Cyclist Hit By Truck On Mass. Ave.

A cyclist was taken to Boston Medical Center with what appeared to be a serious leg injury after witnesses said a truck carrying lumber along Massachusetts Avenue hit her and ran over her bike.

The accident happened in front of Symphony Hall, where construction crews are repairing the sidewalks. A worker who witnessed the accident said the large lumber truck, with a “Reeds Ferry Lumber” logo on the side, was turning right from Westland Avenue and onto Mass. Ave. when she got “pulled under” the truck’s back tire.

“The truck just turned wide and closed her in,” said Dale Colby, who has been doing construction at the scene in front of Symphony Hall. “It brought tears to my eyes. Seeing that woman laying there—it squished her right in. I heard her scream and saw her tied up with the tire.”

After the vehicle allegedly struck the cyclist, bystanders rushed to her aid and stabilized her leg and head until paramedics and police arrived on scene. The operator of the vehicle stopped after the crash, and spoke with officers.

Traffic was brought to a standstill along Mass. Ave., and commuters coming off of an MBTA bus directly behind the crash site were forced to walk through the accident scene as strangers tended to the woman, and tried to keep her calm.

Orange cones and rope, separating the construction crews from the roadway, mark the strip of Mass. Ave. where the crash occurred. There was little space between passing vehicles and pedestrians forced to walk in the street in order to circumvent the ongoing construction.

Colby said that there was no police detail at the scene when the truck allegedly hit the woman. “If there was a cop there this would never have happened,” he said.

Rich Russo, a second construction worker at Symphony Hall, confronted a police officer that showed up after the incident to direct traffic, as paramedics put the woman on a stretcher to bring her to the hospital.

“I said to him, ‘what, now you show up?’ We needed a detail before this happened,” said Russo.

The cyclist’s boyfriend, who did not give his name, showed up to the accident scene after the crash, and got into an argument with police because cyclists and pedestrians continued to pass through the area where the woman was hit, just inches from the traffic crawling by.

In a follow-up email later in the day, the boyfriend reached out to Boston and said the cyclist underwent surgery, and “should be OK.”

Only after the accident, and after the woman’s boyfriend reprimanded police on the scene, did officials erect a more secure path using rope and cones to separate pedestrians from the traffic.

Boston will update this story when more information is available. Police did not immediately say if the driver was issued a citation.

Source: Boston Magazine

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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6 days ago  ·  

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