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3 Dead In 4 Separate Crashes

Cause Of Crashes Under Investigation

BOSTON — Three people are dead following several separate crashes on Massachusetts roadways.

State police were called at 10:55 p.m. Friday to a two-car crash on Route 195 westbound in Rehoboth.

Authorities said a 2002 Nissan Quest driven by Antonio Leitao, 52, of Warren, R.I., was traveling at a high rate of speed when it struck the left rear quarter of a 2005 Ford Van operated by James Serra, 51, of Bellingham.

As a result of the impact, the Nissan spun around and struck a tree on the right side of the roadway. The Ford rolled over several times before coming to rest.

Police said Leitao, his passenger, Kyle Leitao, 19, also of Warren, R.I., and a passenger in the Ford, William Gokey, 74, of Mendon, were transported to Rhode Island Hospital. Their conditions were unknown.

Serra was pronounced dead at the scene.

At about 11 p.m., Revere and state police were called to the area of 270 Broadway for reports of a pedestrian struck by a motor vehicle.

Authorities said evidence and witness statements indicated that a 45-year-old Lynn man was operating a green Ford Explorer when he struck James Lewis, 51, of Revere.  Lewis was first transported to Whidden Memorial Hospital and then to Massachusetts General Hospital, where he died of his injuries. The driver of the Explorer has not been charged with anything at this time.

At about 1 a.m., Boston police responded to a one-car rollover crash at the intersection of Brookline Avenue and the Riverway.

Authorities said Robinson Avendano, 38, of Dedham, was driving drunk when he lost control of a black BMW and struck a tree before rolling over.

A 26-year-old passenger from Dorchester was pronounced dead at the scene.  Both Avendano and another passenger were taken to Beth Israel Hospital with none life-threatening conditions.

Avendano has been charged with operating under the influence and negligent operation of a motor vehicle.

Another crash on Route 93 northbound in Dorchester left one man hospitalized.

Authorities said Edison Correa, 23, of Everett, was traveling at a high rate of speed in a gray Honda Civic when he sideswiped another vehicle.  The impact caused the Civic to crash into the jersey barrier and roll over.

Correa was transported to Boston Medical Center to be treated for severe head trauma.  He was expected to survive.

Source:  thebostonchannel.com


Nursing Home Negligence

Falls in Nursing Homes

Litigators who work with cases involving long term care know how significant the issue of falls can be. Falls are the leading cause of injury and death by injury in adults over 65. Approximately half of the 1.6 million nursing home residents in the U.S. fall each year, and a report by the Office of the Inspector General found that about 10% of Medicare skilled nursing residents experience a fall resulting in significant injury; and, more than 1/3 of hospital falls result in injury. In the rehab setting, rates are often higher – for example, fall rates among stroke patients have been shown to be very high. Immobility and falls can lead to poor outcomes.

Fear of falling is defined as a geriatric syndrome. It not only occurs in older adults who have fallen, but in those with impaired mobility and is associated with decreased physical ability and depression. Care of older adults requires that clinicians be aware of the myriad of issues related to falls including knowledge of this syndrome, increased risk and interventions needed to prevent injury related to falls.

Just about every resident in a long term care setting, including assisted living and sub-acute rehab, is at risk for falling. Between medications, functional and medical issues and advancing age, older adults in most settings are prone to falling.

There are well established standards of care related to fall prevention; but, as I continue to review records related to issues like falls, I am amazed at how often these basic standards are not being practiced. The basics of a fall prevention program include assessment and ongoing reassessment of risk, ensuring a safe environment, medication review, providing therapy as needed, individualized interventions, and staff education.

Basic nursing practice includes assessment, planning (Care plan), putting interventions in place and then evaluating outcomes to determine if those interventions are appropriate and effective. Assessment includes completing fall risk assessments on admission and then as needed. Very often, the fall risk assessments completed by nurses in LTC are inaccurate. The tools utilized in long term care typically include these risk factors: history of falling, use of ambulatory aids, gait/balance issues, medications, secondary diagnoses (i.e. diabetes) and mental status. Care planning is the next step in nursing care - it is the standard of care that as the resident’s status changes, assessments and care plans must be updated, and often, are not. For example, with each fall, there should be updates, or if there is a new diagnosis, i.e. stroke, or worsening dementia, updated interventions should be put into place, with ongoing evaluation of effectiveness.

Care planning and interventions very often are generic and not individualized. For example, a toileting schedule that includes only after meals and before bedtime may not be appropriate. If a resident has issues with constipation or incontinence, this may lead to the need for more frequent toileting to prevent falls. The “make certain call bell is within reach” for residents with dementia is an example of a generic intervention. Older adults with dementia may not recognize a call bell or remember to use it. The debate about use of bed and chair alarms go on – they are a part of an individualized care plan, not a solution to preventing falls. Often, I see delays in putting interventions in place, i.e. with the resident who is incontinent NOT being put on a toileting plan immediately. The other common issue I see when reviewing records is the lack of updating care plans as the resident’s status changes – with every fall, with worsening dementia, physical decline, or new medical diagnosis (i.e. Parkinsonism).

Nurses reviewing records need to pay attention to the MDS, risk assessments, care plans and Interdisciplinary notes with attention to where the standard of care is not being met.
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