International Journal of Advanced Academic Research | Social and Management Sciences| ISSN: 2488-9849

Vol. 6, Issue 2 (February 2020)

EFFECT OF MISLAYING AND MISFILING OF PATIENTS

HEALTH RECORDS IN TWO SELECTED HOSPITALS IN
ABEOKUTA OGUN STATE, NIGERIA

Kayode Sunday Osundina and Olatunji Azeez

Health Information Management Dept., Lead City University Ibadan, Nigeria.
Corresponding Author’s E-mail: kayodeosundina@yahoo.com

ABSTRACT

The study focused on effect of mislaying and misfiling of patient health records in the health
records department of Neuropsychiatric Hospital (NPH), Aro, Abeokuta and Federal Medical
Centre (FMC), Idi-Aba, Abeokuta, Ogun State, Nigeria. The study population for this
research work comprised of Health Information Managers, Health Records Technicians and
Non-Health Records Professionals working in the health records department of the two
selected health institutions.

The study adopted a descriptive survey design in order to deduce the effects of mislaying and
misfiling of patients health records in these selected hospitals. The population comprised of
eighty (80) respondents with the aid of self-designed structured questionnaire and was
validated to establish its reliability.

Questionnaire was personally administered by the researcher. Data collected was analyzed
using Epi-Info software (Epidemiology Information) version 3.5.1 and the results were
presented in tabular form to reveal the respondents’ view based on objectives. The study
found out that mislaying and misfiling of patients health records have negative effects on the
patients and the hospitals in general.

Moreover, 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
of patient health records. Also, the management of the hospitals should provide enough
space, adequate filing equipment and suitable filing environment for health records
department in order to reduce misfiling of records to establish a befitting and standard library.

Keywords: Mislaying and Misfiling, Patients Health Records, Effect of Mislaying and
Misfiling, Selected Hospitals.

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I. Introduction

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 mislaying or 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.

Moreover, 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.

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

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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 mislaying and 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 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.

Statement of Problem

Mislaying and 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
mislaying and misfiling of patient health records in the health records department.

Objective of the Study

1. To examine the available filing and numbering system in health records department.
2. To assess the available filing equipment in the health records department.
3. To assess the types of health records personnel involved in filing and retrieval of
patient health records and suitability or records filing environment.
4. To evaluate the effect of mislaying and misfiling of patient health records in health
institution.
5. To find solution to the problems of mislaying and misfiling of patient health records
in the health records department.

Research Questions

1. What are available filing and numbering systems in the health record department of
Neuropsychiatric Hospital (NPH), Aro, Abeokuta and Federal Medical Centre (FMC),
Idi-Abeokuta?
2. What are the various available filing equipments in the health records department?

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3. What are the types of health records personnel and suitable filing environment in the
health records department?
4. What are the effects of mislaying and misfiling of patient health records in the health
institution?
5. What are the solution to the problems of misfiling and mislaying of patient health
records?

II. REVIEW OF LITERATURE

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. 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.

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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.

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.

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.

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

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

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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.

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.

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.

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 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 and mislaying of patient health
records:

1. 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

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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.
2. 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 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.

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.

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

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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.

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:

 Compactness: To take account of storage space and also need to reduce physical
effort in working the system.
 Accessibility: For speed of location and positive means of identification for the items
contained in the system.
 Simplicity of operation to ensure that the method is understood by those who
normally control it but also by those who require occasional access.
 Economy: Economy, both in cost of installation and operation.
 Elasticity: The system should expand and contrast according to future requirement.
 Cross Reference: This facility must be considered so that a folder can be found under
different heading.
 Tracer System: A tracer card must be placed in position of a removed folder to
indicate the destination of the folder.
 A Method of Classification e.g. Terminal digit or middle digit etc.
 The equipment in use must be effective and efficient of the system.
 The personnel operating the system must be well trained i.e. health records
practitioners.

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.

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

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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.

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.

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.

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.

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 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.

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 mislaying of patients’ health records in the Health Records Library,
they are:

Introduction of colour coding to Health Records Library.

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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.
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.

Problems of Mislaying and Misfiling 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.

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.

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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.

Other filing rules and procedures

Osundina (2005) affirms that following are some basic rules to aid in efficient handling of the
medical records:

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
refiling 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.

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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.
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.

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
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. Mislaying and misfiling syndrome in records management is also
overcome among other benefits.

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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.

