CHAPTER ONE

Introduction

1.1 Background of the Study

Huffman (1994) affirms that the health records of patients are an important primary

tool in the practice of medicine. The whole idea behind it is to provide better care of the

patient through careful recording of every detail having to do with the patient illness and

care rendered. Therefore, health records of the patient should be made available to the

health professionals whenever patient visits the hospital for continuity of their previous

treatment. Failure to produce patient health record by the health information

manager/officer in the hospital due to misfiling of such health record will bring about untold

hardship on the part of the hospital and the patient. That is, the health professionals such as

the hospital management physician (doctors), nurses laboratory scientists etc. would not be

able to review the previous treatment and diagnosis given to the patient and wrong

treatment and diagnosis may be given to the patient at the end, which at times may lead to

the patient’s death, financial loss on the part of the hospital and the patient’s relatives may

sue the hospital for negligence and malpractice for damage done to the patient during the

cause of the treatment.

Yeo (1999), posits that hospitals deal with the life and health of their patients, good

medical care relies on well-trained doctors and nurses and on high-quality facilities and

equipment. Good medical care also relies on good record keeping, without accurate,

comprehensive up-to-date and accessible patients’ case notes, medical personnel may not

offer the best treatment or in fact may diagnose condition which can have wrong

consequences on the part of the hospitals and the patients. In addition, records also provide

evidence of the hospital accountability for its action and form a key source of data for

medical research, statistical report and health information systems.

1
 According to Nandalal (2013), a patient health record communicates information

about their progress to the physicians and other health professionals who are providing care

to the patient. It is a communication link among the patient care-givers. For those health

professionals that provide care on subsequent occasions, the medical records provide critical

information such as the history of illnesses and the treatment given. Also, health records

provide evidence that may assist in protecting the legal interest of the patient, the physician

and the health institution.

Therefore, we keep health records for a number of reasons:

 For communication purposes while caring for the patient.

 For continuity of patient care over the course of the patient illness.

 For evaluation of patient outcome.

 For medico-legal purposes.

 For use as a source of health statistics.

 For research, education and planning.

Huffman (1994), affirms that the health records is an orderly written report of the

patient complaints, the diagnosis findings, treatment and end result that in total form clinical

picture and when completed provides sufficient information to clearly identify the patient to

justify the diagnosis and treatment, and to record result. Because “patient forgets but record

remembers,” the health record is of the value to the patient, the hospital, the physician and

for research and teaching. Sequel to the aforementioned, it could be deduced that health

records keeping is the pivot of medicine. Failure to produce patient health records during

his subsequent visits to the hospital by the health records officer due to misfiling of patient

health records in the health records department may inflict a lot of problem on the patient,

the hospital and the physician. The continuity of the patient care would be hampered, wrong

diagnosis may be given to the patient, patient may be delayed unnecessarily before being

2
attended to by the physician, the hospital management will not be able to review the quality

of care rendered to the patient during his stay in the hospital and the patient relatives may

conclude that negligence and malpractice have been committed during the course of

treatment and therefore sue the hospital management for damages. In order to avoid the

above mentioned, the health records managers/officers should be up and doing in the

hospital to make records of patient available whenever it is needed by the health

professionals for continuity of the treatment.

1.2 Statement of Problem

Misfiling of patient health records have been a great problem to all health

institutions in Nigeria. To review and evaluate the care rendered to the patients by the

hospital management will be a great problem if the patient health records cannot be located.

Moreover, managerial decision will not be easy without the patient case note. A lot of delay

and loss of valuable cost would be experienced by the hospital and the patient. Therefore,

this study wants to investigate the causes, consequence and available solution to the

problems of misfiling of patient health records in the health records department.

1.3 Significance of the Study

The result of the study would be useful to health educators, administrators, and

Government, N.G.O and policy makers. The result will further be useful to students, doctors

and the community at large.

1.4 Purpose / Objectives of the Study

i. To examine the available filing and numbering system in health records department.

ii. To assess the available filing equipment in the health records department.

iii. To assess the types of health records personnel involved in filing and retrieval of

patient health records.

iv. To evaluate the effect of misfiling of patient health records in health institution.

3
 v. To find solution to the problems of misfiling of patient health records in the health

records department.

1.5 Research Questions

i. What are available filing and numbering systems in the health record department of

General Hospital Keffi, Nassarawa state.

ii. What are the various available filing equipments in the health records department?

iii. What are the types of health records personnel involved in filing and retrieval of

patient health records in the health records department of General Hospital Keffi.?

iv. What are the effects of misfiling of patient health records in the General Hospital

Keffi?

v. What are the solution to the problems of misfiling of patient health records?

1.6 Research Hypothesis

Ho: There is no association between the knowledge of the effects of misfiling among

different professions in the study area (General Hospital Keffi).

H1: There is an association between the knowledge of the effects of misfiling among

different professions in the study area (General Hospital Keffi).

1.7 Scope of the Study

This study is limited to General Hospital Keffi, Keffi Local Government Areas to

ascertain the problems associated with misfiling of patients case note in the Hospital.

Despite the fact that the researcher intended to broaden the scope of the study but limits it to

General Hospital Keffi, Nassarawa State due to financial constraint and time factor.

1.8 Operational Definitions of key Terms

I. Statistics: is the science that is concerned with the collection, organization,

presentation, analysis, and interpretation of numerical statement of facts, such that

4
 the degrees of uncertainty in the conclusion drawn from the data are minimized as

access.

II. Analysis: WHO, (2009) stated that is the detailed examination of the elements.

III. Misfiling: file (a document) in the wrong place.

IV. Problem: a matter or situation regarded as unwelcome or harmful and needing to be

dealt with and overcome.

V. Hospital: Wikipedia, (2015) defined hospital as a health care institution providing

medical and allied service to people with specialized staff and equipment that is best

known.

VI. Disease: is any abnormal condition

VII. Patient: is a receiving medical services

VIII. Patient Case Note: Case notes contain a surprising number of documents relating

to patient care, as well as pro-forma record sheets and patient-doctor

correspondence, they can also include lab reports, X-rays, photographs and other

visual representations.

