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ANALYSIS OF THE IMPLEMENTATION OF DRAPPING AND DESTRUCTION OF MEDICAL
RECORD FILES
Muhammad Ganda SaputraA.
Ari KusdiyanaA.
NuryatiA.
Fara Nurdiyana4.
Marreta Aldy Windiana5 Universitas Muhammadiyah Lamongan Muhamadgandasaputra77@gmail.
ABSTRACT
The implementation of drapping and destruction of medical record files at Nashrul Ummah Lamongan Islamic Hospital aims to reduce storage burden, facilitate file retrieval, lessen staff workload, prevent misfiling, and ensure efficient supervision and maintenance of active and useful medical records.
This study employed a qualitative research design with a descriptive approach.
Data were gathered through interviews, observation, and documentation, involving key informants such as the head of the medical records unit, storage and distribution officers, and registration officers selected through purposive Data analysis followed a process of data reduction, presentation, and drawing conclusions.
Findings indicated several aspects of implementation.
In terms of personnel .
an aspec.
, only two officers met the educational qualifications for managing drapping and destruction of medical record files, highlighting a lack of knowledge and training in procedural steps.
Financially .
oney aspec.
, there was a budget plan for this activity.
However, in methodological aspects .
, although Standard Operating Procedures (SOP.
were available, they were not consistently implemented according to established policies.
Mechanically .
achine aspec.
, equipment such as shredding machines and specialized scanners were present.
Materially .
aterial aspec.
, while medical record storage racks existed, specific racks for inactive files were absent.
Documentation regarding the destruction of medical record files also lacked evidence.
To improve the situation, it is recommended that hospital management prioritize training for staff involved in Drapping and destruction medical record files or undertake further studies and evaluations.
This approach aims to ensure that activities adhere to SOPs, enhancing efficiency and compliance with established protocols.
Keywords Destruction.
Drapping.
Medical Record Files INTRODUCTION Hospitals can organize health services to provide quality services.
One of the health service indicators determining the quality of health services in hospitals is the availability of medical records.
The medical record management system is a destruction system, physically destruction medical record archives that have ended their function (Amin et al.
, 2.
Before the destruction of medical records, medical record files must be depreciated.
Drapping reduces archives from storage shelves by moving inactive medical records from active shelves to inactive shelves by sorting on storage shelves according to the last visit year (Shofiarini.
, 2.
The implementation of Medical Records ensures that every service provided to patients and their health history is documented in medical records to guarantee patient safety.
Medical records contain notes and documents regarding patient identity, examinations, treatments, procedures, and other services provided to patients at healthcare facilities (Kemenkes, 2.
According to Regulation of the Minister of Health No.
269 of 2008.
Article 8, paragraph 1, patient medical records must be retained for a minimum of 5 years from the date of the patient's last visit or However, medical records cannot be stored indefinitely due to the increasing number of records in hospitals, which may eventually lead to storage space becoming full and inadequate for accommodating new records.
Referring to previous research conducted by Wasiyah, a study at the Rokan Hulu Regional General Hospital in 2020 revealed that the number of medical records disposed of by the hospital varied In 2013, the hospital disposed of 362 inactive medical records per year.
This number increased to 767 inactive medical records per year in 2014.
However, in 2015, the number of disposed inactive medical records decreased to 362 per year.
Based on the results of interviews and initial observations conducted by the author, in the medical records unit of the Nashrul Ummah Islamic Hospital of Lamongan, the number of medical record files depreciated from 2015 to 2019 was 32,500 files from inpatients.
As for medical record files that have JOHC.
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The Nashrul Ummah Lamongan Islamic Hospital destruction medical record files on January 21, 2018.
With the last visit in 2008, outpatient files were counted in the inactive medical record defence list of 337 files and for inpatient files from 2006 to 2010 with rm numbers 02.
12 - 03.
According to Shofiarini et al.
, .
indicators that influence the implementation of drapping and destruction of medical record files are a.
Man aspect .
, b.
