Looking for thoughts around an issue that our team is struggling with. We've seen an uptick of physical abuse photos being placed in children's charts by various folks. Personally, I don't agree with the practice. I find it unnecessary, a violation of the child's dignity, and even potentially a set-up for miscommunication if the provider seeing a historical note doesn't take the time to learn the details of the event ( ex. bruise caused by babysitter, not parents). The debate is whether or not the pictures are evidence- I believe the answer is yes and therefore we should strive to meet admissibility standards with photos taken by our pedi FNEs and protected by the same process as genital photos. I don't feel there is any medical value per se to have the pictures available in the chart. I also find that folks do scant documentation and let the photos do the talking, so to speak. The prevailing thought is that pedi FNEs do not need to be called in and that anyone can take a photo.
Thankfully, we do have a solid protocol for genital pictures that is known and followed.
Does anyone have a policy to share or strategy ideas to change peoples minds?
Thanks yet again!
Tracey Wagner RN, MSN, CPN, SANE-P
Dear Tracey, So I agree with Diana and your assessment. So years back in our sister Pediatric hospital and ours (when we saw Peds) the Medical Illustration department did all photos (non-forensics and pediatric abuse photos (except genitalia). Finally the medical illustration department said "yeah we won't be doing ANY pediatric abuse photos" So guess who it defaulted to....correct our sister Children's Hospital Forensic Team. So as Diana pointed out a policy should direct who does the photos and for what reason. Our fearless leader in our Children's Hospital forensic nursing unit also has taken the stance, "If we are to be consulted on physical injuries (non-sexual) then we are documenting a consult note as well as taking photos." If there is not a corresponding note with the photos you are no more than an evidence tech. How is that different from our LE colleagues. We are nurses and not "Just Anyone Can Take the Photos."
As Diana says, there should be a reason for the photos, either a forensic reason or a medical reason to illustrate the injury/disease appearance.
I feel for you Tracey, why this has to be a battle all the time I have no idea. Good Luck.
Regards,
Barb
Again, Going back to the purpose of the photographs. If it is for evidence they should be stored as you do all the photographs for evidence. If this is a medical issue they should be stored like photo's taken during surgery for example. there is usually a hospital policy on this. Consent is needed of course. So the reason for the photographs must first be defined. If it is not forensic or a medical need stop taking the photographs. You are treating patients differently than an adult or adolescent and it will end up as a problem.