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Man Killed By Red Line Subway

Service on the Red Line temporarily suspended to reach victim

A 57-year old man was fatally injured after being struck by an inbound Red Line train at the Kendall Square station yesterday morning.

According to the Cambridge Chronicle, the Massachusetts Bay Transit Authority has identified the victim, but no details have been released.

“The investigation is ongoing,” MBTA spokesperson Joe Pesaturo wrote in an e-mail to The Crimson.

First responders to the incident, which took place around 11:20 a.m., shut down power to the third rail of the subway tracks in order to reach the victim.

As a result, Red Line service between Park Street and Harvard Square was temporarily suspended, and shuttle buses were used to ferry passengers while the MBTA Transit Police began their investigation.

Lily L. Hsiang ’13 was riding the Red Line back to Harvard following Thanksgiving break and was at the Park Street station when the incident occurred.

“First [the subway conductor] said that we were going express to Harvard Square…Then we were told there was an emergency medical situation at Kendall Square and that we had to get off the train,” Hsiang said.

The passengers then exited the train at Park Street where, according to Hsiang, bus service was not yet available.  “Everyone was just mobbing for cabs,” she said.

By 1:30 p.m., bus service was discontinued and Red Line operation returned to normal between the two locations.

The Kendall Square incident follows other recent subway-related deaths. On Nov. 15, a 41-year old woman was hit and killed by an Orange Line train, and a 74-year old man was killed in October when he slipped and fell underneath a commuter rail train in Newton. In May 2009, a Red Line train at Porter Square struck and killed a man.

Source:  thecrimson.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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7 days ago  ·  

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