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Marshfield man killed in crash in Pembroke

PEMBROKE – The Town of Needham is mourning the loss of one of their workers today. John A. “Jack” Barisano was killed this morning when the municipal vehicle he was driving was involved in a crash on Route 3 in Pembroke.

Barisano worked for the Town of Needham for close to 12 years – more than ten years as a Highway Forman.

The accident occurred at approximately 6:20 a.m. Monday. Police closed the left lane on the north side of the highway, causing major delays during the morning commute. The pickup truck remained at the site at 9:30 a.m. Monday. State police said they would await the end of the morning rush hour before closing lanes to remove it.

Preliminary investigation indicates that 62-year-old Barisano of Marshfield, was driving a Needham municipal pickup truck and lost control on Route 3 northbound, north of Exit 12 and south of the North River Bridge.

The pickup struck and flipped over the guardrail on the left side of the road and rolled over into the median strip, State Police report. Barisano was ejected.

Rick Merson, director of the Needham DPW, said Barisano worked as a salt shift foreman and was allowed to take his truck home during winter months.

Barisano was transported to South Shore Hospital, where he was pronounced deceased.

At 6:19 a.m. today Massachusetts State Police responded to a crash of a pickup truck on Route 3 northbound in Pembroke, north of Exit 12 and south of the North River Bridge, which resulted in the death of the driver.

According to a spokesperson for the State Police, the preliminary investigation by Troopers Matthew Croteau and William Lennon indicates that Barisano, lost control of work truck, veered to the left and struck the guardrail, and rolled over into the median. The Ford pickup is owned by the Town of Needham Department of Public Works, for whom Mr. Barisano was employed.

The facts and circumstances surrounding the crash, including why the driver lost control of the truck, remain under investigation by Troop D of the Massachusetts State Police, the State Police Collision Analysis Reconstruction Section, and the State Police Crime Scene Services Section.

The left lane at the scene of the crash was closed for approximately 90 minutes to accommodate the rescue response and crash investigation, and then was reopened for the remainder of the morning rush hour. After the end of the rush hour, the lane was closed again and the vehicle was removed from the scene.

“Barisano was a valued employee and will be greatly missed by his colleagues,” read a statement released by Sandy Cincotta, the assistant to Needham Town Manager Kate Fitzpatrick, “Our thoughts and prayers are with Mr. Barisano’s family.”

Source:  wickedlocal.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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