Money aspect .
, c.
Method aspect .
, d.
Material aspects .
, e.
Machine aspects .
Man is the most critical element and cannot be replaced by other elements with thoughts, hopes, and ideas that play an essential role in determining the usefulness of other elements.
Budget .
is one factor that determines the success or failure of the implementation of an activity in achieving goals.
Method .
is a suitable method or activity from various existing alternatives.
The implementation of management in achieving goals will run appropriately and successfully.
Material .
is a tool or means of management.
Equipment .
is a human auxiliary machine used to implement management and achieve goals.
(Rohman, 2.
Based on these problems, the authors are interested in conducting further research on AuAnalysis of the Implementation of Drapping and Destruction of Medical Record Files at Nashrul Ummah Islamic Hospital of LamonganAy by determining problem solutions using the 5M method to explore ideas, providing suggestions and agreements generated to solve problems and as recommendations for improvement efforts.
This method is expected to help the hospital make decisions to improve service quality, especially for destruction activities, to reduce the pile of medical record files on the storage rack, ensure medical record files are maintained physically, information and confidentiality, and minimize active file storage.
METHOD
This study used a qualitative descriptive approach from December 2023 - June 2024 at Nashrul Ummah Islamic Hospital of Lamongan.
Implementing medical record drapping and destruction at Nashrul Ummah Lamongan Islamic Hospital was analyzed based on the 5M aspects (Man.
Money.
Material.
Machine.
Metho.
To ensure data credibility, researchers used source triangulation and technical triangulation.
The informants in this study were the head of the medical records unit, storage and distribution officers, and registration officers with purposive sampling.
Data collection techniques used interviews, observation, and documentation.
Data analysis starts with data reduction, presentation .
isplay dat.
, and conclusion/verification.
RESULTS
Man Based on the results of interviews regarding the level of education of the head of the medical records unit, storage and distribution officers, and registration officers, it could be perceived that the head of the medical records unit and officers from the storage and distribution unit who have the latest education background D3 Medical Records were under the qualification standards set by the Ministry of Health .
The two officers were registration officers and 1 of the storage and distribution unit officers whose educational background was from high school, which means that it was not under the qualification standards of medical records.
The expression of the research informant was as follows:
"My last education level is D3 Medical Records.
for officers in the Medical Records Unit, only two graduated from D3 Medical Records.
For other officers, most of them are high school graduates.
Based on the results of interviews regarding officer knowledge, it could be concluded that officers lack understanding of the general definition and procedures or procedures for implementing drapping and destruction of medical record files.
This was in accordance with the following informant's "To minimize medical record files in the hospital.
"By re-checking the medical record files and selecting the year in the last five years for drapping and Based on the interviews regarding training attended by officers, it could be concluded that medical record officers at Nashrul Ummah Islamic Hospital had never attended training related to medical record management, especially related to drapping and destruction.
However, only one officer had JOHC.
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By the following informantAos statement:
"Ever, training related to basic management that represents and covers everything globally, from entering patient data to assembling and filling.
However, if it is related to specific training regarding the implementation of drapping and destruction, there is none.
Money Based on the interviews, it could be concluded that all informants stated that there was no specific budget related to drapping and destruction medical record files at Nashrul Ummah Lamongan Islamic Hospital.
However, the budget plan related to the place of destruction of medical record files already exists and had been planned.
The budget in the Budget Plan had been included in this yearAos operational plan.
Because later, the budget would be used to socialize medical records.
The expression of the research informant was as follows:
AuNot yet.
The plan for the cost budget is related to the budget for the place of destruction of medical record files.
The budget in the Budget Plan is included in this yearAos operational plan.
Ay Method Based on the interviews conducted regarding the SOP at Nashrul Ummah Islamic Hospital, there was already an SOP regarding the implementation of drapping and destruction of medical record files, which was under implementation.
However, from the results of the researchersAo observations, the researchers found that the SOP related to the drapping and destruction of medical record files in its implementation was not under the HospitalAos SOP.
