INDUSTRIAL ATTACHMENT

REPORT
JARAMOGI ONGINGA ODINGA TEACHING AND REFERRAL
HOSPITAL

[Link] 849_40100

KISUMU COUNTY

COLLEGE: KMTC KAPKATET CAMPUS

COURSE: CERTFICATE IN HEALTH RECORDS AND INFORMATION

TECHNOLOGY

UNIT TITLE: FIELD ATTACHMENT

STUDENT NAME: VALENCE MASITSA

REG NUMBER: C/HRI/23030/434

SUPERVISOR NAME: AUDREY PATROBA

ATTACHMENT PERIOD: 1ST SEPTEMBER TO 1ST DECEMBER 2023

ACKNOWLEDGEMENT
I thank the Almighty for life He granted me. My gratitude goes to my parents for paying my
attachment fees and creating a good environment for my practice. I also acknowledge the entire
Kapkatet fraternity for the support to attend my practicals.

I also thank the a JOOTRH dministration for giving me the opportunity to be able pursue my
attachment. I also acknowledge the in charge HRIO,(Audrey Patroba) for cooperation during
supervision till the end.

I also thank all the JOOTRH HRIOs for enabling me to cope up and farmiliarise with the
departmental practices

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TABLE OF CONTENTS
ACKNOWLEDGEMENT..................................................................................................................................i
TABLE OF CONTENTS...................................................................................................................................ii
DECLARATION.............................................................................................................................................iii
ABREVIATIONS............................................................................................................................................iv
ABSTRACT....................................................................................................................................................v
CHAPTER ONE..............................................................................................................................................1
INTRODUCTION.......................................................................................................................................1
Curative and preventive care and promotion of health of the people........................................................2
CHAPTER TWO.............................................................................................................................................3
[Link].............................................................................................................................................3
2. Registration of patient cards both manually and electronically........................................................3
3. Directing of patients to the next level of service...............................................................................4
4. Sorting of outpatient cards.................................................................................................................4
5. Filing of outpatient cards....................................................................................................................4
6. Retrieval of outpatient cards..............................................................................................................4
7. Capturing of outpatient bio data into MOH 204 A and B...................................................................4
8. Tracing of patient files movement in the facility...............................................................................5
[Link].....................................................................................................................................................5
[Link] and indexing of files using ICD 11..........................................................................................6
11. Main categories of KHIS....................................................................................................................7
12. Editing...............................................................................................................................................7
13. QUALITY ASSURANCE........................................................................................................................8
STRENGTHS.......................................................................................................................................10
WEAKNESSES/ CHALLENGES.............................................................................................................11
RECOMMENDATIONS.......................................................................................................................11

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DECLARATION
I hereby declare that this training report is my original work and have not been submitted
before any academic award either in this or other health facility or institution. I also
declare that during my practical at JOOTRH, I gained a lot of skills that will enhance my
theory at school.

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ABREVIATIONS

JOOTRH -JARAMOGI ONGINGA ODINGA TEACHING AND REFERRAL HOSPITAL

B1-BIRTH NOTIFICATION

D1-DEATH NOTIFICATION

HRIO-HEALTH RECORD INFORMATION OFFICERS

OPD-OUT PATIENT DEPARTMENT

DHIS-DISTRICT HEALTH INFORMATION SYSTEM

KHIS-KENYA HEALTH INFORMATION SYSTEM

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ABSTRACT
This document is an industrial attachment report done at the health records department of
Jaramogi oginga odinga teaching and referral hospital located at kisumu. The JOOTRH has four
wards these are maternity, pediatric, female and male ward. It contains several departments,
outpatient department, orthopedic , rehabilitation, dental, comprehensive care unit, pharmacy,
maternal child health department, laboratory, theatre, X-ray, administration, medical social work
department, procurement, public health, nutritionist, physiotherapy and revenue department. It
headed by medical superintendent every hospital department being headed by in charge.

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CHAPTER ONE

INTRODUCTION
JOOTRH is a government hospital which provides comprehensive medical and surgical services.
It is located at kisumu nearby kondele highway. The hospital is in:

Vision

A center of excellence in quality healthcare services , training an research in East central Africa .

Mission

To provide accessible, responsive quality health care services through innovation, training
and research.

Motto

Flying high in health care

Core values

Client centeredness, professionalism, teamwork, integrity,

environmental .friendliness,equity,patriotism and innovation.