5
 CHAPTER TWO

REVIEW OF LITERATURE

Introduction

2.1 Availability of Patients’ Case notes in the Clinic

Ayilegbe (2008), posits that Health Information Managers are the initiator of

patients’ documentation in any hospital. A patient cannot be attended to in abstract, and

therefore, there must be initial documented fact about him which would serve as a baseline

for the commencement of other health care services by other members of health

professionals. Health Information Managers engage in documentation in every segment of

Health Records Department such as General Outpatient Department (GOPD), Accident and

Emergency (A&E) Records Unit, NHIS Records Unit, Cancer Registry Records Unit, ANC

Records Unit, and other specialty clinics. The role of Health Information Managers in

patient documentation and care cannot be overstressed as it provides necessary “oil” for

smooth running of multifarious hospital services. This is noticeable in the effective

utilization of numbering system which helps greatly in the identification of every patient

regardless of their numerical strength and number of visit at any time. The role of Health

Information Managers in patients’ documentation facilitates follow-up care which in turn

brings smiles on the faces of patients during their visit to the hospital for continuity of the

care.

The accurate and complete documentation by Health Information Managers assures

easy location and availability of patients’ case notes through effective utilization of tracer

cards. The Health Information Managers are also expected to prepare in advance before the

clinic’s day, all the patients’ records that have being booked on appointment with the

respective consultant and making the case notes of patients ready and available at the clinic

for easy access by the consultant in order to facilitate effective treatment of the patients.

6
Without the professional documentation of Health Information Managers in various

specialty clinics vis-à-vis appointment system, general outpatient clinic (GOPD), consultant

outpatient clinic (COPD), accident and emergency clinic (A&E), NHIS clinic, etc,

congestion and chaos would have been the order of the day. Above all, numerous clinical

research activities being carried out for improved health care services can easily be stoned-

walled when Health Information Managers refuse to make patients’ case notes available to

the researchers. More so, what has been documented according World Health Organization

(WHO), standard makes it possible for related cases to be stored and retrieved for research,

teaching, treatment and statistical purposes among others. Hence, Health Records

Department can be termed as “the life wire, life blood and backbone” towards a result

oriented health care services in the nation.

Ayilegbe (2008) affirms that it would be ridiculous to see some patient’s health

records flying about without adequate measures in place for their proper custody.

Painstaking efforts must have been employed to generate health documentation for patients

by various members of health care team. Putting into cognizance the confidential and legal

matters among other issues that may arise from the usage and management of patients’

health document, it behooves the management of a health institution to ensure proper care

and custody of these health information documents. There is statutory requirement for the

proper custody of patients’ health records in every health facility to facilitate availability of

these records whenever they are requested for by the physicians and other health providers

in the health institutions for continuity of patients care. Hence, Health Information

Managers are the chief custodian of all patients’ health records in every organized health

institution. Health Information Managers are recognized by law to ensure professional

custody, safety, and proper management of patients’ health records.

7
 In some health institutions, it would be absurd to entrust the custody of patients’

health records in the hands of staff who are not Health Records Practitioners. This situation

is unhealthy both legally and ethically. Professional standards should be upheld in every

health institution in order to conform to the statutory requirement custody of the patients’

health information. Health Information Managers are qualified, well-trained and skilful in

all functions that pertain to records management. Thus, for qualitative and professional

custody of health records, proper professional placement should be adhered to in order to

achieve the desired health service delivery. Since Health Information Managers are the

custodian of patient’s health records and recognized by law in any health institution to

create, store, retrieve and even destroy unwanted patient health records, therefore,

availability of the patient’s health records in the clinic is the responsibility of the Health

Records Department in any health facility.

Numbering system is critical to ensure proper filing of health records in the hospital

environment.

2.2 Numbering System

Aremu (1999), affirms that numbering system is basically an identifying factor used

to label the record and facilitate its being filed in a systematic manner for easy retention and

retrieval. In most Health Care Institutions, Health Records are filed numerically according

to patient admission numbers. In the past, some Health Care Institutions have filed records

according to names of patients, discharged numbers or diagnostic code number.

Alphabetical filing by patient names is subjected to error than its numerical filing. Filing by

discharge numbers and diagnostic code numbers generally prove to be unsatisfactory

because the importance that records registers generated in the facility are concerned

exclusively with the admission number.

8
 However, filing in numerical sequence involves the additional choice of maintaining

a separate Alphabetical Name Index. This numbering of Health Record offers several

advantages:

1. It facilitates the identification of document pertaining to individual patient, feature

which is important where names are identical or similar.

2. Filing is more efficient.

3. Confidentiality is enhanced.

There are three types of numbering systems that are currently in use in Health Care

Facilities, they are: 1. Serial numbering system, 2. Serial-unit numbering system, and 3.Unit

numbering system.

2.2.1 Serial Numbering System: In this method, the patient receives a new number each

time he or she is admitted to or visited the hospital for treatment. If he or she is registered

five times, he or she acquires five different hospital or registration numbers.

2.2.2 Serial-Unit Number

This numbering system is a synthesis of the serial and unit numbering systems. Although,

each time the patient is registered he receives a new hospital number, his previous records

are continually brought forward and filed under the latest issued number.

2.2.3 Unit Numbering System

Osundina (2005), asserts that unit numbering system involves the allocation of one

number to one individual patient in the hospital which he/she will be using throughout

his/her life time in the hospital. Which means all hospital documentation experiences, notes

relating to a patient are contained in one case folder; the unit should be the patient, the

principle of unit system is that “One Patient, One Record, and One Number”. The number is

quoted as his reference number in all clinical departments of the hospital, no matter how

often he attends. Therefore, the unit system is one in which all notes on an individual

9
 patient, however widely separated in time, and however many departments (in-patient or

out-patient) have rendered service to him, are kept in one folder. The patient is the unit and

is allocated a single number which is quoted as his or her reference in all clinical

departments of the hospital and however often he attends.