The following were excerpts from interviews with informants related to the SOP for drapping and SOP for destruction of medical record files at Nashrul Ummah Lamongan Islamic Hospital:
AuIt already exists and is under the implementation of drapping and destruction at Nashrul Ummah Lamongan Islamic Hospital.
Ay Based on the results of observations, it could be explained that there are SOPs related to the drapping and destruction of medical record files that were not under the implementation at Nashrul Ummah Lamongan Islamic Hospital, which was not in line with the results of interviews conducted with medical record officers who said that the implementation of drapping and destruction was under the HospitalAos Standard Operating Procedures.
Machine The same statement by the four informants stated that the medical records unit had one scanner, which was used to implement the drapping of medical record files at Nashrul Ummah Lamongan Islamic Hospital.
The tool was precisely placed on the table of the head of the medical records unit.
The following were the results of interviews with informants:
AuOne scanner in the medical records unit is used for implementing drapping and destruction.
Ay Based on the results of observations, it could be concluded that Nashrul Ummah Lamongan Islamic Hospital had the availability of a special scanner for the implementation of drapping consisting of 1 scanner in the medical records unit with the type EPSON L3210 in 2018 in good condition, not damaged, suitable for use and functioning properly which was helpful for digitizing medical records.
Based on the results of interviews conducted by researchers, there was one medical record file destruction tool at Nashrul Ummah Islamic Hospital.
The medical record file destruction tool owned by this hospital had been used once to implement the destruction of medical record files that were destruction in 2018.
The following informant's statement:
AuThere is one medical record file shredding machine in the office.
It has been 1x medical record file destruction in 2018.
Ay Based on the results of observations and interviews with the four informants who stated that Nashrul Ummah Lamongan Islamic Hospital had one medical record file shredder machine which had the type HSM Classic 90.
2 of 2012, which was placed in the training room office with conditions that were still suitable for use, but the destruction machine was small, the hospital only had one destruction machine JOHC.
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Material Based on the results of interviews with the four informants, it could be concluded that medical record document storage shelves at Nashrul Ummah Lamongan Islamic Hospital were available.
Which consisted of types of medical record file storage shelves consisting of eight wooden shelves, four glass shelves, and six cabinet shelves.
The following was an excerpt from an interview with an informant:
AuThere are available storage shelves for medical record files with eight wooden shelves, four glass shelves, and six cabinet shelves.
For special inactive shelves, there are none, so they are just stacked in the room.
In a separate room.
The shelf for storing medical record files is almost full now that electronics have helped it, so I do not think about space.
Ay Based on the results of observations made by researchers who stated that the Nashrul Ummah Islamic Hospital had a medical record file storage rack and the availability of particular types of shelves, such as wooden shelves, glass shelves, and cabinet shelves as a place to store files.
It consisted of eight wooden shelves, four glass shelves, and six cabinet shelves.
With the condition of the storage shelves almost full and there was a buildup of inactive files which were still used as one place with active medical record files so that there was a buildup of files and scattered, in addition to accumulation, the condition of storage shelves made of glass would be at risk of breaking easily when the shelves are filled with uncontrolled files.
Inside the shelf, medical record files were starting from 2019 to April 2024.
Based on the results of interviews that had been conducted related to the availability of minutes of destruction at Nashrul Ummah Lamongan Islamic Hospital, namely already available.
In line with the results of interviews with officers who stated that the minutes of the destruction of medical record files were available.
The expression of the informant was as follows:
AuThere is evidence or a sheet of minutes of destruction in the form of a file.
Ay Based on the results of these interviews and observations, it could be concluded that at the Nashrul Ummah Lamongan Islamic Hospital, there was evidence of the minutes of destruction in the form of document files.
DISCUSSION
Man Judging from the results of the study, the educational qualifications of medical record officers at Nashrul Ummah Lamongan Islamic Hospital found that of the two medical record officers who did not comply with the qualification standards set by the Ministry of Health No.