III. METHODOLOGY

The study design used for the study was a descriptive research design. The study population
for this research work covered two selected health institutions, viz: Neuropsychiatric Hospital
(NPH), Aro, Abeokuta and Federal Medical centre (FMC), Idi-Aba, Abeokuta. The subject
comprises of Health Information Managers, Health Records Technicians and Non-Health
Records professionals in these selected Hospitals. The target population for this study was
(100) One hundred while the population of the study is eighty (80).

The eighty (80) retrieved questionnaires from the respondents were used as sample size by
the researcher. The researcher was also convinced that the chosen samples were truly
representative of the population. The instruments adopted for this study was a structured
questionnaire.

Ethical Consideration

Permission to proceed with administration of the questionnaires was obtained from the two
selected health facilities. This was done through discussion with the heads of department of
these facilities, and the participants were assured of the confidentiality of all the information
supplied in the course of this study.

IV DATA PRESENTATION, ANALYSIS AND DISCUSSION OF FINDINGS

The data collection for the study was analyzed, results were presented in a tabular form to
reveal the respondents’ view based on the objectives.

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SECTION B. Research Questions

Table 4.1: Available Filing and Numbering System in Health Records Department

Filing and numbering system in health Yes No

S/NO records department
Do you operate alphabetical filing system for 28 (35.4%) 52 (65%)
1 patient health records in your department?
Do you operate numbering system for patient 77 (97.3%) 3 (3.7%)
2 health records in your department?
Do you operate straight numerical filing system 71 9 (11.25%)
3 in your department? (88.75%)
Have you ever operated terminal digit filing 28 (35.0%) 52 (65.0%)
4 system before?
Are patients’ records properly sorted before 75 (93.8%) 5 (6.2%)
5 filing?
Are you satisfied by the filing method adopted 68 (85.0%) 12 (15.0%)
6 by your department?

Table 4.1 shows that majority of the respondents 77(97.3%), 71(88.75%) and 75(93.8%)
agreed that health records department operates numbering system, straight numerical filing
system and also ensure that health records are sorted properly before filing, while 52(65%)
respondents disagree on the use of alphabetical filing system and terminal digit filing system
in health records department of the two hospitals.

Table 4.2: Available Filing Equipment in Health Records Department

S/NO Filing Equipment Yes No

Do you have steel filing shelves in your 72 8 (10.0%)
7 department? (90.0%)
Are the numbers of filing shelves 46 34(42.5.0%)
8 adequate? (57.5%)
Do you have filing ladders in your health 55 25 (31.2%)
9 records library? (68.8%)
Do you have dividers in each filing 73 7 (8.7%)
10 shelf? (91.3%)
Are the spaces between each filing shelf 58 22 (27.5%)
11 adequate? (72.5%)
Do you have sorting shelves in your 57 23 (28.7%)
12 department? (71.3%)
Do you have enough steel filing cabinets 32 48 (60.0%)
13 in your department? (40.0%)

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Table 4.2 shows that 72 (90%), 73 (91.0%) and 58 (72.5%) accepted that the health records
department have steel filing shelves, dividers in each filing shelf and adequate spaces
between each filing shelf while 34 (42.5%, and 48 (60%) confirmed that the number of
shelves are not enough and the steel filing shelves available in both hospitals were not
enough.

Table 4.3: Types of Health Record Personnel and Filing Environment

Health Records Personnel and SA A N D SD

S/NO Filing Environment
The number of health records officers 19 13 11 21 16 (20.0%)
14 in your department are adequate (23.75%) (16.25%) (13.75) (26.25)
The number of Health records 15 14 8 23 20 (25.0%)
technician in your department are (18.75%) (17.5%) (10.0%) (28.75%
15 adequate? )
Non-Health records personnel should 12 (15.0%) 20 12 21 15
16 be in health record department (25.0%) (15.0%) (26.25) (18.75%)
Non – Health record personnel 8 (10.0%) 10 12 (15.0) 23 27 (33.75)
should be involved in filing and (12.5%) (28.75)
17 retrieval of patients’ record
Health records personnel should fully 60 (75.0%) 16 1 (1.25) 2 (2.5%) 1 (1.25%)
concentrate when filing patient health (20.0%)
18 records
There should be air conditioners in 58 (72.5%) 16 5 1 0 (0%)
19 the filing areas (20.0%) (6.25%) (1.25%)
There should be adequate lightning 67 10 1 (1.25) 0 (0%) 2 (2.5%)
20 system in the filing areas (83.75%) (12.5%)
Lightning system in the filing areas 56 (70.0%) 17 1 5 1 (1.25%)
would reduce mislaying and misfiling (21.25%) (1.25%) (6.25%)
21 of patient health records
There should be a designated room 51 21 3 1(1.25% 4 (5.0%)
for clinical research in the records (63.75%) (26.25%) (3.75%) )
22 library
There should the effective tracer 59 19 1 0 (0%) 1 (1.25%)
23 cards in the filing areas (73.75%) (23.75%) (1.25%)
There should be adequate space in 59 20 1 0 (0%) 0 (0%)
24 the filing areas (73.75%) (25.0%) (1.25%)
Filing environment are conducive for 22 (27.5%) 17 14 16 11
filing and retrieval of patients’ (21.25%) (17.5%) (20.0) (13.75%)
25 records in your hospital

