Compression therapy · debridement · referral
Professional indemnity – Wound care nurse
Wound care is slow to judge: a wrong choice only shows weeks later, when the wound has not closed or the foot has deteriorated. That makes retroactive and run-off cover more important here than average.
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Deze pagina in het Nederlands: Beroepsaansprakelijkheid – Wondverpleegkundige.
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A premium indication, not personal advice. Prefer to talk it through? Call 072 - 509 24 56.
In brief
In wound care the risk lies in choices that look reasonable at the time. Applying ambulatory compression therapy without knowing the arterial status is the best-known example: in a client with peripheral arterial disease, compression can lead to ischaemia and necrosis. There is also bandaging that is too tight, sharp debridement in which healthy tissue or a tendon is caught, negative pressure therapy where there is a contraindication, and a non-healing wound treated for months while an infection, bone inflammation or malignancy lies beneath it.
Your position differs from one assignment to the next. Sometimes you carry out the treatment yourself, sometimes you only advise and the district nursing team or the practice nurse applies the bandage. In the second case your advice is itself the product and the claim is about that, even if you never touched the client. So record in the file what you observed, which measurements were taken, what you advised and to whom, and when you asked for a doctor.
Choose a policy that also insures personal injury arising from the practice of your profession and which describes your specialist procedures. Because the consequence of the wrong treatment only shows after weeks or months, the retroactive date matters more here than in most care professions. The form of policy that goes with this is described on the liability insurance for care and welfare.
This page deals with one situation. The full overview is on Compare professional indemnity insurance (BAV).
What to look out for
Four subjects that lead to claims in specialist wound care.
Compression without vascular assessment
Record the data on which you base the choice for compression and who assessed the vascular investigation. If that basis is missing and tissue necrosis follows, liability is virtually impossible to rebut. Record a refusal or a postponement of compression in the file just as carefully, with the reason for it.
Assessment by photograph and at a distance
Teleconsultations have become normal, but you are then not assessing colour, smell and depth yourself. Agree which situations always require a physical assessment, keep the images with the advice and state what you can and not establish on the basis of a photograph. That reservation is your most important defence when a claim arises.
Equipment and materials at the client's home
A pump for negative pressure therapy or a doppler device is usually borrowed or hired. If such a device is broken at the client's home, that falls under the care, custody and control exclusion. If the device does not work properly and injury results, you are liable to the client for the unsuitable auxiliary item under Article 6:77 of the Dutch Civil Code, even where the cause lies with the supplier.
What falls outside the cover
Excluded are, among others: damage to borrowed or hired equipment; dressings you supply yourself, to which product liability applies; disciplinary measures and fines; intent and wilful recklessness (Article 7:952 of the Dutch Civil Code); and liability you have taken on through an indemnity in a contract for services.
What does your premium depend on?
- Annual turnover from assignments: the common basis for the premium
- Treating or only advising: a consultative role has a different loss profile
- Specialist techniques: debridement, compression and negative pressure therapy weigh more heavily
- Client groups: diabetic foot and arterial ulcers increase the risk
- Retroactive date and run-in period: essential because harm from wound care shows late
- Sum insured and excess: per claim and per insurance year
Insurers weigh these details differently. That is where your saving is.
What is covered
| Situation | AVB | BAV |
|---|---|---|
| A client is left with a damaged tendon after your sharp debridement | No | Yes |
| A bone infection goes unnoticed for months because no referral was made, and an amputation follows | No | Yes |
| While moving your equipment you damage the door frame in the client's home | Yes | No |
| The health insurer recovers from you the follow-up treatment it paid for | No | Provided that |
| A client accuses you of taking medication from his home | No | No |
| You suffer a needlestick injury at a client's home and have to be monitored for months | No | No |
The first two lines are often reported only years later, which is what makes run-off cover valuable.
Frequently asked questions
This is what people ask us most.
A wound does not heal. Does that make me liable?
No. You owe an obligation to use best efforts, not a cure; many wounds fail to close despite correct treatment. Liability only arises if you chose the wrong technique, missed a contraindication or carried on too long without referring. Make sure the file shows when you evaluated the approach and with whom you consulted.
I apply compression at the GP's request. Who carries responsibility then?
The doctor is responsible for the indication, you for carrying it out and for flagging that the indication is wrong. If you see signs of arterial disease, you may not carry on blindly: that is your own professional responsibility. Record your observation and your feedback in writing, because a verbal discussion cannot be proved afterwards.
Why does run-off cover matter more in wound care than elsewhere?
Because the consequence of a wrong choice only shows after weeks or months, and sometimes only after an amputation or a second course of treatment. Your cover works on a claims-made basis: the moment of notification counts. If you stop or switch without run-off cover, precisely that group of late claims falls between two stools, and that is where the most serious injuries are.
The borrowed pump is damaged at a client's home.
Damage to equipment you had in use falls under the care, custody and control exclusion, and it is not on this policy in any event because it is not a treatment error. Arrange this by contract with the supplier or ask for separate cover for hired equipment. Report the damage at once, because an argument afterwards about when the damage occurred is one you rarely win.
Read more
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