GOCARE TRAINING INSTITUTE

INDUSTRIAL ATTACHMENT REPORT AT

JUMUIA HOSPITAL HURUMA

BY

RACHAEL KATHAMBI

ADMNO: GTI/HCA/RK/1104/2023

PERIOD 24TH NOVEMBER 2023 TO 23RD JAN 2024

INDUSTRIAL ATTACHMENT REPORT OF PATIENT ATTENDANCE /CARE GIVER Go Care Training

Institute JANUARY 23 2024

DECRALATION
I hereby declare this is my original work and has not been submitted to any other examination body. No part of
this report should be produced without my concert or that of GoCare Training Institute
Name……………………………………………….Sign………………………..Date………………………..

Supervisor…………………………………………..Sign………………………..Date………………………..

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ACKNOWLEDGEMENT
For the period I have been to Jumuia Hospital Huruma, I would like the following individuals and groups for
the respective help they have done to me. First I would like to thank the Jumuia Hospital Huruma general
administration for allowing us undergo the field attachment in their facility being led by medical superintendent,
also the administration for the recognition they have given to the students studying in the hospital. Finally I
would like to acknowledge the support from my family for her generous funding to make sure am comfortable
at the hospital at the time it was appropriate and her utmost concern to make sure that the entire attachment was
successful. Above all, I thank the Lord Almighty for the divine protection, guidance and the opportunity of a
memorable and fruitful period at Jumuia Hospital Huruma

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ABSTRACT
My report covers different activities in different sections and departments which I all attended and gained new
skills.

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ABBREVIATION USED
MOA- Mode of Admission

DOD-Date Of Discharge

RFA-Reason For Admission

IR- Interpersonal Relation

MDP- Manic Depression Psychosis

TLE-Temporal Lobe Epilepsy

S.V.D-Spontaneous Vertex Delivery

CS- caesarian delivery

DOA-Date Of Admission

OP-Outpatient

DBR-Daily Bed Return

HAS-Hospital Administration Statistics

DHIS-District Health Information System

ART- Antiretroviral Therapy

VCT- Voluntary Counseling And Testing

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FP-Family Planning

CTX- Cortrimoxazole

PWP- Prevention With Positives

DAR- Daily Activity Register

BMI- Body Mass Index

ICD- International Classification of Diseases

Table of Contents
DECRALATION.................................................................................................................................................2
ACKNOWLEDGEMENT...................................................................................................................................3
ABSTRACT.........................................................................................................................................................4
ABBREVIATION USED....................................................................................................................................5
CHAPTER ONE: INTRODUCTION......................................................................................................................7
1.1. Historical Background of Jumuia Hospital Huruma.............................................................................7
1.2. Main Functions or core activities of Jumuia Hospital...........................................................................7
1.3. Mission, Vision statement and core values of the institution................................................................7
1.4. Orgizational structure of Jumuia Hospital.............................................................................................8
1.5. Duties and responsibilities of the key personnel in the organization....................................................9
CHAPTER TWO: HOST ATTACHMENT DEPARTMENT..............................................................................10
2.1. Key functions / Activities of the department.......................................................................................10
2.2. Staff establishment of the department in terms of the number of employees and their duties and
responsibilities................................................................................................................................................14
Functions........................................................................................................................................................16
activities..........................................................................................................................................................16
Tools used.......................................................................................................................................................17
2.3. Student Main objectives for the attachment Exercise.........................................................................18
2.4. Attaché’s assigned routine duties and department’s participation forums..........................................18
CHAPTER THREE: EVALUATION OF THE ATTACHMENT PERIOD........................................................19
3.1. Success/Failure of the attachment exercise vis-à-vis Student main objectives...................................19
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 3.2. Challenges encountered by the student during the attachment period................................................19
3.3. How Challenges were Overcomed/solved..........................................................................................19
3.4. Recommendations...............................................................................................................................19
3.5. Conclusion...........................................................................................................................................19
BIBLIOGRAPHY/ REFERENCES......................................................................................................................20

