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Words on Wounds
A forum to discuss the latest news and ideas in skin and wound care.
Friday, March 18, 2011
Photography Is an Essential Tool in Wound Documentation

Wound documentation is crucial from a legal and clinical standpoint. On admission, patients should receive a comprehensive assessment with appropriate documentation of any skin concerns. Ongoing assessment and documentation allows clinicians to determine if interventions are effective for the treatment/management of existing wounds. Although there are a variety of wound assessment tools to describe the status of wounds, many tools and classification systems lack validity, reliability, responsiveness to change, and feasibility to be used at point of care. For example, the differentiation between a Stage 1 pressure ulcer, deep tissue injury, and moisture-associated skin lesions remain elusive, especially for novice clinicians.

Confusion has also been created surrounding assessment of different wound tissue types based on color. For instance, whether yellow tissue is slough, fibrin, layers of exudate, and adipose tissue is not always that straightforward. Assessment is susceptible to error and subjective interpretation such as descriptions of the extent of localized swelling, maceration, and periwound redness.

Wound photography provides an objective approach to wound documentation. The February CME article in Advances in Skin & Wound Care highlights the merit and pitfalls for using wound photography. To obtain a satisfactory and clear image, clinicians must be trained to take close-up pictures using the macro mode and flashes. Policies should be developed to ensure that patients are informed of the purpose of photography, necessary consents are obtained, and images are stored appropriate area of health records.

Dr. Walter Doege MD said:
The clinical management of pressure ulcers is a challenge for physicians like me. I want to say it is of the uppermost importance to discussing this clinical situation. The photography in a hospital or unit care at admission is very important. I want to have more information and orientation because I have patients in hospice care and palliative care medicine. Up to date in this clinical challenge - pressure ulcers - is fundamental. Congratulations! I wait for an email and to partcipate in this blog. Best wishes. Walter Doege, M.D. psychiatrist member World Psychiatric Association (Brasil)
Dr. Caroline E. Fife MD said:
Most healthcare workers are familiar with “HIPAA,” but only with regard to privacy regulations, However, HIPAA requires that the provider identify the “designated record set” for a patient. This means that the healthcare system must define all the documents which together are going to consist of the “medical record” for a patient, regardless of whether those documents are maintained on paper or electronically, and this includes photographs. If the DRS is PAPER, the best option is likely to print out the digital photos and incorporate them into the paper chart. If your DRS is electronic, then the digital images would ideally be stored as part of that file. You should have a written policy which defines the DRS including the whereabouts of the photos and how they will be retrieved if requested. A good “test” is to call the custodian of medical records for your facility and ask them if they know what constitutes the totality of a patient file for one of your wound center patients.
Ms. Marie E. Torell_Alverio said:
I have been perfoming digital imaging for the past 7 years. It was very difficult to gain the support from administration...however....every thing you mentioned in this article is so true....for me the problem of inacurrate assessments followed by inappropriate treatments based on those assessments was a administration regognized this and allowed for imaging.......our image supports and validates our a result we have 99.9% acurracy and great healing outcomes........
About the Author

Kevin Y. Woo, PhD, RN, ACNP, GNC(C), FAPWCA
Kevin Y. Woo, PhD, RN, ACNP, GNC(C), FAPWCA, is Assistant Professor, School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada; Adjunct Research Professor, MClSc Program, School of Physical Therapy, and Faculty of Health Sciences, Western University, London, Ontario; Wound Care Consultant, West Park Healthcare Centre, Toronto, Ontario, and Clinical Web Editor, Advances in Skin & Wound Care.