MDS Alert

Here are the various views on this method of chronicling wound healing.

Using pictures to track a wound's progress can work for or against a facility in various scenarios, which is why the debate continues over whether to use this documentation tool. Below experts address the benefits and risks of using the approach and what to do if you use photos.

The crux: Whether a facility uses photodocumentation for wounds becomes a "huge issue" in terms of the legal implications, says Dorothy Doughty, MN, RN, CWOCN, FAAN, director of the Emory University of WOC Nursing Education Center in Atlanta. But using the approach can really help you see the difference in a wound from one point in time to the next because you can visualize the wound bed, she adds.

Wilma Bailey, RN, BSN, RN, CWCN, ET, CWS, reports her nursing home organization no longer takes pictures of wounds based on their attorney's advice, but she wishes they could start doing it again. "Sometimes the hospitals tell us the patient had [no wounds] but we end up with surprises."

Nurse attorney Barbara Miltenberger notes that litigation malpractice attorneys at her firm differ in their view of whether pictures can be helpful. "But in general, they say a plaintiff's attorney is just going to blow up a picture of a big wound," says Miltenberger, with Husch Blackwell LLP in Jefferson City, Mo. "And even if it's healing and looks good [to clinicians], lay people think it looks horrible."

What about correlating wound pictures to documentation and tools to show juries how the wound progressed? "The problem is that the cases that get litigated aren't the ones that get better over time," Miltenberger points out. "They got bad and then often worse and the person oftentimes had a lot of concomitant disease." In her view, however, "if pictures help improve care, they should be used, regardless of the fear of litigation." She also suggests that facilities make sure that the physician taking care of the wound look at the wounds and document his or her observations (for more information, see the article on page 54).

If your facility does decide to photodocument wounds, you will need guidelines for taking the pictures, Doughty stresses.

Resource: The Wound, Ostomy and Continence Nurses Society has published a position paper that includes helpful strategies for using photodocumentation. For example, the paper suggests coming up with the following:

The paper also addresses HIPAA and consent issues and notes that states vary in terms of whether they allow pictures of wounds in court (http://www.wocn.org/pdfs/WOCN_Library/Position_Statements/photoposition.pdf).