CHAPTER ONE: INTRODUCTION

1.1. Historical Background of Jumuia Hospital Huruma.

Jumuia Hospital headquartered in Nairobi, is an integrated healthcare initiative of National Council of
Churches, Kenya, a faith-based multicultural and multi-denominational Christian organization. The Jumuia
hospital unites the leading physicians, healthcare professionals and latest healthcare facilities to the system.
Jumuia’s vision, to provide globally competitive healthcare facilities and services is supported by its
mission to provide a comprehensive range of accessible, affordable, high- quality and integrated Christ-
centered healthcare and training services for all. Jumuia Hospital is set to provide the finest healthcare
services with the latest technological support to the people of Kenya and other neighborhood countries. Since
its inception, Jumuia aims to grow, to meet the healthcare needs of one of the most diverse regions in Africa,
and as well continuously set new standards in quality and innovation in patient care, research and community
service. Jumuia sets itself to be widely known for its commitment in transforming healthcare for the benefit of
the society. Jumuia also impacts the society through conducting various social educational and awareness
programs. Most remarkably, Jumuia establishes a long-standing commitment to strengthen the Kenyan
Community through widespread programs that improve the health of its most vulnerable crowd.

Jumuia provides unique value, attention and care to the patients. Our quest for better health and high-quality
care is our driving force. At Jumuia, we are focusing to provide high quality patient care and enhance quality of
life for all, through research and awareness, and we do it irrespective of race, creed or ethnic origin.

1.2. Main Functions or core activities of Jumuia Hospital

Jumuia Hospital has the High class Intensive Care Units and Neonatal ICU for Pediatrics. Jumuia has Major
operating theatres where all critical and major surgeries will be performed and minor operations theatre in the
emergency department in which all minor surgeries will be done.

1.3. Mission, Vision statement and core values of the institution.

Jumuia’s vision is to provide globally competitive healthcare facilities and services is supported by its mission
to provide a comprehensive range of accessible, affordable, high-quality and integrated Christ-centered
healthcare and training services for all.
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Jumuia hospital Core Values – I CARE

I – Integrity

C – Compassion

A – Accessibility

R – Respect

E – Excellence

1.4. Orgizational structure of Jumuia Hospital

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1.5. Duties and responsibilities of the key personnel in the organization.
 Recording Medical History and symptoms.
 Administering medications and treatments.
 Collaborating with teams for patient care.
 Performing diagnostics test.
 Conducting vesical examinations.
 Monitoring patient’s health.
 Provide support and advice to patients.
 Operate medical equipment’s.
 Educating patients about how to manage illness.
 Advocating for the health and well-being of patients.
 Providing basic bedside care.
 Maintain inventory

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 CHAPTER TWO: HOST ATTACHMENT DEPARTMENT

1.1. Key functions / Activities of the department.

a. Psychiatric department
This is the station of records I attended to in the hospital; it deals with treatment of mental illness. Mental illness
is the diseases that affect the mind and the way those individuals think and behave. Throughout the period I got
to know dangers and signs of mental ill patient. Some of the causes of mental illness include social stress or
trauma. There are offensive words that are used to describe mentally sick person are; mad, lunatic, crazy and
insane instead of mentally disturbed, unstable, mentally sick and mentally ill. There are several reasons that
might suggest the admission of a given patient in psychiatric ward which may include general violence and poor
IR, depression, refusing food and even not wearing clothes. Some of psychiatric conditions include; APE, TLE,
MDP, ABS. At the D.O.D the patient is passed through Mental Status Assessment (MSA) wherein case of NAD
the patient is allowed to go back home.
While registering psychiatric patients, care should be taken to obtain enough identification information about
the patient. This helps in case of follow up is needed at any particular time.
It’s in this section that I did analytical hospital statistics. There calculation;
 Average length of stay
 Excess patient days
 Percentage occupancy
 Average daily population
 Average bed days
 Occupied bed days
 Turn over per bed
Functions of health records and information
 Receiving and registering ne patients who are admitted in the psychiatric ward.
 Provide legal admissions when they are needed whereby we have different MOA due to different RFA.
 Receive patient file and parole

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  Do coding of diseases
 Indexing of the coded files
 Retrieve patient files when they are needed
 Filing of the patient files
 Compiling of monthly, quarterly and annually statistics
 Provide data for research when they are needed.
 Teaching students on attachment.
 Creation of master index cards
 Designing of medical forms

