During the initial assessment of a patient’s skin wounds, it’s paramount to properly document all aspects of the wound in order to assure appropriate treatment. One of the most important methods of documentation is photography. But photographing a wound is more than just taking a picture for posterity’s sake; it also creates liability and accountability for the staff as well as the patient.
Along with documenting a wound’s appearance, digital wound photography also helps to create a better means for measurement—and when it comes to wound healing, treatment strategies depend highly on those measurements, which, in turn lead to better healing outcomes.1
As technology progresses, digital wound photography is becoming more ubiquitous than ever. And with this technology, guidelines to implement it are also necessary. In fact, the American Professional Wound Care Association has issued a list of practical guidelines for the use of digital images when it comes to wound photography.
Here are the guidelines:
- Use the same digital camera for successive images.
- Use the same image resolution settings on the digital camera (several are available).
- Use the same light source, intensity and angle.
- Have the camera at the same angle, distance, rotation and height from the wound.
- Choose either pre or post debridement for all images in a sequence.
- Select the same magnification for the digital camera lens (“zoom”).
- Choose a naming convention and put case identification, number or date in the image.
- Choose image archive software that will allow key word searches and audio tags with images.
- Have the wound in the same relative position as previous images.
- Use “fiducial” reference markers wherever possible to achieve consistency (i.e. patient code, date, scale).2
Wound care specialist Kara Couch says:
“[by doing] digital imaging, that’s going to help with efficiency and consistency and objectivity.”
These guidelines are all focused on providing better documentation for the sake of accuracy, but they also all support one or more of three other specific goals.
Measuring and assessing a wound on a patient takes time and can often involve more than one caregiver or nurse. Time spent assessing or measuring skin wounds can also be arduous and difficult for the patient, so the longer it takes, the more discomfort they can be in. By using digital photography, the wound can be visually captured without putting undue stress on the patient. And since digital photography also makes for more accurate measurement and documentation, the overall time spent on healing a wound can be greatly reduced, and therefore efficiency directly correlates to better outcomes.
As the old saying goes, “Consistency is key.” In the case of digital wound photography, having a consistent point of reference is key when it comes to determining how a specific treatment may be working or not working. As the guidelines above indicate, using the same camera with the same settings in the same angle, distance, rotation and height can give a better picture of how treatment is progressing and allow caregivers to adjust their plans accordingly.
Because nurses in post-acute care facilities are busy and have multiple patients they might have to care for, it could be easy to miss something or to misjudge a wound due to distraction or other factors. Digital photography eliminates room for interpretation and avoids the risks of environmental factors that may otherwise skew judgement. As digital photographs and newer technologies allow for less human error, the assessment of a skin wound becomes less subjective and more objective. With less interpretation and less human error, treatment has a better chance of accuracy for each individual.
How digital photography of wounds aids in patient compliance.
Besides the factors of efficiency, consistency and objectivity making digital photography of wounds so important, there are other reasons it’s a great habit to follow. For instance, digital photography of wounds can help keep patients more accountable of the aspects they are responsible for (such as compression, elevation, etc.) by allowing them to see firsthand how their wounds are affecting them.3 If patients can’t see a particular wound on the bottom of their foot or is otherwise too difficult to see, they might not realize the extent of the wound. Being able to share a photograph of the wound with the patient has the potential to make them more compliant with a treatment plan. In turn, sharing photographs of the progression of healing shows the patient how their compliance is aiding in a better outcome.
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