The following procedures contribute to making of a comprehensive Medical

Records Service based on the unit principles helpful in checkmating misfiling of patient

health records:

i. The Central Index: Each patient is issued a central (or master) index the first day he or

she is registered as either an out-patient or in-patient. The following are the information

to be recorded on the central index: Patient’s surname and first name, Patient’s unit

number, Patient’s address (with provision for changes in address), Patient’s date of

birth, Unit number, Date of registration, Patient’s sex etc. The central index should be

completed very neatly and filed alphabetically according to the surname of the patient. It

should never accompany the case note to the clinics or wards. In cases of identical

names; it may be necessary to file cards according to the age of the patients and date of

registration e.g. SULE KAREEM, Age 19, Registered on 1/2/2016 and SULE

KAREEM, Age 32, Registered on 3/3/2016 etc. the patient’s master index card is the

key for locating patient records, and therefore it must be considered the most important

tool in the medical record department.

ii. Tracer System: In Health Records keeping, a Filing System is very important. In order

that a filing system may perform the function of an information service, certain controls

are necessary to ensure the where-about of the issued documents or patient case notes.

Health Professionals who have knowledge of the intricacies involved in the movement

of case records within the hospital will appreciate that the problems associate with

effective controls are formidable. For this reason; a tracer system is absolutely necessary

10
 in any large filing system of the hospital which has multiple users and the tracing

procedure must be followed every time a file is retrieved.

In deciding upon a suitable tracer system, due account must be taken of withdrawal

rate of documents and the time span during which they are required. To deal with

emergency patient; Health Records are required at all hours of day or night and

maintained 24 hours services. Therefore, a tracer system is a system which is introduced

into the unit system when a unit health record is initiated so that the where-about or the

movement of patients’ case notes can be easily ascertained. A tracer card is issued at the

same time the unit Health Record is initiated while the patient is still physically present

in the hospital for health care; the tracer card is sent to the record and is filed away in

the space on the shelf for that case folder. When the case folder is returned, it is the duty

of the Health Record Library staff to ensure that the tracer card is put inside the case

folder and to record the date of return on the tracer card. Whatever actual tracer

procedures that are used, it is necessary to record the same basic minimal information

concerning the recipient of the documents: (1) Date issued (2) Hospital number (3) The

name of the borrower or department (4) Purpose.

2.3 Health Records Library

Aremu (1999), posits that one of the important functions of the Health Records

Department is the custody and retrieval of Health Record for legitimate users. Health

Records Library is where these records are kept. Bulky records requested for research are

released in batches. Health Records completion cubicle is located in this section to enable

the medical officer sit down comfortably and carry out their studies without going away

with patients records. Tracer card must be marked for every case note leaving records

library. The tracer card will show the destination of the patient’s health records.

11
 The Health Records Library should be well ventilated, lightening and well spacious

to prevent unnecessary misfiling of patients’ case folders. The bulky case folders should be

separated into volumes to prevent space problem. The filing shelves should be well labeled

to aid filing and retrieval of patients’ health records. Dividers must be in-between the

shelves or cabinets to prevent fall-over of the case folders which can lead to terrible

misfiling of patients’ health records. Health records library is the pivot of the Health

Information Department because records of the high values are stored in this library such as:

health records of patient that are needed for litigation in the court of law, records of

evidential information, research, administrative and historical values. The following

activities take place in the Health Records Library: sorting of patients’ health records, filing

of patients’ records, numbering of patients’ case folders, classification of patients’ records,

collation of patients’ statistical information, retrieval of patients’ case notes for continuity

of treatment, budgetary provision, accommodation, space planning, records storage

equipment, research and study, etc.

2.4 Health Records Filing System

Osundina (2014), affirms that for Health Records Department to function efficiently,

it is necessary to have an organized method for storing of the health records. Therefore,

filing system can be described as a set of documents arranged in prescribed order for

convenience of reference and preservation. The purpose of filing records is to facilitate

complete and quick retrieval of patient information from them when the needs arise.

The prime responsibility of the Health Records Department is to undertake the

custody, classification and confidential of the patient case history. The department is also

concerned with the custody of index of diseases and operations. However, an effective

filing system should contain a number of fundamental features, they are:

12
 i. Compactness: To take account of storage space and also need to reduce physical

effort in working the system.

ii. Accessibility: For speed of location and positive means of identification for the

items contained in the system.

iii. Simplicity of operation to ensure that the method is understood by those who

normally control it but also by those who require occasional access.

iv. Economy: Economy, both in cost of installation and operation.

v. Elasticity: The system should expand and contrast according to future requirement.

vi. Cross Reference: This facility must be considered so that a folder can be found

under different heading.

vii. Tracer System: A tracer card must be placed in position of a removed folder to

indicate the destination of the folder.

viii. A Method of Classification e.g. Terminal digit or middle digit etc.

ix. The equipment in use must be effective and efficient of the system.

x. The personnel operating the system must be well trained i.e. health records

practitioners.

2.5 Filing Methods

There are three basic methods of filing, namely; alphabetical, chronological and

numerical. These methods can be used singly or in combination according to the

requirement design and the particular circumstance of the institution. No method or system

should be adopted without considering the environment in which to function.

i. Alphabetical Filing: Health record can be filed according to the use of names or letters.

In case of person bearing the same name, placing surname first, middle name and other

name and the card are arranged according to date of birth or date of registration e.g.

master index card. This system is ideal for small hospital or hospital with low patronage.

13
 This method is unsatisfactory in large hospital because it lacks elasticity. The

growth is in middle thereby making continuous expansion within the system difficult for

advanced planning. Human errors are greater here, when filing case notes it does not

require master index card as back up for the system.

ii. Chronological Filing: In this system case folder are arranged and filed in prescribed

order. It is a method of filing according to the date and time of event. This is more

applicable when considered in relation to the content of a folder in relation to

waiting list and follow up system. However, an alphabetical index is introduced

where the number are considerably large. Chronological filing and numerical filing

are not capable of standing alone and required an index to allow access to the

material contained in the system. Chorological filing therefore is not a filing means

of dealing with case folders.

iii. Numerical Filings: This is the system of filings according to numbers. This filing

system overcomes the problems associated to the lack of elasticity as in alphabetical

filing. It allows continuous expansion. Growth is at the end. It’s totally compatible

with the unit system of record keeping.

