Wound photography using smartphone or digital device procedure

1 Aim

This procedure has been prepared to ensure best practice and standardisation of digital wound photography with a smartphone or digital device across the trust.

2 Scope

The target audience for this procedure are frontline clinicians who have a trust owned smartphone or digital device and are directly involved in providing wound care for patients or following first to dress.

3 Link to overarching policy, and or procedure

Wound care and tissue viability manual

4 Procedure or implementation

Digital imaging should be a standard part of wound assessment but not undertaken so frequently that it places unnecessary burden on patients or carers or health and care professionals. Digital images should be recorded as part of the wound dressing procedure before a dressing is applied or after a dressing is removed. Removing a dressing for the sole purpose of taking an image should be avoided.

4.1 Principles

Digital imaging must only happen if the patient or parental guardian gives valid (voluntary, informed, capacity to make the decision) consent.
Matters of privacy, dignity and safeguarding should be practiced in accordance with existing trust policies.
Digital imaging by clinicians should only be undertaken using digital devices owned approved by Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH). Where possible, devices used to capture digital wound images should be encrypted.
Images should be sharp, clear and well formatted (centred, at an appropriate angle) free of extraneous details and with a plain background.

4.2 Assessment

Patients with any wounds or tissue damage will have an initial and on-going assessment of their wound using the trust recognised wound assessment tool on SystmOne skin individual plan of care (IPOC). This assessment should be supported by digital wound photography.

All wounds or tissue damage should be photographed on the initial assessment.

This includes all grades of pressure sores, surgical wounds, leg ulcer, abrasion, blister, burn, skin graft, skin tears, diabetic foot ulcers, sinus wound, bite wounds including insects, laceration, fungating wound, haematoma or any alteration in the skin that may cause concern. The wound should be re-photographed:

monitored during the healing process (4 weeks)
if there are any significant changes or concerns regarding the wound
to show the patient their wound to promoted compliance with treatment
to record changes that could have implications for treatment prior to commencing new treatment
to promoted supportive assessment

4.3 Risk management

Digital imaging by clinicians should only be undertaken using digital devices and digitally approved by RDASH. Where possible, devices used to capture digital wound images should be encrypted.

Precautions are required to reduce risk of cross infection caused by using digital devices in multiple care settings (refer to the infection prevention and control).

General Data Protection Regulation (GDPR) will not be compromised. Identity will be protected at all times.

Tissue viability and lymphoedema service (TVALS) only if the digital image is for a purpose other than the persons treatment or care (for example, education or publication as part of an academic paper) written consent must be obtained for that specific purpose.

4.4 Consent

The clinician is responsible for ensuring the patient or parental guardian has given informed consent before any photography takes place. This consent will be documented in the patient’s clinical record (refer to the consent to care and treatment policy).

4.5 Taking photographs

Continue to follow aseptic non-touch technique procedure.
Ensure the Smartphone is pre-set to record the date and time picture is taken (if this function is available).
Patient consent will be obtained before taking the photograph and this will be recorded in the patient’s clinical record.
Care will be taken to protect patient identity by ensuring that faces or any other obvious features are obscured, for example, face, tattoos, birth marks.
Patient dignity and modesty will be protected by ensuring minimum patient skin exposure. Genitalia will be covered to preserve dignity. If damage is around or on genitalia and safeguarding is a concern, clinical judgement will be used.
The wound and surrounding skin (in particular the perineum) will be cleansed if indicated prior to the photograph being taken.
Follow up photographs will be taken with the patient in a similar position to previous photographs.
Follow up photographs will be taken from a similar angle and distance so that photographs can be compared objectively.
During image capture, avoid physical contact with the patient and prevent the camera or device from coming into contact with the wound or other potential sources of infection.
Ensure that each photo has clear identification, for example, NHS number, initials, date of birth, date of photograph, location of wound, if possible use a sterile ruler.

In the event of not being able to use the sterile ruler, there is an option to use the ‘paint’ application to record the patient’s details in a text box. This should only be used if the details have been omitted by the clinician:

due to the difficulty of the location of the wound
due to the difficulty of taking the photograph
as needed, the patient should be helped into a neutral position which they can comfortably hold, it may be necessary to seek additional assistance from another professional or carer or to separate skin folds to fully view the wound.
where possible, move the camera or the device, rather than the patient
when taking subsequent images, see to replicate the same positioning, surroundings, and lighting of the original image.
email photograph from trust mobile device to personal NHS email account. Check email has been received, delete from trust mobile device. Download the photograph from personal email onto desktop, go into patient record on SystmOne, click record attachment, click attach file, click desktop to locate appropriate photograph, select, this will then add to patients record. Delete photo from desktop and delete email containing patients photograph

See appendix K preparation for taking images of wounds of the wound care and tissue viability manual for printable simplified recommendations for taking images.

5 Storage of photographs

Photographs will be stored in the patient’s main clinical record. This will be the SystmOne electronic patient record whenever possible. The photograph will be uploaded at the earliest opportunity and added as an attachment in the communication folder.

Photographs should be deleted from the camera or mobile device as soon possible after the picture has been added to the clinical record.

Photographs must not be stored on laptops or computers.

No other record of the photograph will be retained unless there is a specific intention for its use as stated within the consent to care and treatment policy.

6 Quality improvement

The quality of digital imaging should be monitored as part of the process for supervision, clinical record keeping and IR1 process.

7 References

8 Appendices

Please see wound care and tissue viability manual webpage for appendices attached to this procedure.

Appendix K Preparation for taking images of wounds

Document control

Version: 3.
Unique reference number: 167.
Approved by: Clinical policies review and approval group.
Date approved: 3 January 2023.
Name of originator or author: Clinical lead for tissue viability and lymphoedema services (TVALS).
Name of responsible individual: Executive director of nursing and allied health professionals.
Date issued: 16 January 2023.
Review date: 31 December 2025.
Target audience: Frontline clinicians who have trust owned smartphone.

Page last reviewed: April 24, 2024
Next review due: April 24, 2025

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