By Windy Cole, DPM, CWSP
A picture is worth a thousand words – how many times have you heard that old adage? There is no bigger truth in wound care documentation. Wound photos serve as a visual reference and act as a testimonial on wound progression in the medical record. Wound photos supplement the EMR and encourage accurate documentation of the wound healing trajectory. The utility of sequential wound photos is diverse and includes proper tracking of the wound status, assisting in dressing selection, and aiding in planning for ongoing care. Properly obtained photos serve as a timeline and can alert clinicians to wound healing issues throughout the course of treatment.
Wound photos help with numerous assessment components, including:
- Wound size
- Wound depth
- Wound tissue and amount (granulation, slough, eschar, epithelial)
- Quality of wound edges and the periwound area (maceration, epibole, shape)
- Pre- and post-debridement wound status, to validate effectiveness
Tips for proper wound photography (see photos):
- Photos should be taken approximately 12 inches away from the patient to document wound and periwound tissue quality & prevent blurring or distortion
- Photos should be taken with the same orientation at each visit
- It is helpful if an additional photo can be taken at the intake visit at a distance where the wound location can be easily identified in relation to other body parts
- Rulers should be included in all wound photos
The photos taken on 10/19/2021 and 10/05/2021 show the wound details whereas the photos from 09/21/2021 give a good overview of the wound location on the extremity.
Wound images should always be reviewed for inaccuracies including poor lighting, abnormal colors, blurry images and inconsistent orientation. Properly taken wound photos can help to justify course of treatment and are helpful to establish quality of care and to show medical necessity of current or future therapies.
Proper photographic documentation can also help prevent potential legal issues. More than 17,000 lawsuits related to pressure injuries are filed annually in the United States.1 This is the second most common form of malpractice litigation, second only to wrongful death claims.1
Wound photos vastly enrich documentation and result in better overall patient outcomes. Sharing wound progress with patients also leads to better adherence to the care plan and can provide continued encouragement, thereby strengthening the caregiver-patient relationship.
- Berlowitz D, Parker V, Niederhauser A, et al. Are we ready for this change? In: Preventing Pressure Ulcers in Hospitals: A Toolkit for Improving Quality of Care. Rockville, MD: Agency for Healthcare Research and Quality; 2012; last reviewed 2014.