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Better signs urged after wrong-way I-95 crash

Father of injured driver says he’ll contact lawmakers on issue

North Stonington – A 22-year-old Massachusetts man whose car was struck head on by a wrong-way driver on Interstate 95 early Saturday underwent nearly four hours of surgery Sunday at Rhode Island Hospital in Providence.

Bruce A. Wall, 22, of Hyde Park, was driving his Oldsmobile sedan south in the left lane of the highway about 2:30 a.m. Saturday when it was struck by a northbound Audi driven by Ellen H. Noordzy, 21, of Exeter, R.I., state police said. The crash occurred near Exit 93.

While Noordzy was treated for chest pain at Lawrence & Memorial Hospital and released, Wall’s father said Sunday that the four-hour surgery to repair broken bones and other injuries would leave his son unable to walk for at least one year.

“In the next couple days he’ll have to go into inpatient rehab to teach him how to use his hands again and teach him how to walk,” the Rev. Bruce H. Wall said.

Wall, who hosts a Boston radio show, said he would press lawmakers to install clearer signage at the exit’s on and off ramps.

He said the condition of the passenger in his son’s car, Evan G. Williamson, 21, of Brewster, Mass., was “touch-and-go.” Williamson was flown by Life Star helicopter from Lawrence & Memorial Hospital to Yale-New Haven Hospital after suffering life-threatening injuries. The hospital would not release his condition Sunday.

Wall said that after seeing his son’s totaled Oldsmobile, it’s “a miracle he’s alive.”

“The car was crushed like an accordion,” he said.

Despite his son having to face a long recovery, Wall is confident “everything happens for a reason.”

“There’s a reason why everything happens and when he looks at the car and the fact that God spared him and pulled him out of it, it can make a person better … we’re going to pull him into a place where he really surrenders his life and wants his life to count for something,” Wall said.

Wall is best known for his early morning Christian satellite and Internet radio show on Boston Praise Radio. He is also a prominent pastor at Global Ministries Christian Church in Dorchester and neighborhood activist for several of Boston’s communities.

Using his son’s near fatal accident as a catalyst, Wall is preparing a live radio broadcast this week to pose a discussion about wrong-way drivers to his global listeners.

He said he has also reached out to Massachusetts State Gov. Deval Patrick in an effort to begin a regional discussion which he hopes will reach state Sen. Andrew Maynard, D-Stonington.

Maynard has previously asked the Department of Transportation to consider installing clearer signs at highway on and off ramps.

On Sunday, Wall visited the accident site to evaluate the signage for himself.

“We did go up and down the northbound ramp and the southbound ramp. It was hard to figure out what happened and try to reconstruct it without the help of police, but I couldn’t really figure out the signage,” Wall said.

Phone calls to Noordzy’s residence and cell phone were not returned.

Source:  http://www.theday.com/article/20101206/NWS01/312069903/1019&town=


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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