EWMA Council

1. To reduce delay in diagnosis and
referral for specialist review through
email referral and photography:
With a photograph on the monitor
the ensuing discussion is now based
on what is seen and not imagined!
This has enabled the prompt commencement
of treatment and prioritising
of specialist assessments.
2. To improve wound assessment and
evaluation and enhance documentation
and team discussion: there is
now a clear link to assessment and
evaluation. There is clear evidence of
progress and efficacy of treatment or
deterioration of the wound bed and
surrounding skin. Photographs have
added clarity to team discussions
and aided education.
3. To promote patient partnership: patients
are not always able to see their
wounds, thus digital photography
has promoted understanding, education
and partnership. This outcome
has been of particular benefit as the
immediacy of the image can give
hope and encouragement; patients
like to have their own prints often in
sequence!
4. To improve multidisciplinary collaboration
across and within services:
on discharge or transfer across
services, photography has helped to
improve communication.
DISCUSSION
This project has had successful outcomes
and the tissue viability service has provided
digital cameras and a framework
for their use across the trust. However,
like any new initiative there have been
some challenges that we are still working
on. The greatest challenge to the project,
despite piloting and refining the process,
has been to get some teams to use the
cameras and email referral forms.When
discussing the diffusion of innovation,
Rogers 2 states succinctly that ‘Getting a
new idea adopted, even when it has obvious
advantages, is often very difficult’.
Here, many innovations thus require a
lengthy period before they become widely
adopted. Rogers’ model describes an innovation
curve that separates people into
innovators, early adopters, early majority,
late majority and laggards. Identifying
why we have had so many ‘late majorities’
and laggards can probably be explained
by the poor use of email and computers
by practitioners whose key role is clinical.
This has been identified as a problem
for the trust and is therefore is being
addressed. Despite the enthusiasm for
the cameras and the opportunities this
would bring, it is still another thing for
the clinical staff to do and in a world of
competing priorities camera use is low
in some teams. Thus, the encouragement
and team training continues.
It is worth noting why the trust has
not used camera phones as these are now
in common use and would therefore be
an easier technology to adopt. Firstly, the
cameras were purchased before camera
phones were of a high enough quality.
Secondly, there is the issue of secure archiving
of photographic images; photographs
will be easy to take but not necessarily
downloaded appropriately or the
advice/discussion provided will not be
recorded. The lack of encryption is also
a concern. Given due consideration, cameras
give the trust more control over the
images and so more security.
This paper has presented the development
of a framework that enables digital
images to be recorded within a secure system.
The outcomes have been successful
but, despite the enthusiasm, some practitioners
have been very slow to adopt the
new technology. It is essential that patients
have access to the same assessment,
wound evaluation and referral process
wherever they are in the borough thus
adoption of this new process needs to be
pursued. m
References
1. Department of Health. Good Practice in consent implementation
guide: consent to examination or treatment.
Department of Health. 2001. http://www.dh.gov.uk/
PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/
en?CONTENT_ID=4005762&chk=7ENk2Q (1.12.06)
2. Rogers EM. Diffusion of Innovations. Simon and Schuster
International. 5th Edition. (2003) Page 1
EWMA Journal 2007 vol 7 no 2 1