clinical guideline for digital photography in wound care

Document level: West Locality Code: CC23

Issue number: 4

Clinical Guideline for Digital Photography in Wound Care

Lead executive Director of Nursing, Therapies Patient Partnership

Authors details Tissue Viability Team 01244 389243

Type of document Guidance

Target audience All CWP staff

Document purpose To provide guidance for the use of digital photography in wound managementfor all health professionals within CWP.

Approving meeting Clinical Practice & Standards Sub-Committee (Chair’s Action)

Date 01-Apr-20

Implementation date 01-Apr-20

CWP documents to be read in conjunction with

CP3 IM7 IM1 CP40 CP10 CP59 IC1 IC3

Health Records Policy Code of confidentiality policy Information Communications Technology (ICT) Acceptable Usage Policy (AUP) Safeguarding children policy Safeguarding adults policy Medical devices and equipment policy Infection Prevention and Control policy Decontamination and disinfection policy The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates; Nursing and Midwifery Council

Document change history

What is different? Guidance on how to upload photographs to the EMIS system using either a desktop computer or IPad. This includes details of how to label the photographs correctly.

Appendices / electronic forms

Appendix 1 has been changed.

What is the impact of change?

This document will change the way photogrpahs are currently being labelled.

Training requirements

No - Training requirements for this policy are in accordance with the CWP Training Needs Analysis (TNA) with Education CWP.

Document consultation

Clinical Services Via policy discussion forum Corporate services Via policy discussion forum External agencies

Financial resource None

http://www.cwp.nhs.uk/resources/policies/cp3-health-records-policy/

http://www.cwp.nhs.uk/resources/policies/im7-code-of-confidentiality-policy/

http://www.cwp.nhs.uk/resources/policies/im1-information-communications-technology-ict-acceptable-usage-policy-aup/

http://www.cwp.nhs.uk/resources/policies/cp40-safeguarding-children-policy/

http://www.cwp.nhs.uk/resources/policies/cp10-safeguarding-adults-policy-including-domestic-abuse/

http://www.cwp.nhs.uk/resources/policies/cp59-medical-devices-and-equipment-policy/

http://www.cwp.nhs.uk/resources/policies/ic1-trustwide-infection-prevention-and-control-operational-policy/

http://www.cwp.nhs.uk/resources/policies/ic3-standard-universal-infection-control-precautions-policy/

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implications

External references

1. IMI National Guidelines (2019) A Guide to Good Practice: Wound Management Photography

Equality Impact Assessment (EIA) - Initial assessment Yes/No Comments

Does this document affect one group less or more favourably than another on the basis of: - Race No

- Ethnic origins (including gypsies and travellers) No - Nationality No - Gender No - Culture No - Religion or belief No - Sexual orientation including lesbian, gay and bisexual people No - Age No - Disability - learning disabilities, physical disability, sensory

impairment and mental health problems No

Is there any evidence that some groups are affected differently? No If you have identified potential discrimination, are there any exceptions valid, legal and/or justifiable? No

Is the impact of the document likely to be negative? No - If so can the impact be avoided? N/A - What alternatives are there to achieving the document without

the impact? N/A

- Can we reduce the impact by taking different action? N/A

Where an adverse or negative impact on equality group(s) has been identified during the initial screening process a full EIA assessment should be conducted. If you have identified a potential discriminatory impact of this procedural document, please refer it to the human resource department together with any suggestions as to the action required to avoid / reduce this impact. For advice in respect of answering the above questions, please contact the human resource department.

Was a full impact assessment required? Select

What is the level of impact? Select

To view the documents Equality Impact Assessment (EIA) and see who the document was consulted with during the review please click here

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Contents 1. Introduction ................................................................................................................................ 4 2. Scope......................................................................................................................................... 4 2.1 Training ...................................................................................................................................... 4 3. Indications for use of the clinical guideline ................................................................................. 4 4. Equipment required .................................................................................................................... 4 5. Procedure .................................................................................................................................. 4 Appendix 1 – Adding photographs via EMIS or IPad ……………………………………………………… 6

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1. Introduction A wound assessment will identify if there is a need for photographic evidence. Photographs are an important component of effective wound assessment and management. The value of clinical photography in wound management lies in the ability to achieve repeated views over time, adding objective visual confirmation to the written record, and can provide evidence of the wound healing process and appropriate wound management. The purpose of this document is to provide guidance to all staff who are responsible for taking digital photographs in wound management:

Adhering to this guideline and ensuring appropriate written consent and confidentiality;

Security and storage of camera equipment;

Quality and accuracy of data recorded and safe storage of photographs.

2. Scope This guidance applies to all staff employed by CWP that are associated with wound care management. 2.1 Training Prior to taking any wound photography, new staff members must read through the Clinical Guidelines for Photography in Wound Care. Health care professionals must also have successfully undertaken the Basic Tissue Viability course provided by the Tissue Viability Team. 3. Indications for use of the clinical guideline These guidelines must be used following a comprehensive wound assessment which identifies the requirement for digital photography to support successful wound documentation. 4. Equipment required All staff have access to the following equipment:

The digital camera digital which has been Trust approved and/or IPad

A sterile sheet (available from dressing packs) is to be used as this is preferred and recommended by the Institute of Medical Illustrators (2019) as this provides a high quality, standardised image.