2.6 Filing Equipment in Health Records Department

Osundina (2014), posits that adequate filing equipment, lightening, and temperature

contribute to the productivity of filing personnel in the records library. The following are

some types of filing equipment, they are: (1) filing cabinet (2) Elevator cabinet (3) Fixed

shelves (open or closed) (4) Mobile shelves (manual/mechanical) (5) Four drawer steel

cabinet (6) Ladder.

Whichever equipment chosen, the aim is to provide largest number possible in the

space available at most reasonable cost. The closed shelves are becoming popular because

14
of its added advantages, security and keeping dust or dirt away from records. Shelves are

recommended over cabinet for the following reasons:

1) It is less expensive than cabinet.

2) Filing and pulling are faster because there is no opening and closing of the drawers.

3) Shelves are space safer.

While it is true that cabinet provides a somewhat neater filing area, it also protects

records from dust and dirt, good housekeep in an open shelve filing area can make up for

this advantage. Moreover, the door that shelves have now, are taking advantages over the

cabinet.

2.7 Aids to Accurate Filing in Filing Environment

Aremu (1999), affirms that the following will aid the Qualified Health Records

Personnel in solving the problems of misfiling of patients’ health records in the Health

Records Library, they are:

 Introduction of colour coding to Health Records Library.

 Introduction of efficient tracer system to Health Records Library.

 Legibility in numbering case folders.

 Introduction of terminal digit filing system.

 Adequate ventilation and lightening in the filing areas.

 Introduction of centralized filing system.

 Largest storage of health records library.

 Good spacing between filing shelves as well as good dividers.

 Length and height of shelves should be minimized.

 Adequate security measures in the filing area.

 Constant supervision of the filing clerks working in the library.

15
  Division of labour in the health records library to prevent unnecessary burden on

staff.

 Provision of auxiliary equipment, for example, sorting shelf, ladder, stool guide

cards etc.

 Prompt collection of patients Health Records after patient is discharged from the

ward.

 Prompt collection of patients Health Records in the clinic after consultation.

2.8 Problems of Misfiling and Mislaying of Patients’ Case notes in Health Records

Department

Huffman (1994), opines that regardless of the number of record control system used

in the health records department file area, occasionally, a patient’s record will be placed in

the wrong location (misfiling) or will not be signed out correctly (mislaying). Various

techniques are available to assist a person in locating a medical record that has been

misfiled. Among these techniques are:

1. Look for transpositions of the last two digits of number, or of the hundreds or

thousands digits. The number 46-37-82 may be filed as 46-37-28 or 46-73-82.

2. Look for misfiles of “3” under “5” or “8” and vice versa; and “7” or “8” under “9”.

The number “9” may be taken as a “7” if it is worn.

3. Look for misplacement or mislaying of health records on the floor, tables, racks,

cabinets and shelves

4. Check for a certain number in the hundred group just preceding or following the

number as 485 under 385 or 585, or under other similar combinations.

5. Check for transpositions of first and last numbers.

6. Check the folder just before and just after the one needed. It sometimes happens that

a folder is put into another folder rather than between two folders.

16
2.9 Colour Coding of Record Folders

Huffman (1994), posits that colour coding refers to the use of colour on folders to

aid in the prevention of misfile and in the location of misfiled records. Colour bars in

various positions around the edges of folders (known as blocking) create distinct patterns of

colour in various sections of the file. A break in the colour pattern in a file section signals a

misfiled record.

Colour coding is most effective when used in conjunction with terminal digit and

middle digit filing, although it is said that workable colour-coding systems can be used for

straight numerical filing.

One approach to colour coding in a terminal digit file utilizes ten different colours to

signify the first primary digits 0 through 9. Two colour bars or blocks appearing in the same

position can be used to signify each of the two primary digits. In this case the top colour bar

represents the left-hand digit of the primary digits. In this case the top colour bar represents

the left-hand digit of the primary set, and the bottom colour bar represents the right-hand

digit of the primary set. If brown is the colour assigned to the digit 8 and green is the colour

assigned to the digit 4, a chart numbered 169484 in a terminal digit file is colour coded with

a brown band on top, with a green band directly beneath it.

Additional colour bars may be added to indicate secondary digits and there are many

combinations which can be used. In setting up a colour-coding system, it is generally

advisable to limit coding with colour to two or three digits. This ensures a simple, easy-to-

learn system. Folders already colour coded may be purchased from commercial firms or

employees of the medical records department may apply colour tape to folders.

2.10 Other filing rules and procedures

Osundina (2005), affirms that following are some basic rules to aid in efficient

handling of the medical records:

17
1. When records are returned to health records department, they should be sorted before

being filed. This facilitates the finding of needed, but unfiled records, and makes the

re-filing easier.

2. Except for hospital personnel who have been instructed to use the file area during

evening and night hours, only health record department personnel should be

authorized to handle records. Physicians, hospital staff members, and personnel from

other departments of the hospital should not be allowed to pull records from the

permanent filing area. During the evening hours, emergency room personnel and

supervising nurses should leave returned records at a designated place in the record

area or in one specified location if the health records department is closed.

3. Records with torn covers and those with loose papers should be repaired promptly to

prevent further damage or loss of valuable information.

4. An audit of the files should be made periodically to locate misfiled records and check

requisitions which indicate records that have not been returned. Such an audit might

promptly indicate that certain clinics or departments are holding records beyond the

prescribed time limit. In such cases the medical record director will then investigate

the situation and take any corrective measures indicated.

5. Health records of medical record department personnel, and records involving legal

actions, should not be stored in the general files; these can be filed in a locked file

cabinet in the medical record director’s office. However, out-guides should be placed

in the permanent file to indicate that these records are in a “special” file.

6. Filing-area personnel should be responsible for keeping the shelves neat and orderly.

Disorderly files increase the likelihood of misfiles.

7. Medical records being processed or used by employees within the department should

remain on desk tops or in specified files so they can be available at any time.

18
 8. Written procedures for filing-area personnel are of assistance in their training and in

their maintaining control over the files.

9. Records which are voluminous should be separated into two or more volumes.

10. The person supervising the file area should keep a report of activities in the area. Item

include: number of requisitioned charts pulled each day, number of emergency calls,

number of misfiles or records which could not be found. Count such as these

provides useful information for planning work and for control over the files.

