Module 10 Nursing Responses to Elder Mistreatment An IAFN Education Course

1. Module 10Nursing Responses to Elder MistreatmentAn IAFN Education Course Photo-Documentation in Elder Mistreatment Cases

2. Learning Objectives By end of this module, participants will be able to: • Discuss cases in which photo-documentation of findings is appropriate • Describe nursing roles in photo-documentation • Describe how to photograph findings using basic forensic techniques and document photographic images on body maps

3. Case Study Questions • Do you think photographic images are necessary in this case? Why? If so, what specific images would you document? • What are your practice setting procedures for taking forensic photographic images? How would your procedures play out in this case? • Is consent needed to take photographic images in this case? How might it be obtained? • Does photo-documentation become part of the health record? If not, where are photographs stored?

4. Photo-Documentation Purposes • Photo-documentation in elder mistreatment (EM) cases can supplement written documentation • Photographic images can often give life to patient history and findings from an EM assessment Blue Cross Blue Shield of Michigan et. Al, Reach out, intervening in domestic violence and abuse: The health care provider’s reference guide to partner and elder abuse, 2007

5. What Happens to Photographs? • Photographic images become part of the patient medical record. They may also become part of evidentiary reports • Medical photos can be subpoenaed and presented in court as evidence

6. Who Should Take Photographs? How? • Every health facility needs policies and procedures to determine how photographs are to be taken and by whom, as well as how to store photographs and copy digital images • Staff nurse? • Other staff? • Forensic nurse examiner or medical photographer?

7. Digital Cameras • Digital cameras are rapidly replacing 35 mm cameras. There are many digital cameras on the market • Facilities should have a fully functioning camera available at all times with charged batteries and ample memory on memory card or CD-ROM

8. Consent to Photograph • Explain to the patient or his/her guardian why you would like to take photographs, procedures to take and store photographs, and potential uses of photographs • A signed consent by the patient or his/her guardian is required to take photographs P. Gray-Vickrey, Recognizing Elder Abuse, 1999

9. Basic Techniques • True/accurate representation of a wound • Use of measurement scales • “Rule of thirds” • Labeling photographic images • Storing images in medical record • Timing of photographing wounds/evidence

10. 1. Accurate Image • Obtain a true and accurate image of what was seen upon examination and treated on the day of the exam • Be familiar with camera functions that control lighting

11. 2. Use of Scales • A measurement scale should be included in each photograph to indicate approximate size of injury • Commonly used scales: standardized rulers, coins and pencils • Ensure that the injury is clearly visible along with the scale

12. Common Forensic Photography Scales

13. ABFO Standardized Rulers • The American Board of Forensic Odontologists (ABFO) has developed a standardized “right angle” ruler recommended for known or suspected bite injuries • The right angle scale can be used in any image

14. 3. Rule of Thirds Photographs should be taken using a forensic photography technique called “rule of thirds” • Start with a front-facing, full-body photograph of patient • Photographs of each injured area should be taken from three different distances • 6 feet • 4 feet • 2 feet

15. 4. Labeling Images • All photographic images must be properly labeled with the following information • Patient name • Date of birth and ID number • Facility name • Date and time photograph is taken • Photographer’s name • Location of wound • Case number (if assigned)

16. Labeling Images • Most software for digital cameras permits words to be superimposed directly onto an image • To limit words on an image, include patient information in the first and last photo taken to ensure accurate case identification. Then other photos can just include location of the wound

17. Labeling Photographic Images Multiple pressure ulcers to left lateral calf, left heel, left foot and right foot

18. Labeling Images • If and when photos of wounds are printed, never write directly on the back or front of prints • If information is not imposed on an image using computer software, printed photographs can be labeled using 2” x 4” shipping labels

19. 5. Documentation • Digital images can be labeled, burned onto a non-rewriteable CD-ROM, stored in the medical record and then printed as needed. Alternately, images can be printed multiples to a page and placed in the record along with the CD-ROM. • Medical photos can be combined with medical records by printing digital images on a blank facility progress form or taping photographs on facility progress forms

20. 6.Timing • When possible, take pictures of wounds prior to and after treatment • When there is physical evidence, photograph evidence where it was found on body and/or clothing • Take follow-up photographs as needed if there is ongoing contact

21. Body Maps • Every time nurses take photographic images of a patient, they should also document wounds on a pre-printed body map/diagram, noting- • Area of body • Type of injury • Size of injury

22. #1 Right lateral hip 2X2 cm bruise #2 Left medial thigh 2X4 cm bruise #3 Right lateral lower leg 2X4 cm abrasion Example Body Diagram

23. Closing Assessment • What have you learned from this module that you can apply to your practice setting?