Photo Documentation Aids Home Health

Janet Puglisi, RN, BSN
President of Associated Professional
Home Health Care, Inc. in Longmont, CO.

Reprinted with permission from: Developments in Photo Documentation Vol 1 #2 Winter 1996

The photo documentation of wounds and skin conditions is an essential part of the medical recordkeeping process at Professional Home Health Care, Inc.

Photos also provide our nurses with a boost in time management.Just one picture can greatly reduce the amount of written description they must provide as part of the required documentation.

At Professional Home Health Care, we recommend that all wounds be photographed upon admission and/or during a patient's initial assessment.The nurse will then share the photograph with the case manager.Together they decide upon a frequency and schedule for follow-up photos.

In this decision-making process we include the parameters suggested in the Briggs publication, Protocol: Photo Documentation of Wounds and Skin Conditions (available free from Briggs by requesting mailer #2860-896).

During this time we also decide upon a frequency for sending photographs to the patient's doctor.This particular policy has really helped our doctors become part of the home treatment approach to wound care.The doctors feel more in control, and our time on the telephone is decreased.The end result is better cost management.

While we have not tracked the exact cost savings, all parties involved with the process are very aware of its impact on the time factor.This cost containment issue will be explored in the near future as part of our agency's CQI program.

We have also chosen to push forward with the photo documentation program based upon the response from regulatory agencies.We recertified at 100% with Medicare, received commendation from JCAHO, and were told our wound pictures are most impressive' end 'definitive for documentation.

Our agency has also worked the Polaroid® HealthCam®2 system into the nurse training and orientation program.AII new nurses are trained to use the system during their orientation, and we hold additional sessions as needs arise.

The size of our office requires that we use the camera on a sign out basis.The individual nurse is responsible for the care and cleaning of the camera following each use.This way, we have ongoing records of cleanliness, operationality and film needs without having to resort to separate record- keeping procedures.

Part of the permanent medical record.

The maintenance of the camera is assigned once a year to a local camera shop for cleaning and an overall "check-up."

In terms of tracking wound care, we have found the Briggs forms to be perfect for documentation.

We are now taking clear, accurate pictures with the help of the Polaroid Light Lock™ Close-Up Lens.We also have future plans to use the photographs for in- services, but need to develop the formal program first.