2.11 Computerization of Patients Health Information

Ayilegbe (2008), posits that computerization of patients health information is the

last stage of patients’ health records in the health records department. Computerization of

patients’ health information is a means of capturing patients’ health data and information

through electronic application. This is achieved through the utilization of a computer

system. The installed program facilitates easy data capturing, processing, storage and

retrieval. For the achievement of a desired result, there is need for all Health Records

Personnel to be Computer literate. They must be skilled and proficient in the utilization of a

computer system to obtain needed health data from the patients, especially during new

documentation and registration at General Outpatient Department (GOPD), Accident and

Emergency (A&E) Records Unit, NIHS Records Unit etc.

When good software is obtained, ease of entry of data can be guaranteed among

other benefits. The beauty of Electronic Health Records can easily be achieved when these

computer systems are networked. Entries can be made simultaneously in various Health

Records thematic areas. The module for Electronic Health Records should have a sub-

section for modification or updating so that necessary amendment can be effected as at

when necessary. When documentation of patient is completed and captured, it can be

19
accessed in any of the units, provided they are on network. Some of the bio-data needed for

new and follow-up patients’ documentation and registration are as follows:

Patient’s surname, middle name, first name, unit number, gender, data of birth, age address,

GSM no, occupation, state or origin, tribe, marital status, religion, name of next-of-kin etc.

Whenever a patient comes to health facility without his unit or hospital number, his

records can easily be tracked through a module called “patient porto”

This can be achieved within a few seconds. This has great advantage over the

manual system where the patients’ master index is consulted before the patient’s health

records can be located. Misfiling syndrome in records management is also overcome among

other benefits.

Some constraints to management of Electronic Health Records are:

 Lack of uniform standard rule for Health Information Management Practice.

 Issue of confidentiality of patient information.

 Electronic fraud e.g. hackers.

 Lack of uniform legal framework.

 In Nigeria, there is no consistent electricity supply to maintain the system.

 Lack of government interest and political will to establish, maintain and sustain the

system.

20
 CHAPTER THREE

Research Methodology

3.1 Introduction

This chapter focuses on the research design, area of study, population, sample and

sampling technique, instrument for data collection and method of data analysis.

3.2 Research Design

According to Feirer, (1994) a design is the outline shape or plan of something.

Walton (1981), defines design as an intentional planning or inventing and making of an

article for a particular use.

The study design to be use for the study was a descriptive research design. Hence

this study design permits the investigation of the problem of the misfiling of patient from a

population who supply the required information and to whom that is generalized.

3.3 Area of the Study

The study area for this research work will cover the entire General Hospital Keffi,

Nasarawa State.

3.4 Population of the Study

Dakun, Ogbonna, Lere and Bulus (2001) define a population as a collection of

individual items either of things or of people with common characteristics. In other word, a

population is any group of individuals that has one or more characteristics in common that

are of interest to the researcher.

The subject comprises of Health Information Managers, Health Records Technicians

and Non-Health Records professionals in the study area. The study area consist of thirty six

(36) Nurses, twenty three (23) Attendants, Nine (9) Health Record Professionals, eight (8)

Administration staff, Seven (7) accountants, three (3) technical staff, eight (8) Pharmacists,

21
three (3) Medical Doctors and twenty (20) Medical Laboratory Staff respectively.

Therefore, the sample population for the study will be eighty (80) staff from the study area.

3.5 Sample and Sampling Technique

The sample for this study would constitute all the health Information Managers,

Health Records Technicians and Non-Health Records professionals in the study area. The

sampling technique to be used for this research work will be purposive sampling under non-

probability random sampling techniques. This type of sampling technique is one which is

selected based on the opinion of an expert. Results obtained from purposive sampling are

subject to some bias, due to the frame and population not being identical.

3.6 Instrument for Data Collection

The instruments adopted for this study will be structured questionnaire consisting of

questions raised in chapter one above.

3.7 Method of Data Analysis

The data collected for the study will be analyzed using simple percentage and mean,

results will be presented in a tabular form to reveal the respondents’ view based on the

stated objectives.

3.8 Ethical Consideration

Permission to proceed with administration of the questionnaires will be obtain from

the selected health facility. This will be done through discussion with the head of

department of the health facility and the participants are assured of the confidentiality of all

the information supplied in the course of the study.

22
 CHAPTER FOUR

4.1 Data Analysis and Presentation

This chapter is the presentation, interpretation and discussion of results collected

during the course of this work. The purpose of the study is to investigate the causes,

consequence and available solution to the problems of misfiling of patient health records in

the health records department in General Hospital Keffi, Nasarawa State. To achieve this

purpose, a total of 80 questionnaires were distributed and 80 were returned meaning 100%

response.

4.2 Analysis of Research Questions

Research question one: Do you operate alphabetical filing system for patient health
records in your department?
Table 1
RESPONSES NUMBER OF RESPONSES PERSENTAGE %
YES 2 2.5
NO 78 97.5
TOTAL 80 100
The table above proves that alphabetical filing system is not the adopted for patient health

records in the hospital, as 97.5% of sampled respondents attest to that.

Research question two: Do you operate straight numerical filing system in your
department?
Table 2
RESPONSES NUMBER OF RESPONSES PERSENTAGE %

YES 79 98.75
NO 1 1.25

TOTAL 80 100

Table 2 indicates that Keffi General Hospital operate on straight numerical filing system as

79 out of total sampled population agree while only 1 disagreed.

23
Research question three: Have you ever operated terminal digit filing system before?

Table 3
RESPONSES NUMBER OF RESPONSES PERSENTAGE %

YES 0 0
NO 80 100

TOTAL 80 100
Table 3 proves that the health facility in the study area does not and have never operate

terminal digital filing system before. 80 respondents representing 100% attest to this.

Research question four: Are patients’ records properly sorted before filing?
Table 4
RESPONSES NUMBER OF RESPONSES PERSENTAGE %
YES 34 42.5
NO 46 57.5
TOTAL 80 100
Table 4 shows that there is a mixed reaction in the opinion on patients records properly

sorted before filing, the highest respondent of 46 representing 57.5% of sampled population

disagreed to this while 34 respondents representing 42.5% of sampled population agreed.

