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Photos in the medical record

We are in the process of converting to electronic medical records. I have either seen on the list or heard at confrences that extravasation injuries should be photographed as part of the documentation (as well as other wounds and such). We are wondering what type of cameras were the best to use. If we continue with the poloroid camera we cannot easily attach the photo to the electronic record. If we get a digital camera the concern is that changes are easily made to digital photos, and are they as effective to use? and are they considered reliable for court? Any thoughts or experiences are welcome.


I would choose a digital

I would choose a digital camera as the pictures with any camera will only be as good as the skill of the person taking the picture. Who do you fear will manipulate the digital picture? Someone inside your organization would have to have access to the medical records, access to software such as Photoshop, and know how to use to in order to make any changes to this photo. I suppose it is possible but not likely to happen. How frequently are medical records altered or spoiled for malicious reasons? Digital pictures are used all the time in legal cases that I review. If a patient with a serious injury from extravasation or infiltration walks into a law office, you better believe on of the first things they will do is to take photos. These are the ones I see when I review the case. I do not have the chance to see photos of what the site looked like when the nurse was giving the meds or last assessed the site. Nurses also do not document the signs and symptoms very well nor use a grading scale, which is actually the national standard of practice. This leaves the expert with many questions about the actual condition of the site. Did the nurse overlook something or was there truly nothing that the nurse could have seen? The photo will support the nurses claim but it is not usually available. So my vote would be to establish a policy and procedure for using the digital camera and actually use it! Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

I use digital.

You can insert text as appropriate.  You can save the image as a pdf if concerned about others manipulating it, but I don't usually do that.  I would talk to your IT people about what types of files can be uploaded into the medical record.

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

Donna Fritz
electronic trail

And most electronic records have a "trail" of who accessed the specific patient's record, date and time.  So once it's loaded into the system, we can track who accesses.  Is your concern that the RN who takes the photo might alter it before loading?  My own perspective is that this would be counterproductive to defending yourself, unless blatant malpractice or negligence was involved.

altering records

It was my boss who was concerned about altering the records. What you all have answered does help a lot. Thanks

Gail McCarter, BSN,CRNI

Franklin, NH

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