CLINICAL PHOTOGRAPHY: CLARIFICATION OF COMMON PROBLEMS FACING THE WOUND PHOTOGRAPHER

MARJORIE GROOM, MSHCA, BSN, RN, CWOCN, DAPWCA

wound photography

OBJECTIVES

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

WHY NOT 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

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 medical

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

CONSENTS

WHAT DOES GO INTO THE PHOTOGRAPH?

Make it easy Families drop off patients Contained within the consent to be treated on

The wound, properly draped A measuring guide with the patients id, no names Date Identifying anatomy

admission Photographs taken for educational and medical purposes

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 to

BEFORE THE PHOTOGRAPHING BEGINS

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

images

the knees

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 the

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

draped No stool No dirty dressings Ungloved hands

photograph

Educate on how important it is to follow the policy

NOW THE FUN BEGINS!

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

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

NOW, THIS IDENTIFIES THE PATIENT, DATE, AND ANATOMICAL 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 goes

to 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 legal actions

WEB SITES

WOCN POSITION PAPER

http://www.wocn.org/pdfs/WOCN_Library/Position_State

http://www.pronto.com/user/search.do?displayQuery=wound%20camera&SEM=true&query =wound%20camera&adid=1196568568-8498066d0_mbs&ref=kodak%20wound%20photographing%20camera&creativeid={creative}&site={pla cement}&loadingComplete=true http://www.woundcare.org/newsvol2n1/ar1.htm http://www.imi.org.uk/natguidelines/IMINatGuidelinesWoundManagement.pdf

ments/photoposition.pdf