Activities done at psychiatric ward

 Registration of new patients
 Reception of patients
 Coding
 Tracing of patient files.
 Indexing of coded files
 Booking of patients
 Clinical preparation
 Filing of patient files
 Retrieving of patient files

b. Data Center Department

Here is where reports are generated. Reports from all departments are collected from all departments and wards
to be combined and reported to the next level. The next levels include; health information unit, district medical
records office and county medical records office.
Functions of health records officer in data Centre
1.) Compilation of DBR from wards.
2.) Calculating HAS.
3.) Aggregation of all data and information for various departments and sections.
4.) Compilation and analysis of reports i.e. monthly, quarterly and annually.
5.) Upload of reports to the DHIS system timely, accurate and complete.
6.) Presentation and dissemination of health information.
7.) Participate in development of AWPS or service delivery indicators.
8.) Maintaining security of health records equipment.
9.) Designing medical forms
10.) Preparing section unit health record budget
11.) Attend Health Records meeting as delegated to the HRIO
Reporting tools found in Data Centre
 MOH 717- monthly workload
 MOH 710- immunization and vitamin A summary sheet
 MOH 705A- under 5 daily outpatient morbidity summary sheety
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 MOH 705A –over 5 daily outpatient morbidity summary sheet
 MOH 713- nutrition monthly reporting
 MOH 515- community health extension workers summary sheet
 MOH 105- service delivery report.
 MOH 731- Comprehensive HIV/Aids facility reporting form.
 MOH 718- inpatient morbidity and mortality summary sheet.
 MOH 711- An integrated tool for reproductive
 MOH 708- environmental health service.
 MOH 734- CDRR for HIV nutrition commodities
 MOH 706- laboratory summary report.
 MOH 364-sexual based gender violence summary form.
 MOH 643- CDRR laboratory commodities
Ways in which Data is submitted to the next level
There are two ways in which data is submitted to the next level;
(a) Through DHIS
Here computers are involved in keying in the information.
(b) The second way is through hardcopy e.g. tallying
The information is distributed in four copies in the following order;
1.) The original copy should be sent to the health information unit
2.) First duplicate copy should be sent to the district medical record office
3.) Second duplicate should be sent to the provincial medical record office
4.) Third duplicate should be maintained by the hospital medical records
Uses of service delivery and workload reports
 Hospital budgeting
 Planning
 Monitoring and evaluation
 They are used as communication tools

c. Causality/Emergency department
At this station, it acts as the reception for the people who are in emergency conditions. It also acts as the
reception for the inpatient clients. The registration and admissions of the patients is the main activities that take
place here. The admission is done using EMR for the new admissions and readmissions. Readmission is done
for those given patients have come for another admission and that means previously have been admitted in the
same facility. The software used in the EMR in admission is called Check Health Information System (CHIS).
When admitting a patient, the details of the patient are captured into the Inpatient Register (MOH 305). The
details include the patient number, full names, residents, the person who brought the patient and the ward
admitted.
The patient is generated by numerical way of listing patients as the way they get admitted, the patient being
admitted is given a unique identifying number to the next previous patient in the ascending order. The patient
there for is given the Inpatient Card, whereby in case of a readmission, the particular patient should show the
card the Health Records officer to avoid forgetting in case it happens.
Duties of health records officers at casualty include

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  Teaching students on attachment
 Filing patients notes
 Issuing of files to patients
 Registering patients
 Retrieving and tracing of patient files
 Birth notification
 Filing back patient files
 Doing file search for research

The standard operating procedures for registering patients

 DATE- the actual date the patient seen at the facility
 OPD No- A unique identification number given to a new patient annually
 REVIST-OPD number of the patients who return to the facility for services during the calendar year
 FULL NAMES-At least three names of the patient
 SEX-Should be recorded as M for male and F for female
 AGE IN YEARS-Actual stated age of the patient expressed in figures/numbers and NOT A or C
 ADDRESS-Physical, land marks or telephone number of the patient and the next of kin

d. Outpatient Department
It acts as the reception for outpatient patients. The outpatient department deals with those patients who come
treatment for just a while and go back home. Here the patient is received and given the direction on how he is
going to receive the treatment

Outpatient management

 Patient registration and billing for:

 Special clinics
 X-ray
 Medical examination
 Eye and simple extraction of teeth

Procedure for billing

Click on GOK, revenue code its records department to specify where you are billing from for accountability.
Enter the patient OP number on the receipt that has been registered with….. then get charges on either request
form that has been given by the doctor or prescription that has been written on the paper that the patient has just
come with, click on the search services and enter the request services.

