3 dead in wrong-way crash on I-195 in Westport

WESTPORT, Mass. (WPRI) — Three people were killed and several others were injured in a serious crash on I-195 eastbound Wednesday morning.

According to Massachusetts State Police, the crash took place at about 8:15 a.m. in the area of Exits 10 and 11, near the Westport-Dartmouth town line.

The preliminary investigation indicated a livery vehicle crossed the median and struck an oncoming BMW head-on.

Two occupants of the livery vehicle and the driver of the BMW, a 23-year-old New Bedford woman, suffered fatal injuries, police said. The names of the victims have not been released pending family notification.

Two passengers of the BMW, a 25-year-old Fall River man and a male toddler from New Bedford, were taken to Rhode Island and Hasbro Children’s Hospitals to be treated for injuries. Police said a third occupant of the livery vehicle survived and was also transported to Rhode Island Hospital.

After the initial crash, police said a Subaru Outback struck the BMW and caught fire. The driver, a 27-year-old man from Vermont, was taken to the hospital with minor injuries.

A car driven by a 34-year-old Raphael Carrancho from Fall River was hit by the livery vehicle following the initial crash. He suffered a shoulder injury but was not transported to the hospital.

In an exclusive interview with Eyewitness News, Carracho described the scene. “Cars flipping over, cars twisting, cars catching on fire…I mean, you can watch action movies and see all those things happening. When it’s real life, it’s not a joke,” he said.

Carrancho told us his 5-year-old son was in the back seat, what was all he could think about.

“I will be praying for the families that lost loved ones and again, you know what I mean, I’m going to thank God that God was watching over me…Drive safe, everyone,” Carrrancho added.

A fifth vehicle driven by a 73-year-old Rhode Island man also sustained damage, according to police.

The scene was cleared by about 11 a.m. and all eastbound lanes have since reopened, according to MassDOT.

“This is very unusual for this area,” said Westport resident Alex Pereira. “Typically it’s small fender benders, maybe a car gets totaled, but it’s usually not this bad.”

The cause of the crash remains under investigation.

Source: WPRI

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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