A woman has been admitted with a third-degree burn on her foot. A nurse is required to clean and re-dress the injury twice daily (9 am and 4 pm). At 11:30 am the burns specialist is performing her rounds and needs to see how the wound is responding.
11:31 am. The burns specialist enters the patient’s room on morning rounds. She opens the PicSafe® application on her personal device and compares how the wound appeared yesterday vs now.
11:33 am. She then updates the patient’s medical record with, both, the latest wound photos and her comments, inclusive of planned treatment alterations, if indicated.
11:37 am. She chats with the patient briefly, explaining what she is thinking about the wound and what the patient can expect at that point, says goodbye for now, and moves on to her next patient.
11:31 am. The burns specialist enters the room on morning rounds. She needs to see how this patient’s wound is progressing so begins undressing the wound.
11:41 am. She looks at the wound and makes notes in the chart, attempting to interpret the crude drawings and handwritten descriptions of her colleague (a non-burn specialist) who admitted the patient yesterday.
11:45 am. She is a bit confused by one part of the admission chart note when compared with what she sees today. She, therefore, must call her colleague who is currently at home after "a long night on call", to clarify whether or not a specific structure (nerve, artery, or tendon) drawn in the chart but unlabelled, was actually present and visible at time of admission. The wound was ordered as "debrided" in ED, but it appears to have "changed" in structure as per her exam today. If it has changed, what was the condition/appearance of that structure at the time of admission, and were they certain it was actually a damaged artery rather than a critical nerve or tendon? (Answers to these questions will significantly change the appropriate treatment plan for the patient.)
11:51 am. As the specialist cannot contact the admitting doctor to answer her questions, she informs the nurse that until she can speak with her colleague, "Just re-dress it and I’ll figure out what must be done once I have a clear understanding of what we’re dealing with here. We may need to take this to theatre, after all."
12:21 pm. The nurse finishes dressing the wound, and the orders are charted.
If the nurse were to take a photo at 9 am: