Crashed tow truck cannot be removed from building

A tow truck that crashed into a Roxbury, Massachusetts building Monday is still there because of fear that pulling the truck out of the building could cause a collapse.

Officials fear that the building may come tumbling down when the truck is removed from the six unit apartment building.

“We heard the whole building shook, it was like boom, boom, boom,” said Crystal Lipomi, a resident.

Lipomi was inside her home when the out of control Boston Transportation tow truck slammed right into it.

“I could see the whole truck in the building, bricks everywhere, smoke. I went upstairs and I heard the fire department come. The fire department came and they told us we have to leave the building. We had to jump out the window,” said Lipomi.

“It hit that building so hard that bricks started coming tumbling down,” said Karen Preston.

Witnesses said the tow truck was going very fast down Saint James Street moments before the crash.

“He said his foot was on the gas and he couldn’t reach the brake and all you heard you heard was…boom into the building, and the building started falling down,” said Cheryl Holmes, a witness.

Before slamming into the house, he first hit Holmes’ car.

“He hit my car, bounced of my car he hit it so hard, he went into the silver car. The sliver car went this way, his truck went that way,” said Preston, whose car was also hit.

“The accident was substantial, we’re just grateful that nobody, including the driver, was hurt. As you can also tell by the activity behind me, this accident is being investigated by the Boston Police,” said Boston Transportation Commissioner Thomas Tinlin.

Some of the residents inside the home were evacuated to a bus, without knowing when they might get to go back inside.

“We can’t go back in there. They said we need to find a place to sleep,” said Lipomi.

The tow truck will stay inside the building at least until Tuesday afternoon.

The investigation is ongoing. There is no word on the driver’s name or the driver’s record.


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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7 days ago  ·  

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