55 of 2013 concerning the implementation of medical recorder work, namely the minimum education taken is a graduate:
Diploma 3 (D.
as an intermediate expert in medical records and health information .
Diploma 4 (D.
as applied bachelor of medical records and health information .
Undergraduate degree (S.
as a bachelor of medical records and health information .
MasterAos degree as a bachelor of medical record and health information.
Medical record officers who are not medical record graduates have knowledge, which means that they still lack understanding and mastery of procedures related to the implementation of drapping and destruction of medical record files.
The importance of mastering the competencies of medical recorders is related to their educational background and career path in the medical records unit.
Human resources are needed to meet medical recordersAo competencies to carry out work in the medical records unit (Hatta, 2.
in the research of Ohoiwutun et al.
, 2021.
Education affects officers to assist them in mastering specific knowledge and skills to improve their shortcomings and minimize errors.
Researchers assessed the level of education of the four officers implementing the drapping and destruction of medical record files at Nashrul Ummah Lamongan Islamic Hospital, and only two officers were under the medical record qualification standards.
Moreover, the two officers still do not meet the established qualification standards.
Based on the interview results, the officer just knew the procedures or steps for implementing drapping and destruction.
Officer knowledge, that was understanding what was meant by drapping and destruction, the purpose of drapping and destruction, and how long the shelf-life limit had been set to store active medical record documents into inactive medical record documents.
Staff knowledge related to the definition of drapping and destruction was not under the definition according to Law number 43 .
concerning Archives, which states that archive drapping is an JOHC.
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In addition, the definition of destruction, according to Amin et al.
, is a process of physical destruction of medical record archives that have ended their function.
Based on the research results, it could be seen that the officers implementing drapping and destruction just knew the procedures or steps related to the drapping and destruction of medical record This problem is in line with research (Turwadi and Ernawati, 2.
, which states that the obstacles in drapping and destruction activities are that the available human resources lack understanding of drapping and destruction activities because most of the officers do not have a medical record background and do not receive special training related to drapping and destruction of medical record The interview results explained that medical record officers at Nashrul Ummah Islamic Hospital had never attended training related to medical record management, especially related to drapping and However, they had attended training related to essential management, including everything such as entering patient data, assembling, filling, and others.
The training activities attended by the head of the medical records unit were carried out outside the hospital, organized by DPC PORMIKI (Professional Association of Indonesian Medical Recorders and Health Informatio.
, organized by Lamongan Regency.
This is in line with the research of Apriliani et al.
, .
which states that the implementation of drapping and destruction activities can be influenced by never attending training on medical records related to the activities of drapping and destruction medical record files.
This is because it is essential to conduct medical record training to improve the skills and knowledge of officers in organizing medical record services.
Therefore, researchers assume that training is needed for medical record officers at Nashrul Ummah Islamic Hospital so that drapping and destruction can be carried out correctly and under applicable standards or policies.
Based on the research results, it could be seen that the officers implementing drapping and destruction had never attended special training related to the drapping and destruction of medical record Money Based on the interview results, it was explained that the Nashrul Ummah Lamongan Islamic Hospital had no specific budget related to drapping and destruction medical record files at the Nashrul Ummah Lamongan Islamic Hospital.
However, the budget plan for destruction medical record files already exists and had been planned.
The budget in the Budget Plan had been included in this year's operational plan.
Researchers say the budget for implementing drapping and destruction at Nashrul Ummah Lamongan Islamic Hospital did not yet exist.
However, the budget plan in the RAB related to the destruction site had been included in this yearAos operational plan.
Because later, the budget would be used to socialize medical records.
The implementation of drapping and destruction activities requires a This was mentioned by Susanto et al.
, who stated that in planning the drapping and destruction of medical records, namely the budget to be used to socialize medical records.
Based on the Ministry of Health of the Republic of Indonesia .
number 377 concerning professional standards for medical recorders, one of the supporting competencies of medical record professionals is preparing and using budgets.
Budgeting is expected to help explain the need for funds in an activity.
