Reader Question:
A Picture Is Worth A Thousand Words - Especially In Wound Care
Published on Tue Dec 02, 2003
Q: How can our agency best use photographs to document wound care?
A: Photographs let providers communicate clearly with each other and provide the most reliable documentation for medical, legal and reimbursement purposes, experts say. Taking a photo of the wound at start of care provides a baseline for measuring outcomes. As a risk management tool, agencies should take photos of wounds before a patient is transferred to a different care provider, whenever there is a change in the wound condition and every two weeks even if there is no change, advises Burtonsville, MD health care attorney Elizabeth Hogue. She recommends that agencies:
Have the patient sign a photo consent form before you begin photo documentation. Ideally this is a one-sentence part of the basic consent form you have each patient sign. If a patient does not agree to photos, cross that sentence out and have the patient initial it, she says. General confidentiality provisions cover photos, so no special confidentiality agreement needs to be added to the consent.
Use adhesive tape or labels to state the patient's name, the wound location and the date on which the photo was taken. Create this label when you take the photograph. This method allows you to prove the accuracy of the picture, since just labeling the photo after the fact "leaves too much room for error," Hogue warns.
Include the photo in the patient's permanent record. If you use a digital camera, print out the photo so it can be added to the chart. Some cameras include a measurement scale in the picture, but a simple Polaroid camera and a separate centimeter-measuring device placed next to the wound work fine.
Provide all the other documentation a photo doesn't cover. Your notes should document the depth and circumference of the wound, any tunneling present, the type of tissue and the color, odor and amount of any discharge. Train staff in a standard method of measuring wounds so measurement is consistent among staff members, Hogue advises.