At a time when the doctor sends the charges and it reflects immediately the patient no is entered… you click on
the respective services and you bill as you give the receipt out.
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Patient registration

There is creating new patient file- for the first visit and here the patient has to pay ksh.70 for the registration.
This is for the first time for the patient’s name to be entered into the system. The information about the patient
is entered into the system and the receipt printed out. The information about the payments reflects to the
doctor’s systems.

Revisit

For those who have ever come to the facility and their names are reflecting in the system. Here the patient only
pays ksh.50 for the visit. All his or her information is captured from the system and is displayed.

Registers that are found in outpatient department

a) Outpatient (over 5) Register MOH 204B – this register is for registering all patient over 5 years who
visit the hospital through the section. Their number is generated separately.
b) Outpatient (under 5) Register MOH 204A- this register is for registering all patients who are less than 5
years of age. There outpatient numbers are generated separately.

The registers are not commonly used nowadays due to electronic registration using EMR. The system has all
information required from the patient captured and the patient given an outpatient appointment card which
carries the OP number of the patient, names and location. The card helps the patient in case of revisit to be
traced in the system easily.

1.2. Staff establishment of the department in terms of the number of employees and their duties and
responsibilities
A. Comprehensive care Centre (CCC)
CCC is a clinic on it’s on and is managed as any health facility. At this station. Clients are received from
different entries after having been diagnosed or tested positive. These entries include; PMTCT, IPAD, TB
clinic, OPD, VCT, IPDCh. There are several clients who are also transferred in from different facilities in the
count. The patients at this station they are enrolled onto either CTX or ARVs as per the level of CD4 counts in
the body. The type of filing system that is used in this section is straight numerical for the patients who started
ART with the facility, for the transferred in they are filed alphanumerically.

Ethics practiced in records

Health records that work in the CCC must operate under bound laws to make sure the information about any
patient cannot be exposed to any outsider. This law of conduct includes;

1) Confidentiality- it involves the privacy of the clients and the information they having.
2) Discipline- this is a code of conduct of behaving well before other staff, patients and to other students.
3) Communication- it refers to the transmission of information from one person to another. It can be within
the department or from the top management and it carries different information as per to the chain of
command.
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 4) Security- the information about the patient should be handled under a high security, the information
should never be interfered with in any manner.
5) Disclosure- the patient of the patient is not supposed to be disclosed to any person since it can be used as
a weapon against that person. But due some circumstances the information is disclosed out;
 By court order
 Patient’s consent
 Safeguard the interest of the hospital or for the doctor
 Transfer of information between authorized health agencies
 Disclosure for higher duties of outbreak of diseases or side effect.
6) Ownership- the records used belong to the hospital but they normally carried by patients during every
time of revisit.

Heath Management Information System (HMIS)