Table 4.3 shows that majority of the respondents, 36 (46.25%), 43(53.75%), 36(45%) and 50
(62.5%) disagreed that the number of health records officer, and health records technicians
in health records department are adequate, and that non-health records personnel should be

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involved in health records activities. While 77 (96.25%) and 73(91.25%) agreed that there
should be adequate lightning system in the filing areas as lightning system reduces
mislaying and misfiling of patient health records.

Table 4.4: Effect of mislaying and misfiling of patient Records

Effects of mislaying and misfiling of Yes No

S/NO patient health records
Have you ever experienced mislaying 75 (93.8%) 5
and misfiling of patient health records in (6.2%)
26 your department?
Do you think that clinical research 71 (92.2%) 6
activities may be hampered if patients’ (7.8%)
27 case files are missing?
Do you think that wrong 72 (90.0%) 8
treatment/diagnosis can be given to a (10.0%)
patient’s if is original case notes cannot
28 be found?
Do you think that mislaying and 66 (82.5%) 14
misfiling of patient records may lead to (17.5%)
29 patient death?
Do you think that mislaying and 75 (93.8%) 5
misfiling of patient health records can (6.2%)
30 lead to patient delay in the hospital?
Do you think that hospital can lose 65 (81.3%) 15
valuables cost if the patient health (18.7%)
31 records cannot be found?

Table 4.4 shows that majority of the respondents, 65 and above (81.3% and above) agreed
that mislaying and misfiling of patient health records occurred and that clinical research
activities may be hampered if patients’ case files are missing, that wrong treatment/diagnosis
can be given if patient original case notes cannot be found.

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Table 4.5: Solution to the problems of mislaying and misfiling of patients’ health
records

Solution to the problems of SA A N D SD

mislaying and misfiling of
S/NO patient health records
Sorting of case notes before being 54 (67.5%) 20 5 0 (0%) 1 (1.25)
filed can reduce mislaying and (25.0%) (6.25%)
32 misfiling of patient health records
Access to the filing area should be 50 (62.5%) 22 2 (2.5%) 5 1
restricted to only health records (27.5%) (6.25%) (1.25%)
professional to reduce mislaying
33 and misfiling of records?
Transposition of number should be 36 (45.0%) 38 3 2 (2.5%) 1
checked when searching for (47.5%) (3.75%) (1.25%)
34 missed records
Introduction of shelves dividers 38 (47.5%) 32 5 5 0 (0%)
will reduce misfiling of health (40.0%) (6.25%) (6.25%)
35 records
Color coding of case notes can 41 (51.25%) 26 5 4 (5.0%) 4 (5.0%)
reduce mislaying & misfiling of (32.5%) (6.25%)
36 patient health records.
Regular training of staff will 46 (57.5%) 32 0 (0%) 1 1 (1.25)
37 reduce misfiling of records (40.0%) (1.25%)
Good tracer system will reduce 56 (70.0%) 21 0 (0%) 1 2 (2.5%)
mislaying and misfiling of (26.25%) (1.25%)
38 patients’ health records
Computerization of patients’ 54 (67.5%) 18 4 (5.0%) 1 3 (3.75)
health records is a lasting solution (22.5%) (1.25%)
39 to missing patients’ case files

Table 4.5 shows that majority of the respondents, 74 and above (92.5% and above) agreed
that sorting of case notes before being filed, access to the filing area should be restricted to
only health records professional, that transposition of number should be checked when
searching for missed records, and that adequate use of tracer system, regular training of staff
and lastly, computerization of patients’ health records is a lasting solution to mislaying,
misfiling and missing of patients’ health records in the health care institutions.

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 hospitals
selected (NPH, Aro, Abeokuta and FMC, Idi-Aba, Abeokuta) attested to this fact and this has

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clearly shown that the hospital can only be rated high in performance when there is prompt
availability of patients 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 (NPH, Aro, Abeokuta and FMC, Idi-Aba, Abk).

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.

Recommendations

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

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