Information System (HMIS)
It is in CCC that we learnt tools used to collect and how data is collected. The tools used to
collect data are, daily activity register MOH 366, MOH 731, MOH728, Pre-ART Register MOH
361A, ART register MOH 361B.
In patient files there is a blue card (MOH 257) which we extract information that we use for
tallying in the DAR Register. The totals from DAR are transferred to Monthly Tally Sheet MOH
728 and finally it is reported into MOH 731.
MOH 361A is used to show all the patients that have enrolled into care including those
transferred in. while MOH 361B is used to update the conditions of the patients who enrolled
to ART up to when these patients die, transferred out and lost to follow.
Analysis and interpretation of data
I learnt about ways and presentation of data,these were; pie charts, line graph, tables and
histograms.
Tools used in ccc
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They include the following;
Pre-ART Register MOH 361A
ART Register MOH 361B
Daily Activity Register MOH 366
Monthly Activity Sheet MOH 728
Patent Appointment card MOH 258
CCC Patient Card MOH 257
Functions of health records and information officers
a)
b)
c)
d)
Booking clients for every next revisit
Retrieval of files
Tallying daily Register and combining daily report
Filing back
e)
f)
g)
h)
i)
Giving direction to clients
Updating and initiation of ART Registers
Making of daily calendars
Registration of clients into EMR
Enrollment of patients and generating unique numbers
Tracing back patients records
j) Sorting files
k) Checking for misfiling
l) Recording of viral loads and CD4 results
Activities done by health records and information managers
a)
b)
c)
d)
e)
f)
g)
h)
i)
relating and handling of clients
to keep the records that belong to the patients
maintaining confidentiality of the patient’s information
booking appointments dates for patients
understanding the terms used in the CCC
understanding the tracing system used
understand the tools used in the CCC
understand the filing system used and the ethics used in records
making the daily reports
CENTRAL RECORDS/LIBRARY
Central records act as the central library for records for the patients. After discharge, patients
files are collected and brought here, through a series of activities are stored here. Files are
collected from different wards. When files are picked from any given ward after discharge, the
files are captured in the MOH 361 to show that they have been dispatched to the central
records for storage.
At this station, I learnt about coding and indexing of diseases. Coding is the assigning
alphanumeric value to a disease or a condition. There are three ICD 10 books that are used for
coding;
I.
II.
III.
volume 1(tabular list) -this one is used for confirming codes
volume 2(instruction manual)-this book is used for providing guidelines
volume 3(alphabetical index)- this is used for coding. And has three sections (section 1,
section 2 and section 3)
There are established steps for coding diseases. These are;
(a) Identify the type of condition to be coded and refer to the appropriate section to be
coded i.e. section 1, section 2 or section 3.
(b) Locate the lead term. Lead term is always a noun for pathological conditions.
(c) Read and be guided by any notes that appear under the lead term.
(d) Read any term enclosed in the parenthesis after the lead term.
(e) Follow carefully any cross-references found in the index (see this and this).
(f) Refer to the tabular list to verify the suitability of the code selected.
(g) Be guided by any inclusion r exclusion terms under the selected codes or under the
chapter, block or category heading.
(h) Finally, assign the code.
Functions
(a) Receiving files from wards
(b) Coding and indexing
(c) Sorting of files
(d) Filing
(e) Retrieving of patients files when need arise
(f) Tracing of patients files
(g) Checking of misfiling
(h) Issuing of burial permit
activities
 Sorting files as per the last two terminal digits
 Filing back
 Tracing the file incase its missing from the library
 Retrieving the files for readmission of the patient
 Coding
 Indexing diseases
Tools used
 Computer- the computer is used to capture the received the files, the name, conditions
and the wards from which the files are coming from.
 ICD 10 Books; vol 1 and 3- these are used for coding
 Tracer book- it is used to follow up a given file that was taken ou the central records
section to other places such as wards and by who took it.
 Diagnostic disease index card- index cards are used to monitor the disease trends, that’s
is there is outbreak of a given condition, pandemics, epidemics and endemic conditions in
the population catchment of the locality served by the hospital.
Maternity
This section is only for women. Most of them come to deliver and others for pregnancy
checkups. In maternity there are units of file collection, these are; antenatal ward, postnatal ward
and new born unit. During collection of files, they are written in the dispatch book and received
at the records department.
Functions
 Coding and indexing of diseases
 Issuing of birth and burial permits by use of B1 booklet
 Admission and registration of patients and clients
 Filing of patients files
 Tracing
 Retrieving patients’ files
Tools used
 Post- natal register
 Maternity register MOH.333
 In-patient register MOH.301
 B1 Booklet Mother booklet
 Summary sheet MOH.718
Activities
 Admission of expectant women
 Registration
 Filing
 Tracing
 Retrieving
 Coding and indexing
Consultant Clinic
It’s a special clinic that operates on outpatient manner and deals with patients with
chronic conditions who come on regular basis for checkups, treatment and close
monitoring. It has medical Outpatient Clinic (MOPC), surgical Outpatient Clinic (SOPC)
and Pediatric Outpatient Clinic (POPC).
Functions
 Booking clinics for patients for the next clinic as per the type of clinic
 Retrieving of patients files
 Filling back
 Checking of misfiling
Tools used;
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Computer-for checking patient name, IP numbers or OP numbers just in case the
patient doesn’t remember.
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Patients’ cards- which has got patient information as per the clinic and the booking
dates.
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Tracer book- for locating files that has left out to other sections of the hospital.
Activities
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Booking of clients for the next clinic
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Retrieving of patient file to be taken to the doctors
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Filing back
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Tracing of patient files
CHALLENGES, RECOMMENDATION AND CONCLUSION
Challenges
There was several challenges that we encountered during the entire period of attachment.
 Shortage of staff- there are limited number of health records and information officers
in the hospital. In vasualty there was even one health records officer and yet patients
to be attented to are in large number. They keep waiting at the queue especially at
lunch hours.
 Inadequate computers. The computers are a few in number. In data center there was a
single computer which is supposed to be operated by several people. This creates a lot
of inconveniences
 Inadequate space
 Misfiling
 Lack of commitment
 Overcrowding
 Lack of regular internet connectivity
 Misfiling
 Misfilling of DBR in wards
 Dust in retrieving files
 Lack of kick-stools for short individuals
Recommendation
 The hospital administration and those concerned should;
 Install more computers
 Increase the number of staff
 Create more space to avoid overcrowding
 Encourage those concerned to be careful when filing to avoid cases of misfiling
 Be committed to their work
 Work on the internet to ease work
 Encourage those concerned to fill the DBR daily
3.3 Conclusion
Despite the above challenges, we undertook our attachment and came out successful. We
recommend other students to come for attachment at KCGH, work hard and be disciplined