Ask the care expert ... about photographing wounds

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Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA
Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA

I am a charge nurse on a skilled unit. We do not take photos of wounds, but I would really like to take pictures. As they say a picture is worth a 1,000 words. Do you agree?

No, unfortunately, I do not agree. Here are some reasons why. 

1. At one time in my career, I took wound pictures, but with the ability to Photoshop an image, I am no longer a cheerleader. 

2. Taking a photo often makes a nurse lazy with documentation. He or she relies on the picture to explain the looks, drainage and size of the wound. Unless there is a reference point in the photo, such as a dime, that you can get an exact measurement from, just taking a photo will not help your documentation. Depending on the lighting, distance from the wound and formatting of the picture, a tiny wound may look huge, and a huge wound tiny.

3. Depending on the light in the room and flash usage, a nice pink wound can be made to look gross and non-healing, especially to the non-healthcare juror. You need to think proactively that this record may be in court one day. Will this picture make a juror feel ill? Think of the size they will expand this picture to … no wound picture can pass for a bouquet of sunflowers! 

In short, photos cannot replace good policies for wound documentation. If it is a problem for your facility, this would be a perfect opportunity for a QAPI project. 

Tackle the wound documentation, answer the whys, forget the photos, teach clinical documentation, and use proper terminology. Take a look around the Internet for good documentation, and visit the newly launched Quality Assurance Performance Improvement (QAPI) website at http://go.cms.gov/Nhqapi. I am sure you will find beneficial info here. Also check out the Advancing Excellence website, at www.nhqualitycampaign.org.