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Using digital photography to assess pressure ulcers in two acute care hospitals.
Purpose: The purpose of this IRB approved study was to determine whether a photograph that was taken of a wound on a patient in an acute care setting, could accurately and reliably convey the characteristics of a pressure ulcer.
Hypothesis/Statement of Problem: There has been a heightened awareness of pressures ulcers in acute care. Hospital administration was interested in documenting pressure ulcers present on admission with digital photography.
Background: This study was implemented to determine if digital wound photography can document the presence and stage of a pressure ulcer in acute care.
Methods: This non-experimental, cross sectional study used a convenience sample of 100 pressure ulcers in adult inpatient population located in 2 acute care hospitals. The pressure ulcers were assessed at the bedside by 1 of 4 Certified Wound, Ostomy, Continence Nurses (CWOCN). Within 24 hours the wounds were photographed by one of 14 RN’s who received an 8 hour class on wound photography presented by a Medical Photographer. The photographs were sent to a 3 person panel of experts composed of 3 CWOCNs. The assessments included the staging accepted by the NPUAP, and the 13 characteristics of pressure ulcer assessments established by the Bates-Jensen Wound assessment Tool (BWAT). The onsite assessments were compared to those done by the expert panel.
Results: When the assessments were compared interrater reliability (Kappa) for wound staging ranged from fair to moderate, correlations on the 13 characteristics ranged from weak to moderate, and the percent agreement was relatively low.
Outcome: The development of standardized education and competencies for taking and examining digital photographs may increase agreement among raters. Caution should be exercised when using digital photography.