Improving Patient Care Through the Standardization of Digital Photography in Wound Documentation

Purpose/Rationale: Chronic wounds decrease the quality of life for 3-5 million Americans and add financial burden to the health care system. Complete and objective documentation of wounds allows appropriate treatment to be initiated, evaluated for effectiveness, and modified as appropriate. Complete documentation also provides the records necessary for a provider to receive payment for appropriate care. Undocumented pressure ulcers cost hospitals, on average, over $10,000 per patient. Photography is increasingly being used for the assessment and documentation of wounds in various healthcare settings.

Methodology: Analysis of wound documentation at a 114-bed hospital facility in Northern California revealed information fragmentation and photography that did not meet industry standards for wound documentation. Root cause analysis validated a multi-pronged approach to improving photographic wound documentation.  Interventions included: creation of a new policy and procedure, development and testing of training materials and job aids, and staff training. Interventions were evaluated with surveys and chart audits. 

Results: Following these interventions, the quality and quantity of wound photographs increased as measured by random chart audits. Ninety-five percent of registered nurses responding to surveys (n=22) self-reported increased confidence in photography skills, and time spent transferring pictures to patients’ charts was significantly reduced. Data collection was limited by time constraints.

Conclusion: The quality of photographic wound documentation was elevated to industry standards through the standardization of photographic practices, streamlining of nurse workflow, and hands-on training. Risk of non-reimbursement for community acquired pressure ulcers was minimized through improvements in documentation standards. Disruptions to nursing workflow were prevented/limited through the inclusion of nurses at all levels of assessment and planning. More data collection is needed to evaluate the impact on patient outcomes. The inclusion of wound photography in Electronic Medical Records (EMRs) may improve patient care, enhanced coordination of care, facilitated interdisciplinary communication and promoted nurse knowledge acquisition.