It is in CCC that we learnt tools used to collect and how data is collected. The tools used to collect data are,
daily activity register MOH 366, MOH 731, MOH728, Pre-ART Register MOH 361A, ART register MOH
361B.
In patient files there is a blue card (MOH 257) which we extract information that we use for tallying in the DAR
Register. The totals from DAR are transferred to Monthly Tally Sheet MOH 728 and finally it is reported into
MOH 731.
MOH 361A is used to show all the patients that have enrolled into care including those transferred in. while
MOH 361B is used to update the conditions of the patients who enrolled to ART up to when these patients die,
transferred out and lost to follow.
Analysis and interpretation of data
I learnt about ways and presentation of data, these were; pie charts, line graph, tables and histograms.
Tools used in ccc
They include the following;
 Pre-ART Register MOH 361A
 ART Register MOH 361B
 Daily Activity Register MOH 366
 Monthly Activity Sheet MOH 728
 Patent Appointment card MOH 258
 CCC Patient Card MOH 257
Functions of health records and information officers
a) Booking clients for every next revisit
b) Retrieval of files
c) Tallying daily Register and combining daily report
d) Filing back
e) Giving direction to clients
f) Updating and initiation of ART Registers
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 g) Making of daily calendars
h) Registration of clients into EMR
i) Enrollment of patients and generating unique numbers
Tracing back patients records
j) Sorting files
k) Checking for misfiling
l) Recording of viral loads and CD4 results
Activities done by health records and information managers
a) relating and handling of clients
b) to keep the records that belong to the patients
c) maintaining confidentiality of the patient’s information
d) booking appointments dates for patients
e) understanding the terms used in the CCC
f) understanding the tracing system used
g) understand the tools used in the CCC
h) understand the filing system used and the ethics used in records
i) making the daily reports
B. Central Records/Library.
Central records act as the central library for records for the patients. After discharge, patients’ files are collected
and brought here, through a series of activities are stored here. Files are collected from different wards. When
files are picked from any given ward after discharge, the files are captured in the MOH 361 to show that they
have been dispatched to the central records for storage.
At this station, I learnt about coding and indexing of diseases. Coding is the assigning alphanumeric value to a
disease or a condition. There are three ICD 10 books that are used for coding;
I. volume 1(tabular list) -this one is used for confirming codes
II. volume 2(instruction manual)-this book is used for providing guidelines
III. Volume 3(alphabetical index)- this is used for coding. And has three sections (section 1, section 2 and
section 3)
There are established steps for coding diseases. These are;
(a) Identify the type of condition to be coded and refer to the appropriate section to be coded i.e. section 1,
section 2 or section 3.
(b) Locate the lead term. Lead term is always a noun for pathological conditions.
(c) Read and be guided by any notes that appear under the lead term.
(d) Read any term enclosed in the parenthesis after the lead term.
(e) Follow carefully any cross-references found in the index (see this and this).
(f) Refer to the tabular list to verify the suitability of the code selected.
(g) Be guided by any inclusion r exclusion terms under the selected codes or under the chapter, block or
category heading.
(h) Finally, assign the code.
Functions
(a) Receiving files from wards
(b) Coding and indexing
(c) Sorting of files

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 (d) Filing
(e) Retrieving of patients files when need arise
(f) Tracing of patients files
(g) Checking of misfiling
(h) Issuing of burial permit
activities
 Sorting files as per the last two terminal digits
 Filing back
 Tracing the file incase its missing from the library
 Retrieving the files for readmission of the patient
 Coding

Tools used
 Computer- the computer is used to capture the received the files, the name, conditions and the wards
from which the files are coming from.
 ICD 10 Books; vol 1 and 3- these are used for coding
 Tracer book- it is used to follow up a given file that was taken ou the central records section to other
places such as wards and by who took it.
 Diagnostic disease index card- index cards are used to monitor the disease trends, that’s is there is
outbreak of a given condition, pandemics, epidemics and endemic conditions in the population
catchment of the locality served by the hospital.
C. Maternity
This section is only for women. Most of them come to deliver and others for pregnancy checkups. In maternity
there are units of file collection, these are; antenatal ward, postnatal ward and new born unit. During collection
of files, they are written in the dispatch book and received at the records department.
Functions

 Coding and indexing of diseases

 Issuing of birth and burial permits by use of B1 booklet
 Admission and registration of patients and clients
 Filing of patients files
 Tracing
 Retrieving patients’ files
Tools used
 Post- natal register
 Maternity register MOH.333
 In-patient register MOH.301
 B1 Booklet Mother booklet
 Summary sheet MOH.718
Activities
 Admission of expectant women
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  Registration
 Filing
 Tracing
 Retrieving
 Coding and indexing
D. Consultant Clinic
It’s a special clinic that operates on outpatient manner and deals with patients with chronic conditions
who come on regular basis for checkups, treatment and close monitoring. It has medical Outpatient
Clinic (MOPC), surgical Outpatient Clinic (SOPC) and Pediatric Outpatient Clinic (POPC).
Functions
 Booking clinics for patients for the next clinic as per the type of clinic
 Retrieving of patients files
 Filling back
 Checking of misfiling

Tools used;
 Computer-for checking patient name, IP numbers or OP numbers just in case the patient doesn’t
remember.
 Patients’ cards- which has got patient information as per the clinic and the booking dates.
 Tracer book- for locating files that has left out to other sections of the hospital.
Activities
 Booking of clients for the next clinic
 Retrieving of patient file to be taken to the doctors
 Filing back
 Tracing of patient files

1.3. Student Main objectives for the attachment Exercise

 Exposing my new knowledge through team work, challenges and risks in addition to other issues in the
field.
 Developing understanding and work ethics, employment demands, responsibilities and opportunities
 To improve in research capabilities