In addition, the optimal use of funds in medical record activities, especially in the implementation of drapping and destruction of medical record files, can properly smooth the course of Absent budget planning could affect the availability of facilities and infrastructure needed at Nashrul Ummah Islamic Hospital.
Method Based on the results of interviews and observations, the Nashrul Ummah Lamongan Islamic Hospital already has SOPs (Standard Operating Procedure.
related to the implementation of medical record drapping and destruction, which were guidelines or procedures for carrying out drapping and destruction activities so that officers know how to carry out these activities optimally.
However, the hospitalAos implementation of drapping and destruction was not under the standards.
There is SOP Document No.
748/SPO/RM-JANGMED/RSINU/IX/2022 concerning the retention or drapping of medical record files, which explains the definition of retention or drapping, the purpose of drapping, policies and procedures for implementing drapping and agencies related to the implementation of retention or drapping of medical record files at Nashrul Ummah Lamongan Islamic Hospital.
JOHC.
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| Journal of Health Care In addition, at the Nashrul Ummah Lamongan Islamic Hospital, there is an SOP Document No.
749/SPO/RM-JANGMED/RSINU/IX/2022 concerning the destruction of medical record files which explains the definition of destruction, the purpose of destruction, policies in destruction, procedures or steps in the implementation of destruction of medical record files and agencies related to the implementation of destruction of medical record files at the Nashrul Ummah Lamongan Islamic Hospital.
According to Khairunnisa et al.
, 2022 about the procedures contained in the Ministry of Health .
SOP for drapping, such as documents that have been stored for five years calculated from the date of the patientAos last treatment retention, admission, and discharge summary forms, medical resumes, informed consent, operation reports, remain stored for five years from the date of drapping or sorting.
Other forms are destruction under the conditions written in the medical record document drapping guide, the separation of documents is carried out based on the type of disease, and for pediatric patients, retained according to particular needs, such as medical record documents that have been inactive for two years are assessed by an assessment team consisting of a medical committee, and medical record officers and medical records that have met the requirements for destruction are reported to the head of the hospital.
According to the researcherAos assumption about standard operating procedures (SOP) at Nashrul Ummah Lamongan Islamic Hospital, there was already an SOP for drapping and destruction, which was running well.
However, it had not followed the existing provisions.
for example, the implementation of drapping and destruction was not carried out within five years, and the implementation at the Nashrul Ummah Lamongan Islamic Hospital exceeds the time limit of more than five years.
Hence, the implementation of drapping and destruction was not well organized.
Machine Based on the results of interviews and observations conducted by researchers, a special scanner for implementing the drapping and destruction process at Nashrul Ummah Lamongan Islamic Hospital was available.
The medical records unit had one special scanner for drapping medical record files, which had the type EPSON L3210 in 2018, which helps digitize medical record documents.
According to researchers on a unique scanner tool for the drapping of medical record files at Nashrul Ummah Islamic Hospital, a unique drapping scanner tool was available to help officers scan inactive medical record files, assisted by one scanner tool.
From the results of the scanner, medical record files that still had use value, such as medical resume sheets, operation sheets, baby identification sheets, approval sheets, entry and exit sheets, and death sheets, were stored in special disk folders.
According to (Lestari et al.
, 2.
Scanners are helpful as a storage medium to assist in maintaining valuable forms so that these forms can be preserved and stored in the form of files if needed at any time before the medical record files are destruction.
Medical record files can be destruction using file destruction tools such as paper shredding tools to destruction medical record archives physically (Istikomah et al.
, 2.
Based on the results of interviews and observations conducted by researchers at the Nashrul Ummah Lamongan Islamic Hospital, it had one destruction tool or a particular medical record file shredder in the implementation of destruction, which had the type HSM Classic 90.
2 in 2012.
As for the implementation of medical record file destruction activities at Nashrul Ummah Lamongan Islamic Hospital based on the statement of the head of the medical record unit who stated that the destruction was carried out with some medical record files using an existing shredding machine and some medical record files were burned due to the small size of the shredding machine and the long process of shredding files in the machine.