Services provided at JOOTRH

 Antenatal services
 Antiretroviral therapy services
 Basic emergency obstetric care services
 Curative inpatient services
 Family planning
 Growth monitoring and promotion
 Home based care
 Immunization
 Integrated management of childhood illness
 Prevention of mother to child transmission of HIV
 Radiology services e. g X-ray, ultrasound, magnetic resonance imaging (MRI)
 Tuberculosis diagnosis

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Curative and preventive care and promotion of health of
the people

 Quality clinical care by a more skilled and competent staff

 Treatment techniques such as surgery
 Laboratory and other diagnostic techniques appropriate to the medical, surgical, and outpatient
activities
 Inpatient care until the patient can go home or back to the health center
 Training and technical supervision to the health center as well as a resource center for health
center for health centers at each subcounty.

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CHAPTER TWO
 During my industrial attachment at JOOTRH, I went through various departments including:
 The outpatient department
 Laboratory department
 Comprehensive care clinic department
 Central records department
 Accident and emergency department
 Maternal child health department

At the outpatient department the HRIOs took me through various important practices, examples;

1. Receiving of outpatient clients

2. Directing of patients to the next level of service
3. Registration of patient cards both manually and electronically
4. Sorting of outpatient cards
5. Filing of outpatient cards
6. Retrieval of outpatient cards
7. Capturing of outpatient bio data into:
 MOH 204A- Outpatient under five years register
 MOH 204B-Outpatient over five years register

[Link]
On arrival of patients who were seeking for medication at the health facility, I was able to warmly receive
them at the outpatient department and listen to them and explaining to them what they were needed to do

2. Registration of patient cards both manually and electronically

This included details like;

i. The patients name (first name, surname and the last name)
ii. Age
iii. Sex
iv. Phone number
v. Date of birth
vi. Sub location

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 On entering the same details electronically, the hospital number which was the patient unique
identifier was usually obtained.

3. Directing of patients to the next level of service

At JOOTRH,the next level of service from the records department is the customer cares desk. The
patients were usually directed to the desk after leaving the records department where there were
various services were offered including;

a. TB screening
b. Nutrition status for children
c. The patients weight
d. Childrens height
e. Blood pressure
f. Body temperature

4. Sorting of outpatient cards

This included arranging of all patient cards after being used by the patients numerically ready
for filing.
5. Filing of outpatient cards
This included arranging numerically the sorted files in the filing system

6. Retrieval of outpatient cards

This was mostly done in the case of re-visits. The patient cards had to be retrieved for continuity of
patient care.

7. Capturing of outpatient bio data into MOH 204 A and B.

The details in the MOH 204 included:

 date
 OPD NO The. (new)
 OPD NO. (re-visit)
 Full names
 Age
 Sex
 Name of the health facility
 Village
 Telephone number
 Weight

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  BMI
 Temperature
 BP
 TB screening
 Diagnosis
 Treatment or prescription
 Remarks.

8. Tracing of patient files movement in the facility.

Types of tracing systems.

 Common tracer card

 Requisition holder
 Computerized system
 Booking register
 Individual tracer card

Contents of a tracer card

 Date
 Inpatient number
 Name of patient.
 Destination of the file
 Taken by who
 Receiving column

[Link]
Is the arranging of medical files in a systematic order

Types of filling system

[Link] filing system

[Link] system-used for filling x-ray files special reports post mortem reports, it also considers
which vowel comes first

[Link] system-filling according to the time of initiation of the document.

 Numerical filing includes straight numerical and terminal digit filing system.

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  Straight numerical always continuous doesn’t matter the change in years.
 Terminal filling using the last two-digit number.

[Link] and indexing of files using ICD 11

Procedure for coding.

A. Review the health

B. Identify the diagnosis and procedures to be coded
C. Identify the principal diagnosis and the alphabetic index
D. Review any sub terms under the main terms in the alphabetical index.
 Volume 1 –tabular list
 Volume 2-instructional manual
 Volume 3-alphabetical index

Coding of pregnant related conditions.

 Any conditions affecting mothers go to pregnancy, child health, use chapters rather than
code in infectious conditions.
 External cause of morbidity has 4 codes
 4th code comes from volume 1 (site) because they are preventable codes of morbidities.
 Death coding.

immediate cause of death – what just happened before death is quantified for time (day, hours
minutes or seconds)

 Underlying cause
 When coding morbidity use the discharge summary
 When coding deaths use death notification (D1)
 Any child born death
 Still birth
 Macerated
 Fresh are not written D1 they are written B1, B1 are written to a child born alive and born
dead
 Any child born alive and dies is written both D1 and B1.

