Whilst no method of measuring a wound has been found to be absolutely accurate, 3D scanning techniques have been found to produce the most reliable results, however their greater costs mean that they are more likely to be reserved for research studies, where a particular treatment is being evaluated. Acetate tracing can also be a useful aid to wound management however, perhaps due to its simplicity and cost-effectiveness, the ruler method of wound measurement is more likely to be selected for the general day-to-day practice of wound management. The most reliable ruler method involves recording the greatest length, head-to-toe and the greatest width, perpendicular to length.
Wounds change shape as they heal, and the head-to-toe orientation ensures the length and width points remain constant. The recommended method for measuring depth is to carefully insert a cotton-tipped bud, into the wound area, then by grasping it at the wound edge, measure depth of insertion against a ruler. Plastic probes are also available that are pre-marked with cm markings. Like all methods of wound measurement, the ruler method cannot be relied upon to be absolutely accurate, although it does provide a useful aid to indicate any changes. 3. Why might photographs be requested?
The most common reason for requesting clinical photography of a patient’s wound is to provide a record of the natural course of, or impact of treatment on a condition. Photographs are normally taken for the patient’s case notes but may also be requested for legal purposes, whereby it is suspected that the wound has been caused either intentionally, or as a result of neglect (medical illustrators should refer to IMI National Guidelines for Photography of Non-accidental Injuries for specific guidance). Photographs can be taken to show the patient their wound for reassurance purposes and in order to promote compliance with treatment.
They may also be used by community nursing staff for monitoring and assessment within the patient’s home, following discharge from hospital-based care. Community nursing staff may also take their own photographs at times, to monitor wound progression outside of the hospital environment (community staff should seek advice from their Medical Illustration Department to ensure their photographic practice conforms to their individual trust or health board standards – refer to section 9). Photographs may also be supplied directly to the patient to help them to monitor any changes that occur to a wound, after being discharged from hospital.
This particular process can have a significant positive impact in the reduction of patient readmission rates, as early detection of deterioration in the wound can help to reduce the severity of the deterioration overall. Occasionally, it may be necessary for a patient with a wound to be referred to another specialty, or for medical practitioners to consult with counterparts within other trusts or health boards for diagnostic advice. Photographs may also be taken for remote triage purposes whereby key medical staff (e.g. Tissue Viability Nurses) are based at another hospital site and cannot view the wound in person.
In cases such as this, it may be necessary to transfer patient images via email to the requesting clinician, so that patient care can continue wherever they are situated. The act of sharing data (including photographs) for the purpose of remote access by off-site clinicians however, must adhere to local procedures for safe and secure methods of practice. page 10