Reducing the risks of wound consultation: adding digital images to verbal reports

The purpose of this study was to examine the impact of digital images on the assessment and recommendations of a WOC nurse who was providing remote nurse-to-nurse consultations on home care patients with wounds.

In a descriptive comparative study, data were collected by home care nurses from a sample of 43 adult patients with a total of 89 wounds with various etiologies. To determine whether or not the addition of a digital photograph influenced the WOC nurse's assessment and recommendations, the WOC nurse first completed a wound assessment and recommendation form based on a verbal report from the home care nurse. The WOC nurse then accessed digital images of the wounds and made any indicated modifications to the original assessment and management plan, providing a rationale for any changes. Comparisons were made between the assessment completed by the home care nurse and the WOC nurse's assessment and between the WOC nurse's assessment and recommendations based only on a verbal report and his or her assessment and recommendations based on the combination of a verbal report and a digital photograph.

Although there was a high percentage of agreement between the wound assessments completed by the home care nurse and those completed by the WOC nurse, areas of disagreement often impacted on the overall assessment. The agreement rates between the WOC nurse's assessment and recommendations based only on a verbal report versus those based on a combination of verbal report and digital photographs were as follows: total agreement (26/89 = 29.2%), trivial disagreement (11/89 = 12.4%), and clinically relevant disagreement (52/89 = 58.4%).

WOC nurses who provide remote nurse-to-nurse consultations without directly visualizing the patients' wounds through digital images are at risk for under-or overtreating patients' wounds. Digital images also provide an opportunity for the WOC nurse to mentor home care nurses in wound assessment and care.