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All fresh and macerated still births must be audited and renewed responded so that more deaths
are prevented by immediate actions and must be uploaded.

Maternal perinatal deathly surveillance and response

 You must have adequate registers to the facility

 Responsibility of actual data lies with HRIOS

11. Main categories of KHIS

 Tracker-used to upload daily report
 Aggregate-used to upload monthly report

How to upload data in DHIS

 Log in
 Application
 Data entry
 Data set
 Period
 Organization unit
 Choose facility
 Entry data
 Validate
 Complete

12. Editing
Systematic arrangement of documents in a medical file.

Editing procedures of medical files.

 Inpatient admission form

 Continuation sheet
 Inpatient treatment sheet
 Nursing notes-cardex
 Nursing care plan
 Morning and evening temperature chart
 Fluid intake and output chart

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  Blood pressure table
 Charge sheet
 Discharge summary form
 Radiological request and report form.
 Laboratory request form and report form.

Editing procedure of caesarean section files.

 Referral forms.
 Doctor notes
 Laboratory request
 Consent form
 Theatre pre-operative check-list
 Anaesthetic notes
 Theatre consumption sheet
 Nursing cardex
 Discharge summary
 Charge sheet

Editing of SVDS files

 Referral forms
 Doctors notes
 Laboratory request
 Treatment notes
 Nursing
 Discharge summary
 Charge sheet

13. QUALITY ASSURANCE.

Dimensions of data quality.

 Accuracy –data that has correct or actual information

 Completeness-all information that is needed must be entered

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  Reliability-data should observe consistency.
 Precision-data must have sufficient details.
 Timeliness-data should be up to date
 Confidentiality –privacy be protected from deliberate bias or manipulation.

Causes of poor-quality data

I. Poor primary registers

II. Lack of enough manpower
III. Lack of integrity
IV. Error in reporting
V. Lack of enough training
VI. Production of false data
VII. No private sections report

Importance of quality data

a) Assists in decision making based on;

b) Patient care
c) Health planning and budgeting
d) Designing and monitoring public health interventions
e) Informed policy formulation
f) Resource mobilization and management.

Steps followed in data quality assurance

 Check all data sources for any missing data element

 Check for any missing records in all data sources including any missing data set
 Check for any missing patient files-medical registration or data sets
 Check for consistent or errors across the different data sources-transcription from/to
appropriate data services
 Check for timeline in generations and submissions to high reporting levels should be in
accordance to the existing MOH standards guidelines
 Check for the accuracy of reports by recounting from source documents

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  Ensure that the filing and storage condition of patient files, register, and health facility
reports adhere to guidelines specified in SOPs
 Review the data entry process at the health facility
 Follow up on any actions agreed during previous data quality assessment
 Check for availability and use of recommended guidelines, procedures, and or protocols
 If any error within any data source including electronic data set for monthly report has
been identified, it must be immediately corrected as close to the point of entry
 Document identified errors
 Identify cause of errors in data set if possible and recommend measures to correct errors
in data collection process
 Give direct feedback to relevant staff in possible
 Produce and deliver a formal report of data collection, process including errors identified
&measures.

SWOT

S-Strength

W-weaknesses

O-opportunities

T-threats

Being a facility, JOOTRH had its own strengths, weaknesses, opportunities and threats.

STRENGTHS

 There is enough staff since both day and night shifts are well covered
 There is availability of WI-FI which helps in smooth running of hospital practices
 The records department is a stand-alone department
 All the departments are well incorporated with the management
 Computers are available

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WEAKNESSES/ CHALLENGES

 The filing system is complicated since it is not well maintained.

 The name the birth notification are not easily found because the books used to give the
information are tortured leading to wrong information
 There are power outrages
 Inadequate supply of commodities including drugs
 The hospital uses old version computers
 Inability of patients to pay for medications
 There was delay in clinic preparations leading to overcrowding of patients

RECOMMENDATIONS

 The HRIOs should improve the communication skills

 The HR department should enhance good and proper maintenance of computers so as to
facilitate good working capacity
 They should introduce a tracer card in the library
 The doctor should communicate to the HRIO workers before booking an appointment so
as to avoid confusion during clinics.
 The filling area should be improved so as to avoid overcrowding.
 Mending should be done in the library to create more space for files.
 The hospital should improve the filing system in the clinics.

CONCLUSION

 The hospital should strengthen power supply by provision of power backup for efficient
service delivery to the patients.
 For efficient revenue collection the hospital should restructure patient flow in the facility.

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