So, some medical record files were burned.
According to the researchers, the shredding tool or medical record file destruction tool at Nashrul Ummah Lamongan Islamic Hospital was the availability of a unique shredding tool for medical record files in the implementation of destruction that functioned appropriately, useful for shredding sheets of medical record documents that had been declared inactive or that had no use value.
Medical record files can be destruction using file destruction tools such as paper shredding tools to destruction medical record archives physically (Istikomah et al.
, 2.
in the process of destruction medical record files which are tools needed in the implementation of drapping and destruction of medical record documents.
This is supported by (Susanto, 2.
Material Based on the results of interviews and observations, it was explained that there was a medical record file storage rack at Nashrul Ummah Lamongan Islamic Hospital.
There were three types of shelves, namely shelves made of wood, shelves made of glass, and cabinet shelves.
On the inpatient medical record file storage rack, there were five shelves.
on the outpatient medical record file storage JOHC.
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| Journal of Health Care rack, there were eight wooden shelves, four glass shelves, and six cabinet shelves.
The medical record files on the storage shelves were from 2019 to April 2024.
The researcher considered that at the Nashrul Ummah Islamic Hospital, a medical record storage rack was located in the filling room in the medical records unit.
However, medical record files from outpatient and inpatient care are placed separately.
Nashrul Ummah Lamongan Islamic Hospital has no special shelf for storing active medical record files.
The storage rack was not optimal where outpatient and inpatient medical record files were separated and not stored in one storage rack.
In line with Nuraini's research, in 2022.
Kusnadi's citation 2018 said that a separate storage place between outpatient and inpatient files will hinder providing medical record files if patients come for treatment for post-hospitalization control.
Properly storing separate medical record files will certainly inconvenience officers in finding the desired ones.
In addition, the separate storage of medical record files causes the provision of medical record documents for services to patients and other purposes to be longer.
According to researchers, the minutes of destruction at Nashrul Ummah Lamongan Islamic Hospital already exist.
There was evidence of destruction documentation in the form of document files, which explained the evidence of having carried out the destruction or shredding of medical record files carried out in 2018, known by the director, reported to the district health office and signed by the head of the medical records unit of the Nashrul Ummah Lamongan Islamic Hospital.
The minutes of the destruction were made at the time of the destruction and signed by the head of the destruction team, the secretary of the destruction team, and known to the Head of the Hospital / Health Center.
The number of minutes of medical record destruction was made in triplicate, namely:
The Hospital keeps the original medical record destruction minutes sheet as an archive.
The second sheet of minutes of destruction is sent to the Hospital Owner.
The third sheet is sent vertically to the Director General of Medical Services of the Indonesian Ministry of Health.
CONCLUSION
Based on the results of research related to the implementation of drapping and destruction of medical record files at Nashrul Ummah Lamongan Islamic Hospital on the aspect of man, namely the last education of the officer implementing the drapping and destruction of medical record files, only two officers were under the established medical record professional standards.
However, the officerAos knowledge was limited to the procedures or steps for the implementation of drapping and destruction, and the officer has never participated in special training activities regarding the implementation of drapping and destruction of medical record files.
The money aspect was that there is already a cost budget plan for drapping and destruction medical record files.
The method aspect was that there was a special SOP for drapping and destruction, but it had not been implemented under the provisions of the established policy.
The machine aspect was the availability of a medical record shredding machine and a scanner specifically for the drapping and destruction of medical record files.
The material aspect was the availability of medical record storage shelves, but there was no special shelf for inactive medical record files.
Moreover, the availability of documentation of the destruction of medical record files was called the minutes of destruction.
It is expected that hospital management can facilitate officers to attend training in drapping and destruction medical record files or further studies according to qualifications so that they have an educational background that is under the standards of medical record personnel and conduct monitoring and evaluation so that the implementation of activities is under Standard Operating Procedures.
REFERENCES