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EXTENDED ABSTRACT · PRAGUE 2006 Short Paper Improving wound assessment through the provision of digital cameras across a Primary Care Trust Abstract This paper describes a Trust wide project initiated by the Tissue Viability service to improve wound care services and outcomes. Tower Hamlets is an inner city Primary Care Trust that has both Elderly Service in-patients plus District Nursing services. Project funding was secured to provide digital cameras across the Trust with the aim of: 1. Reducing delay in diagnosis and referral for specialist review. 2. Improving wound assessment and evaluation 3. Promoting patient partnership 4. Improving multidisciplinary collaboration within and across services Meeting the aims of the project was not difficult because the benefits of digital cameras are plain for both staff and patients, providing unambiguous discussion, facilitating patient and staff understanding, plus instant referral. Whilst the benefits for utilising this technology are clear, the issues surrounding the safe handling and storage of data were a challenge. Different protocols were required for the various Trust venues and were dependent on whether computer systems were networked or linked to GP software; the protocols required for secure archiving and the associated training will be presented. This paper also addresses the greatest challenge of the project, which has proved to be embedding camera use and the secure archiving of patient information across the wards and district nursing teams. INTRODUCTION Tower Hamlets Primary Care Trust (THPCT) has an urban population of 200,000 residents for whom the District Nursing service is managed across 17 teams. In addition there are 6 in-patient wards for Older Peoples services including four dedicated wound care beds. The Tissue Viability service works across the Trust and service boundaries and referrals for wound care advice and assessments are received by telephone from <strong>EWMA</strong> Journal 2007 vol 7 no 2 nursing, medical and allied health professionals. Guidelines are in place for management of all wound types and practitioners are expected to utilise the specific wound, leg ulcer or pressure ulcer assessment forms. PROJECT AIMS Several issues were identified that resulted in the process of referral, wound assessment and evaluation not being as robust as they could be, specifically that: n Phone referrals and descriptions of the wound bed could be ambiguous, causing either a delay in review or an inappropriate referral. n Digital cameras were only used by the Tissue Viability team; Polaroid cameras were used by some district nursing teams but obtaining the film was always problematic. n There was poor wound and surrounding skin assessment and evaluation. n There was incomplete wound information passed between community and rehabilitation services. n The patient’s General Practitioner and even some patients (due to its site) rarely saw the wounds thereby preventing partnership and valuable discussion. Thus the aims of the project were: 1. To reduce delay in diagnosis and referral for specialist review through email referral and photography. 2. To improve wound assessment and evaluation and enhance documentation and team discussion. 3. To promote patient partnership 4. To improve multidisciplinary collaboration across and within services Funding was secured for the provision of digital cameras and quality colour printers for each District Nursing team and ward. The aim was for nursing teams to photograph wounds and email � Scientific Article Alison Hopkins MSc, DN Cert, RGN. Clinical Nurse Specialist (Tissue Viability) Tower Hamlets Primary Care Trust Correspondence: Tissue Viability Primary Care Mile End Hospital Bancroft Road London E1 4DG alison.hopkins@ thpct.nhs.uk
Scientific Article them to the specialist team for advice and discussion. The next step was to ensure a correct process for data collection and storage. SECURE DATA COLLECTION AND STORAGE In order to ensure the safe use of digital images, a clear protocol for use needed to be developed. This was necessary to enable practitioners to follow a clear process for image production, storage/archiving and retrieval. This protocol was based on the THPCT’s guidelines ‘Consent to Examination and Treatment’ (see original source, Department of Health guide 1 ). Practitioners needed to be aware of the legal issues surrounding photographic consent and the use of the photograph outside patient records, such as education or publication. [See Box 1] Box 1 Photographic consent issues • Informed consent (patient or their relative/carer) can be obtained through written or verbal means and documented. • Obtaining consent is a continuous process and not a one off event. • Information must be provided: why the photograph is required, how it will be used, who will see it and how often photographs may be taken. • Photographs can be used for education purposes if the patient cannot be identified. • Photographs must never be used for publication without written consent It is essential that the practitioners were aware that the photograph is part of the patient’s medical history and thus must be retrievable at any time. This requires good 0 Fig 1 archiving and images must be saved without alteration. Records must be kept of the nurse specialist advice given by phone or email. Thus an email referral form was developed [Fig 1] that enabled attachment of the photograph and sections that addressed the assessment and concerns. The protocol made it explicit that NHS encrypted email addresses must be used. One of the problems identified when developing the protocol was that the IT systems varied across the trust; not all the nursing teams had access to the GP patient record systems and thus could not attach the photograph to the patient’s records. For those teams that were not networked, we had to ensure that the photographs were not stored on the computers (in case of theft) and thus had to be deleted after printing. These variations meant that the protocol had to be specific to each team’s requirements. However, this is now no longer an issue because the IT systems have been standardised across the trust. Email encryption was also an essential part of ensuring a secure process. For this reason only trust or NHS servers must be used. Referrals are usually received by phone in the specialist service thus it is incumbent on the team to regularly check emails for referrals. The referring teams have also been instructed to leave phone messages so that no delays are incurred. Two practitioners from each ward or team were trained in the use of the camera and printer, archiving of photographs and use and storage of the referral documents. PROJECT OUTCOMES The development of protocols and training has enabled the project aims to be met: <strong>EWMA</strong> Journal 2007 vol 7 no 2
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