Research question five: Are you satisfied by the filing method adopted by your
department?
Table 5
RESPONSES NUMBER OF RESPONSES PERSENTAGE %

YES 32 40
NO 48 60

TOTAL 80 100
Table 5 poses an outcome that the filing system adopted by the study area is not satisfiable.

As 48 respondents out of the sampled population are not satisfied while 32 respondents

thought otherwise.

24
Research question six: Do you have steel filing shelves in your department?
Table 6
RESPONSES NUMBER OF RESPONSES PERENTAGE %

YES 11 13.75
NO 69 86.25

TOTAL 80 100
From the table above, 11 respondents representing 13.75% of sampled population agreed

that the have steel filing shelves in their department while the highest no of respondents 69

representing 86.25% disagreed to this statement.

Research question seven: Are the numbers of filing shelves adequate?

Table 7
RESPONSES NUMBER OF RESPONSES PERSENTAGE %

YES 1 1.25
NO 79 98.75

TOTAL 80 100
Data from table 7. Indicates that 98.75% of sampled respondents (representing the highest

population sampled) disagreed that the number of filing shelves to be adequate in the study

area.

Research question eight: Do you have filing ladders in your health records library?
Table 8
RESPONSES NUMBER OF RESPONSES PERSENTAGE %

YES 4 5
NO 76 95

TOTAL 80 100
The information from sampled population in table 8 shows that there are no ladders in their

health records library. 95% of the total population disagreed while only 5% agreed.

25
Research question nine: Do you have sorting shelves in your department?
Table 9
RESPONSES NUMBER OF RESPONSES PERSENTAGE %

YES 56 70
NO 24 30

TOTAL 80 100
Table 9 indicates that there is sorting shelves in the department as 70% agree while 30%|

disagree that there is sorting shelves.

Research question ten: Do you have enough steel filing cabinets in your department?
Table 10
RESPONSES NUMBER OF RESPONSES PERSENTAGE %

YES 3 3.75
NO 77 96.25

TOTAL 80 100
Records from table 10 shows that there is no enough steel filing cabinet in their department

due to their responses as 77 respondents representing 96.75% of the population disagreed

whereas 3 respondents representing 3.75% agreed to the statement.

Research question eleven: The number of health records officers in your department are
adequate
Table 11
RESPONSES NUMBER OF RESPONSES PERSENTAGE %

YES 7 8.75
NO 73 91.25

TOTAL 80 100
From data in table 11, it was agreed by 7 respondents representing 8.75% that the number of
health record officers in their department are adequate, while 73 representing 91.25%
disagreed.

26
Research question twelve: Health records personnel should fully concentrate when filing
patient health records
Table 12
RESPONSES NUMBER OF RESPONSES PERSENTAGE %

YES 74 92.5
NO 6 7.5

TOTAL 80 100
Data collected from research question 12 shows that health records personnel should fully

concentrate when filing patient health records to avoid misfiling.

Research question thirteen: Lightning system in the filing areas would reduce mislaying
and misfiling of patient health records.
Table 13
RESPONSES NUMBER OF RESPONSES PERSENTAGE %

YES 68 85
NO 12 15

TOTAL TOTAL 100

Information gathered from table 13 shows that adequate provision of lightning system in the

filing areas would reduce mislaying and misfiling of patient health records. This was proved

as 68 respondents representing 85% of sampled population agreed while 12 respondents

representing 15% disagreed.

Research question fourteen: There should be effective tracer cards in the filing areas
Table 14
RESPONSES NUMBER OF RESPONSES PERSENTAGE %

YES 70 87.5
NO 10 12.5

TOTAL 80 100
Data in table 14 shows that it is advisable to make available effective tracer cards in the

filing areas to make it easier for patient to be treated with ease and promptly.

27
Research question fifteen: Filing environment are conducive for filing and retrieval of
patients’ records in your hospital.
Table 15
RESPONSES NUMBER OF RESPONSES PERSENTAGE %

YES 7 8.75
NO 73 91.25

TOTAL 80 100
Information from sampled population shows that filing environment are not conducive for

filing and retrieval of patients records in the study area. As respondent who are staff of the

study are proved it.

Research question sixteen: Do you think that clinical research activities may be hampered
if patients’ case files are missing?
Table 16
RESPONSES NUMBER OF RESPONSES PERSENTAGE %

YES 79 98.75
NO 1 1.25

TOTAL 80 100
Data gathered from the table above shows that clinical activities can be hampered if patients

case file are missing. As data indicates that 79 respondents representing 98.75% of the total

population agreed to this.

Research question seventeen: Do you think that wrong treatment/diagnosis can be given to
a patient’s if is original case notes cannot be found?
Table 17
RESPONSES NUMBER OF RESPONSES PERSENTAGE %

YES 67 83.75
NO 13 16.25

TOTAL 80 100

Information from table 17 indicates that 67 respondents representing 83.75% of total

population agreed that wrong treatment/diagnosis can be given to a patient if his original

28
case notes cannot be found. While 13 respondents representing 16.25% of sampled

population disagreed.

Research question eighteen: Do you think that mislaying and misfiling of patient records
may lead to patient death?
Table 18
RESPONSES NUMBER OF RESPONSES PERSENTAGE %

YES 76 95
NO 4 5

TOTAL 80 100
Information gathered in table 18 indicates that mislaying and misfiling of patient records

may lead to patient death as it will be difficult to know his or her health history.76

respondents out of total sampled population agree while only 4 respondents disagreed.

Research question nineteen: Do you think that mislaying and misfiling of patient health
records can lead to patient delay in the hospital?
Table 19
RESPONSES NUMBER OF RESPONSES PERSENTAGE %

YES 77 96.25
NO 3 3.75

TOTAL 80 100
In table 19, research shows that mislaying and misfiling of patient health records can lead to

patient delay in the hospital as 96.25% agreed while only 3.75% disagreed.