1.4. Attaché’s assigned routine duties and department’s participation forums.

 Teaching students on attachment
 Filing patients notes
 Issuing of files to patients
 Registering patients
 Retrieving and tracing of patient files
 Birth notification
 Filing back patient files
 Doing file search for research

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 CHAPTER THREE: EVALUATION OF THE ATTACHMENT PERIOD

1.5. Success/Failure of the attachment exercise vis-à-vis Student main objectives.

Success/ failure of the attachment exercise vis-a-vis student's main objectives. Built a strong network of
industry colleagues and professionals. Discovered more about a professional path 14 Comprehended and
displayed relevant experience that strengthens my resume. Investigated what it's like to work in your desired
field. Limited Scope: Getting assigned with specific tasks or projects that have a limited scope or do not provide
a comprehensive view of the organization's operations. This has restricted the learning opportunities and
prevent me from gaining a holistic understanding of KRA's functions. Dealing with Confidential Information:
Ensuring the proper handling and protection of such information has been a challenge, especially since I was
not adequately briefed on data privacy and security protocols

1.6. Challenges encountered by the student during the attachment period.

There were several challenges that we encountered during the entire period of attachment.
 Shortage of staff- there are limited number of health records and information officers in the hospital.
In vasualty there was even one health records officer and yet patients to be attended to are in large
number. They keep waiting at the queue especially at lunch hours.
 Inadequate computers. The computers are a few in numbers. In data center there was a single
computer which is supposed to be operated by several people. This creates a lot of inconveniences
 Inadequate space
 Misfiling
 Lack of commitment
 Overcrowding
 Lack of regular internet connectivity
 Misfiling
 Misfiling of DBR in wards
 Dust in retrieving files
 Lack of kick-stools for short individuals

1.7. How Challenges were Overcomed/solved.

 Though the challenges faced me, they gave me an experience and taught me more. I acquired skills in
improving my confidence in solving problems and gain the confidence to interact with different
categories of people. The following are some ways I used in solving the challenges I faced.
 I was able to cope with the limited time period I had and work tireless to see success in the training, I
adopted time management skills which enabled me catch up with the lost time.
 Being proactive-there being no much work, I engaged myself in other productive projects and activities
relating to my career which enabled me gain much experience and streamline my career.
 Some of my relatives aided in assisting me financially to the success of my training.
 Success/failures of the attachment exercise
 I had much success in my attachment I had the opportunity to show my workmanship and apply my
class knowledge to solve and accomplish the tasks that were handed to me. I felt quite at home with the
activities that the nursing department undertakes
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 I was given tasks that’s were quite related to what I had learnt. the tasks included
 Creating spatial database of all the hospitals department
 Filling the several data that describes the hospital blocks
 Management of patients and helping
 I was able to learn and perform vital signs
 Distinguished pathological waste, anatomical waste, teeth, and placenta and serum containers.
 I was able to meet various capable head of departments and medical officers who gave me insight into
the industry. Achieving the tasks given to me gave me more confidence for any task thereafter. I found
out that. I could do the same thing experienced employers were doing. this was an indication that the
skills I had acquired in school were relevant and has set on a path towards a successful career all in all.
1.8. Recommendations
 The hospital administration and those concerned should;
 Install more computers
 Increase the number of staffs
 Create more space to avoid overcrowding
 Encourage those concerned to be careful when filing to avoid cases of misfiling
 Be committed to their work
 Work on the internet to ease work
 Encourage those concerned to fill the DBR daily

1.9. Conclusion
Despite the above challenges, we undertook our attachment and came out successful. We recommend
other students to come for attachment at KCGH, work hard and be disciplined
Summary of Attachment Report:
During my attachment period at the KCGH I had the opportunity to
gain valuable experiences and knowledge in strategic management. The attachment provided me
with insight into different fields of strategic management and allowed me to develop various
skills that are essential for a successful career in this area. One of the main experiences I gained
during my attachment was being exposed to the practical application of strategic management
concepts in a real-world setting. I was assigned various tasks and projects related to strategic
planning, risk management, and innovation. This allowed me to understand the importance of
aligning organizational goals with strategic initiatives and the need for effective risk assessment
and mitigation strategies in a dynamic business environment. Additionally, I had the chance to

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BIBLIOGRAPHY/ REFERENCES

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