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MARJORIE GROOM, MSHCA, BSN, RN,

CWOCN, DAPWCA

CLINICAL PHOTOGRAPHY: CLARIFICATION

OF COMMON PROBLEMS FACING THE

WOUND PHOTOGRAPHER

OBJECTIVES

List various items to be included in the policy and procedure for

wound photography

List when/ how to photograph, storage of photographs, and

what to include in photograph

Discuss legal ramifications, pro and con, of photographing

wounds in a variety of medical settings

WHY PHOTOGRAPH?

One picture is worth a thousand words, charting

becomes much easier

Better communication between team members

Education of staff, patient and family members

Verifies charting and/or graph tracings

Legal aspects

WHY NOT PHOTOGRAPH?

All staff members do not carry out what the policy states

Legal ramifications if not done appropriately

Does not show all aspects of the wound

Depth

Overgrowth

Tunneling

SO, YOU WANT TO PHOTOGRAPH, WHAT NEXT? Get your ducks in a row

Decide on a camera, get costs

How are photos going to be stored?

Who is going to take photographs?

Will photos mesh with EMR?

What kind of permit is needed?

What kind of wound gets photographed?

Meet with the appropriate manager

Then, meet with legal counsel at facility

DEVELOPING A POLICY AND PROCEDURE Remember, it must be able to be followed

Maybe, start out with one type of wound and work up to others

Pressure ulcers make a good starting wound

When to photograph the wound, admission or when it is found,

weekly and upon discharge How to label the photograph

How to store the photograph when the chart is sent to medicalrecords

Who takes the photos and where they are placed in the chart

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CONSENTS

Make it easy

Families drop off patients

Contained within the consent to be treated on

admission

Photographs taken for educational and

medical purposes

WHAT DOES GO INTO THE PHOTOGRAPH?

The wound, properly draped

A measuring guide with the patients id, no names

Date

Identifying anatomy

WHAT DOES NOT GO INTO THE PHOTOGRAPH? Please, bear in mind the patients modesty!

Try to show only the wound

No Foley catheters, or a little of them as possible

If the photo is of the sacral area, do not include from mid back tothe knees

It is good take a photo to close-up and at a distance, but stilldraped

No stool

No dirty dressings

Ungloved hands

BEFORE THE PHOTOGRAPHING BEGINS

Make it clear that you the CWOCN do not take all theimages

Educate staff on what is and what is not to be photographed

Create super-users on each shift/nursing unit

Include the CNAs/PCTsMake it competitive

Educate on how to use the camera and what goes into thephotograph

Educate on how important it is to follow the policy

NOW THE FUN BEGINS!

Lets look at wound measuring guides

You can make one specific to your facility

Get them from lots of reps that sell wound care products

Easy way to label wounds Lawyers differ on labeling, but if the label is within the photo,

there can be no doubts

THIS IS AN EXCELLENT PHOTO OF A DVT, BUT WHOIS IT?

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NOW, THIS IDENTIFIES THE PATIENT, DATE, ANDANATOMICAL PART MEASURING GUIDES

LETS TALK CAMERAS Variety on the market

Websites at end of presentations

Can to Instant Photos

Difficult to store with EMR

Fade or discolor over time

Qualities of camera

Digital

Network with EMR

Be able to print for chart viewing

Software to prevent /reduce risk of tampering with images

STORAGE

Find out what happens to any photos when chart goesto medical records

Best option: software attached to EMR

If not: photos are scanned into record to prove taken

Very poor quality

Must keep original for as long as statute of limitations for legalactions

WEB SITES

http://www.pronto.com/user/search.do?displayQuery=wound%20camera&SEM=true&query=wound%20camera&adid=1196568568-8498066d-

0_mbs&ref=kodak%20wound%20photographing%20camera&creativeid={creative}&site={placement}&loadingComplete=true

http://www.woundcare.org/newsvol2n1/ar1.htm

http://www.imi.org.uk/natguidelines/IMINatGuidelinesWoundManagement.pdf

WOCN POSITION PAPER http://www.wocn.org/pdfs/WOCN_Library/Position_State

ments/photoposition.pdf