Research question twenty: Do you think that hospital can lose valuables cost if the patient
health records cannot be found?
Table 20
RESPONSES NUMBER OF RESPONSES PERSENTAGE %

29
 YES 58 72.5
NO 22 27.5

TOTAL 80 100
Table 20 above shows that hospital can loose valuable if patients records are not properly

kept. This was proved as 72.5% of sampled respondents agreed while only 27.5%

respondents disagreed.

Solution to the problems of mislaying and misfiling of patients’ health records

Table 21
S/N Solution to the problems of mislaying and SA A N D SD
misfiling of patients’ health records
1 Sorting of case notes before being filed can reduce 56 20 1 2 1
mislaying and misfiling of patient health records

2 Access to the filing area should be restricted to 61 18 1 0 0

only health records professional to reduce
mislaying and misfiling of records?
3 Regular training of staff will reduce misfiling of 27 51 2 0 0
records
4 Good tracer system will reduce mislaying and 31 46 1 1 1
misfiling of patients’ health records
5 Computerization of patients’ health records is a 23 54 0 3 0
lasting solution to missing patients’ case files

5+4 +3+2+1 15
Criterion score = = = 3.0
5 5

Frequency distribution table for respondents on the solution to the problems of mislaying

and misfiling of patient’s health records:

30
1. Sorting of case notes before being filed can reduce mislaying and misfiling of patient
health records
Table 22
Score (X) F FX
1 1 1
2 2 4
3 1 3
4 20 80
5 56 280
Total ∑ f =80 ∑ FX=368

Mean score = X =
∑ FX = 368 = 4.6 X = 4.6
n 80

The table above shows that Sorting of case notes before being filed can reduce mislaying

and misfiling of patient health records, with mean 4.6 is greater than 3.0 which is the

criterion score.

2. Access to the filing area should be restricted to only health records professional to
reduce mislaying and misfiling of records?

Table 23
Score (X) F FX
1 0 0
2 0 0
3 1 3
4 18 72
5 61 305
Total ∑ f =80 ∑ FX=380

Mean score = X =
∑ FX = 380 = 4.75 X = 4.75
n 80

31
Table 23 shows that Access to the filing area should be restricted to only health records
professional to reduce mislaying and misfiling of records. Since the mean is 4.75 which is
greater than 3.0
3. Regular training of staff will reduce misfiling of records
Table 24
Score (X) F FX
1 0 0
2 0 0
3 2 6
4 51 204
5 27 135
Total ∑ f =80 ∑ FX=339

Mean score = X =
∑ FX = 339 = 4.24 X = 4.24
n 80

The table above indicates that regular training of staff will reduce misfiling of records. With

the mean as 4.24 that is greater than 3.0.

4. Good tracer system will reduce mislaying and misfiling of patients’ health records.
Table 25
Score (X) F FX
1 1 1
2 1 1
3 1 3
4 46 184
5 31 155
Total ∑ f =80 ∑ FX=344

Mean score = X =
∑ FX = 344 = 4.3 X = 4.3
n 80
Table 25 proved that Good tracer system will reduce mislaying and misfiling of patients’

health records. With the mean of 4.3 that is greater than 3.0.

32
 5. Computerization of patients’ health records is a lasting solution to missing patients’
case files
Table 26
Score (X) F FX
1 0 0
2 3 6
3 0 0
4 54 216
5 23 115
Total ∑ f =80 ∑ FX=337

Mean score = X =
∑ FX = 337 = 4.2 X = 4.2
n 80

Table 26 shows that computerisation of patient’s health records is a lasting solution to

missing patients case file as 4.2 mean is greater than 3.0 so we accept the statement.

33
 CHAPTER FIVE

Summary of Findings, Conclusion and Recommendations

This study was undertaken to investigate the causes, consequence and available

solution to the problems of misfiling of patient health records in the health records

department of Keffi General Hospital, Nasarawa State.

5.1 Summary of findings

From the analysis of findings so far, the study area does not use alphabetical filing

system nor have they ever operated terminal digital filing system, but rather they use the

straight numerical filing system in their department. It was also discovered that, there is no

proper sorting of patients records before filing which means the method employed is not

satisfactory. It was also revealed that durable steel filing shelves are not the method of filing

system they use which is grossly inadequate. One good thing about the filing system that

was attested by the respondents is that, they have sorting shelve department.

The study also revealed that, there is inadequate number of health record officers,

and was advised to fully concentrate when filing patient health records. It was agreed upon

to make provision for lightning system in the filing area to reduce mislaying and misfiling

of patient’s health records. Suggestion was made to produce effective tracer cards in the

filing area to ease location of patients record. Data gathered, also revealed that clinical

research activities may be hampered if patients case file are missing which could lead to

wrong treatment or diagnosis given to the patient if his original case note is missing.

This study uncovered that mislaying and misfiling of patient’s record may lead to

death as no health history to aid continuity. The hospital may lose income, revenue

generation and value to the general public and will be termed as gross misconduct of

professionality, lack of organize system of operation and improper record keeping, therefore

reducing the quality of health care services being rendered.

34
5.2 Conclusion

The result of the study revealed that mislaying and misfiling of patient health

records will have negative effects on patients and hospitals as majority of respondents in the

hospital selected (the health records department in General Hospital Keffi, Nasarawa State)

attested to this fact and this has clearly shown that the hospital can only be rated high in

performance when there is prompt availability of patient’s health records in the clinic for

continuity of patient care.

Moreover, high quality service delivery of any health institution can only be

measured with prompt availability of patients’ health records to the authorized and

legitimate users.

The study has clearly shown that there was solution to the problems of mislaying and

misfiling of patient health records in the health records’ department of the two hospitals

under review (the health records department in General Hospital Keffi, Nasarawa State).

It was further revealed that if all necessary qualified personnel and functional working tools

are provided, then misfiling and mislaying of patient records would be eliminated or greatly

reduced.

5.3 Recommendations

In view of the significant and negative effects that mislaying and misfiling of

patient’s health records have on patient and hospitals, the following recommendations are

hereby made:

1. All health institutions should be mandated to employ qualified and trained Health

Information Managers to man the department of Health Information Management so

that their knowledge in management of patients’ health records will assist in

reducing mislaying and misfiling of patient health records.

