Pictures ARE Worth a Thousand Words

Carol Hall, BSN, RN, CWOCN1, Shelli Chernesky, MBA, MSN, RN, CCRN2, Jennifer Wintz, BSN RN QIA3, Tomas Armendariz, BSN RN3, Nicole DeSimone, MD4 and Ravi Sarode, MD4, (1)U.T. Southwestern Hospital at Zale Lipshy, WOCN, Dallas, TX, (2)apheresis, UT Southwestern, Dallas, TX, (3)Apheresis, UT Southwestern at Zale Lipshy, Dallas, TX, (4)Apheresis, UT Southwestern, Dallas, TX
Objective: Extracorporeal photopheresis (ECP) is an approved treatment for cutaneous T-cell lymphoma (CTCL)and acute/ chronic graph versus host disease (GVHD) following hematopoietic stem cell transplantation.  These patients need skin monitoring for ECP response.  In the past, only descriptive terms were written in the patient's documentation; therefore, we began photographic documentation of skin changes to determine if the photographs would provide better assessment of skin progress in response to treatment.

Methods:  ECP therapy is protocolized and usually consists of a total of 32 or more treatments over 10 months or longer.  The course may be continued depending on response to the ECP.  A digital camera with removable memory card was purchased for the apheresis clinic.  A baseline photograph is taken of the patient prior to ECP therapy initiation.  Photographs of the same sites of skin and same distance from the affected area are taken for accurate assessment of clinical response every 8th treatment for GVHD and once a month for CTCL, or with any new skin changes as needed.  The photographs are downloaded to the electronic medical record by the apheresis nurse with an accompanying note describing the color, texture, size, and area of skin involvement as well as patient's description of itching and/ or pain.  The physician assesses the progress during each visit and corroborates the changes.

Conclusion:  So far fourteen cases have been entered since implementation November 2016. Four had their treatment plans revised to improve the skin involvement of their disease processes.  Continuous photographic monitoring of skin changes allows for accurate assessment and monitoring of response to ECP.  This documented process enables clinicians to assess the progress of the patient objectively throughout the therapy and allow for adjustments to the ECP plan of care.