5. Procedure

No Action Rationale

1

A digital photograph should be taken for all wounds on initial assessment or if any significant changes to the wound occurs which may have implications on the course of treatment.

To provide a visual clinical record of the wound status.

2

Explain and discuss the procedure of digital photography. Obtain verbal consent and record consent on EMIS records prior to taking the photograph.

To ensure the patient understands the procedure including the benefits and evidence of digital photography. To ensure informed consent is achieved in line with local policy.

3 Ensure patient is comfortable and in a suitable position to take the photography.

To ensure desired digital image is obtained.

4 Ensure minimum exposure of patient skin. To ensure patient dignity and modesty is not compromised (as site may include sacral and genital areas).

5

Apply a sterile field close to the site. (If unable to comply with this action, rationale should be documented in patient EMIS records).

To ensure desired digital image obtained by minimising shadows and any lighting flare.

6 Cleanse wound and/or surrounding tissue (in particular the perineum).

To ensure desired digital image is obtained.

7 Ensure clean gloves are applied before using the To prevent the risk of infection

http://www.cwp.nhs.uk/

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No Action Rationale

camera. contamination.

8

Only use the designated camera/IPad supplied by the Trust for the purposes of wound care management. Mobile telephones should never be used to take clinical photographs, as the act involves substantial unacceptable risks to the security and confidentiality of the images, with the potential for legal action to be taken against an individual or organisation, if a patient’s privacy or rights were to be compromised.

To ensure standardised digital images are obtained. To ensure digital cameras are not used for any other purpose.

9 The digital camera must be pre-set at all times to record and print the date and time of the image.

To comply with record keeping policy

10

Obtain a desired image including a wide area of healthy tissue and separate detailed close up images. Visual wound measurement scale will be used in each photograph; this will be placed next to the wound. Paper sterile rulers supplied in the dressing pack will be used for this purpose, please ensure it is visible in the picture. The patient’s identification/initials and wound location should be added to the sterile ruler. (If unable to comply with this action, rationale should be documented in patient EMIS records).

To ensure desired digital image is obtained and provides evidence of the wound site and surrounding area.

11 A reference with the position of the wound on the body should be entered when downloading the photograph onto EMIS. (SEE APPENDIX 1)

To minimise risk of unidentifiable images.

12

Transport photograph taken via the digital camera/IPad back to the team base and upload images within 24 hours. Under no circumstances should the image be downloaded and stored onto a computer, but should be downloaded direct onto the patients EMIS notes.

This is in line with record keeping policy and the Data Protection Act (1998) to ensure clinical care is safe; and to ensure a secure method of storing confidential information. This also facilitates archiving and retrieving information.

13

Permanently delete all digital images from the camera/IPad after the image has been uploaded and prior to passing the camera to colleagues. This should include any deleted photographs within the deleted photographs folder on the IPad.

To ensure safe storage of confidential information.

14

All staff sharing digital cameras are accountable for those images taken and are responsible for deleting those images. When the member of staff has uploaded from their IPad, the picture MUST be deleted from their IPad or Sent Emails if sent via email. If the photograph is sent via email it is that staff members responsibility to ensure the photograph has been uploaded.

To ensure safe storage of confidential information.

15

Store digital cameras securely at all times in a locked cupboard within the team base when not in use or transit. Camera equipment must be transported in the allocated camera case.

To ensure safe storage of confidential information. To comply with local policy. Digital cameras must not be stored in staff vehicles.


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Appendix 1 – Adding photographs to EMIS via desktop or IPad

1. Upload the required photograph to EMIS – Document – Attach document

2. Find the photograph you require and fill in the photo details


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3. For TYPE – search for Medical Photography

4. For SOURCE – Search for YOUR team

5. DOCUMENT TITLE: DELETE information already in this box


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6. In this box (DOCUMENT TITLE) write the BODY PART, and indicate whether it is LEFT, RIGHT, LATERAL

or MEDIAL – For example: Left lower leg; Right lateral malleolus; Sacrum etc….

7. This is the FREE TEXT BOX. Click on this, then place the onto the the picture and click.


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8. A free text box will appear on the photograph with the words “Enter Text” in it.

9. Double click in the box. You can then highlight the words “Enter Text” and delete. You can then write

in the box.


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10. The text size can be altered using the Aˆ and A ᵛ - Increase or Decrease Text Size

11. You can also add an arrow, just to ensure it is made clear where the wound is on the photograph.


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12. The thickness of the arrow can be changed by using this

13. When all details have been added to the photograph, click on “File” to save the photograph.


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How To Edit and Add Details to Photopgraphs on the IPad

Take photograph

Click onto the small box (which contains photograph) on the right of the photograph

Click on edit

Click on the 3 dots

Click on mark up

Choose a pen (1st one is the best)

Write patients name and number on photograph if required

There is an eraser if you make a mistake.


clinical guideline for digital photography in wound care

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