35
 2. The management of the hospitals should be informed of their responsibilities in

providing space, adequate filing equipment and suitable filing environment for

health records department because the above-mentioned factors contribute to

mislaying and misfiling of patient’s health records in health institutions.

3. Health Information Managers should maintain high level of decorum and

concentration when filing patients’ record in the health records library.

4. Good tracer system should be put in place by Health Records Officers in order to

track the movements of patients’ case notes in the hospital.

5. Patients’ health records should be computerized to aid quick and timely retrieval of

patients’ information.

5.4 Suggestion for Further Studies

The researcher suggest for similar research work to be carried out in different local

government towards identifying problems responsible for misfiling of patients case note.

36
References

Afuye, A.K. (1999); Human Health Infocracy in Democracy Doctrine. Ekiti: Pan-African
Health Information Communications Ltd.

Afuye, A.K. (2001). Strategies and Policies on Release of Patient Information (1st ed.).
Ekiti: Pan-African Health Information Communications Ltd.

AHIMA. (2003). Electronic document management as a component of the electronic health

records. Practice brief. Available online at www.ahima.org.

AHIMA. (2003). The complete medical records in a hydbrid disclosure. Practice brief.
Available online at www.ohima.org.

Aremu, H.B. (1999). Health Records Management 1 & 11 Ilorin: Decency printers &
sanitation LTD.

Ayilegbe, B.K (2008). Essence of documentation in health care institution, Kano: Debisco
printing press.

Ayilegbe, B.K. (2015). The Dynamics of Patients’ Discharge Summaries. Kano: Debisco
printing press.

Benjamin, B. (1980). Medical Records. Edinburgh: Churchill Livingstone.

Federal Ministry of Health (1996). National Health Information Management Information

System (Health Facility Summary Forms). Lagos: FMOH Publication.

Geoffrey, Y. (1999). Managing Hospital Records.London : International Record

Management Trust.

Huffman, E.K. (1994). Health Information Management (10th Edition).Berwyn :

physicians’ Record Company.

Lippincott, W and Wilkins. (2006). Steadman’s Medical Dictionary. Baltimore: A Wolters

Kluwer Health Company.

Murphy, Gretchen, Mary Alice Hanken, and Kathleen Waters. (1999). Electronic Health
Records: Changing the vision. W.B. Saunders Company.

Osundina, K.S. (2004). Principles and Practice of Health Records Management. Ilesa: K.S.
Osundina Publications.

W.H.O. (1983). Guidelines for Medical Records Practice W.H.O. Publication

37
 Appendix

Letter of Introduction

School of Health Information

Management and Biostatistics,
Plateau State College of Health
Technology, Pankshin.
P.M.B. 013 Pankshin.
Plateau State.
2nd June, 2021.
Dear Respondent,

I am a final year student of the above-mentioned institution, embarking on the

project topic “The problem of misfiling of patient case note in General Hospital Keffi,

Nasarawa State”.

I am solidity for your assistance for the answering of all the questions contain in this

questionnaire. The information given will be treated confidential and for my academic

purpose only.

I count on your cooperation in completing the questions presented below.

Yours sincerely

ESHIMITU O. EMMANUEL

(Researcher)

38
 SECTION A
i. SEX = a) Female [ ] b) Male [ ]
ii. QUALIFICATION: a) SSCE [ ] b) Diploma/Technician [ ] c) Degree [ ] d) Others [ ]
iii. RELIGION: a) Christianity [ ] b) Islam [ ] c) Traditional worshiper [ ]
iv. AGE: a) 20-30 [ ] b) 31-40 [ ] c) 41-50 [ ] d) 51and above [ ]
v. DEPARTMENT: a) Nursing and Medicals Personnel [ ] b) Attendant and Health
Record [ ] c) Medical Laboratory [ ] d) Pharmacy [ ] e) Administration, Technical and
Accounting [ ]
SECTION B
Available Filing and Numbering System in Health Records Department
S/NO Filing and numbering system in health records department YES NO

1 Do you operate alphabetical filing system for patient health

records in your department?
2 Do you operate straight numerical filing system in your
department?
3 Have you ever operated terminal digit filing system before?
4 Are patients’ records properly sorted before filing?
5 Are you satisfied by the filing method adopted by your
department?

Available Filing Equipment in Health Records Department

S/NO Filing Equipment in Health Records Department YES NO
6 Do you have steel filing shelves in your department?

7 Are the numbers of filing shelves adequate?

8 Do you have filing ladders in your health records library?

9 Do you have sorting shelves in your department?

10 Do you have enough steel filing cabinets in your department?

Types of Health Record Personnel and Filing Environment

S/NO Types of Health Record Personnel and Filing Environment YES NO
11 The number of health records officers in your department are
adequate

12 Health records personnel should fully concentrate when filing

patient health records.
13 Lightning system in the filing areas would reduce mislaying
and misfiling of patient health records.
14 There should the effective tracer cards in the filing areas

15 Filing environment are conducive for filing and retrieval of

patients’ records in your hospital.

39
Effect of mislaying and misfiling of patient Records
S/NO Effect of mislaying and misfiling of patient Records YES NO
16 Do you think that clinical research activities may be hampered
if patients’ case files are missing?

17 Do you think that wrong treatment/diagnosis can be given to a

patient’s if is original case notes cannot be found?

18 Do you think that mislaying and misfiling of patient records

may lead to patient death?

19 Do you think that mislaying and misfiling of patient health

records can lead to patient delay in the hospital?

20 Do you think that hospital can lose valuables cost if the patient
health records cannot be found?

Solution to the problems of mislaying and misfiling of patients’ health records

S/NO Solution to the problems of mislaying and misfiling of SA A N D SD
patients’ health records
1 Sorting of case notes before being filed can reduce mislaying
and misfiling of patient health records

2 Access to the filing area should be restricted to only health

records professional to reduce mislaying and misfiling of
records?
3 Regular training of staff will reduce misfiling of records
4 Good tracer system will reduce mislaying and misfiling of
patients’ health records
5 Computerization of patients’ health records is a lasting
solution to missing patients’ case files

40