# Presentation: 084132

## Utilizing Digital Wound Imaging in Long-term Care: 

**Is a Picture **_**Really**_** Worth a Thousand Words?**
**Carla Tukis, BSN, RN, Kelly D. Skinner, MSN, CRRN, ANP, GNP, Julia Lom, BSN, RN, **
**Elizabeth O’Handley, BSN, RN, Jean Barboza, BSN, RN, & Howard Dillon, BSN, RN**** **
**VA Boston Healthcare System**

**The healing progress of three, Stage IV pressure ulcers in a sixty-five year old, T4 ASIA A male with: hypertension, congestive heart failure and chronic obstructive lung disease is detailed.  The spinal cord injured male was admitted to the long-term Spinal Cord Injury unit on 1/18/05 and was discharged on 11/7/05 with **_**healed pressure ulcers**_** on the left stump, left sacrum, and left ischium.**

**LOGO**

**LOGO**

**Digital Images of Left Trochanter Wound**

**Wound Care Templated Progress Note**

**Patient Profile**

**Digital Images of Sacral Wound**

**Digital Images of Left Stump Wound**

**Wound Care Rounds & Equipment**

_**Wound Care Rounds**_
**Who? Nursing, Physician, Physician Assistant **
**& Patients**
**When? Every Tuesday morning**
**Where? At the bedside of each patient with a **
**wound**
**              **
_**Equipment**_
**Digital Camera**
**Measuring Devices**
**Dressing Supplies (gauze, tape, saline, cotton-**
**tipped applicators, tegaderm, scissors, etc.)**
**Proper Protective Equipment (PPE)**
**Wound Care Rounds Documentation Form**

_**WOUND ASSESSMENT:**_
_**Date wound identified:  **_
_**Location:**_** **
**Length of wound:  __ cm  **
**Width of wound:   __ cm **
**Depth of wound:   __ cm**
**Undermining/Tunneling: __ cm at __:o‘clock****                                      **
_**Stage: **_
**__ Stage 1 (Reddened area, skin intact, non-blanchable erythema)**
**__ Stage 2 (Blister or skin break, partial thickness skin loss)**
**__ Stage 3 (Skin break exposing subcutaneous tissue, full thickness)**
**__ Stage 4 (Skin break exposing muscle or bone)**
**__ Unable to Stage (Tissue obscuring)**
** **_**LONG TERM CARE ONLY: MDS requires reverse staging of wounds:**_
_**Wound bed color:**_** __ red  __ yellow  **
** ****__ black   __ mixed **
** **_**Wound Shape:**_** __ round/oval  __ elongated  __ irregular  __ linear  __ butterfly **
** ****__ other as described**
_** **__**Tissue in wound bed: **_
**__ White/gray, non-viable tissue**
**__ Non-adherent, yellow slough**
**__ Loosely adherent, yellow slough**
**__ Adherent, soft black eschar**
**__ Firmly adherent, hard black eschar**
** **_**Granulation:**_** __ none  __ bright **
** ****__ beefy red  __ shiny **
** ****__ granular with velvety appearance**
** **_**Exudate:**_** __ none  __ bloody  __ serosanguinous  **
**__ serous__ purulent __ foul purulent**

**        **
**        **_**VA Boston Healthcare System**_**                                                     **
**     ****the 8-1-C staff was featured in an article  **
**        ****entitled: “*****Recipe for Staff Satisfaction” ***
**     **_**Advance for Nurses**_**, (2004), 21(4), 10, 38.**

**Outcomes:**
**Wound Improvements/Healing**
**Patient Satisfaction/Increased Quality-of-life**
**Staff Satisfaction/Sense of Accomplishment**

**1-18-05**

**1-18-05**

**1-18-05**

**3-1-05**

**3-1-05**

**3-1-05**

**5-3-05**

**5-3-05**

**5-3-05**

**5-27-05**

**5-27-05**

**5-27-05**

**9-20-05**

**9-20-05**

**11-7-05**

**11-7-05**

_**Drainage:**_** **
**__ scant  __ small  __ moderate  __ large copious**
** **
_**Induration: **_
**__ Minimal firmness**
**__ Less than 2 cm around the wound**
**__ 2-4 cm extending less than 50% around wound**
**__ 2-4 cm extending greater than or equal to 50%  **
**     ****around the wound**
**__ Greater than 4 cm in any one area**
_**Surrounding tissue:**_** **
**__ pink or normal for dark skinned person**
**__ bright red and/or blanches to touch**
**__ white or gray pallor or hypopigmented**
**__ dark red or purple and/or non-blanchable**
**__ black or hyperpigmented**
**__ bruised**
**__ macerated**
_**Has the wound shown evidence of improvement since last assessment? **_
**__ initial   __ healed   __ improving  __ unchanged   **
** ****__ worsening**
**  **
_**Skin Interventions:**_
**__ Nutrition consult**
**__ Rehab consult**
**__ Reposition every __  hours in bed**
**__ Elevate heels off bed surface and avoid skin-to- **
**      ****skin contact**
**__ HOB at 30 degrees or unless otherwise ordered**
**__ Manage moisture, friction & shear with the  **
**     ****following: **
**__ Do not massage bony prominences**
**__ Increase activity and mobility as tolerated**
**__ OOB time limit to __  hours**
**__ Reposition every __  minutes in wheelchair**
**__ Dressing changes**
**__ Patient gives permission for digital capture**