NH teen killed in Andover crash

ANDOVER – A 19-year-old Londonderry, N.H., man died after a two-car crash at 4:12 a.m. on Interstate 93 northbound, south of Dascomb Road.

According to Trooper Kevin Bibeau of State Police Barracks in Andover, the teenager, whose name has not been released, was driving a 2001 Ford Taurus heading northbound when it exited the roadway to the left, onto the shoulder. The Taurus then corrected to the right, re-entered the highway, and then slid back off the road to left again, crossed the shoulder and collided with the center media. The force of the collision sent the Taurus back to the right, causing it to roll over and come to rest in the center lane of the highway.

It was then that a 2004 Dodge Dakota pickup truck traveling northbound in the center lane saw the Taurus on the roadway ahead. The Dakota’s driver, 51-year-old man from Bradford, applied his brakes but skidded into the Dakota, according to Bibeau.

The teenager was ejected from the Taurus at some point in the crash and preliminary investigation indicates he was not wearing a seat belt.

He was transported to Lahey Clinic in Burlington, where he was pronounced dead.

The Dakota’s driver was transported to Winchester Hospital with minor injuries.

The names of the victims are being withheld pending state police notification.

All northbound lanes on Interstate 93 were closed during the investigation. The road was partially opened by 5 a.m., with all lanes reopening by approximately 6:15 a.m.

The accident is being investigated by Troop A of the Massachusetts State Police, with the assistance from the State Police Collision Analysis and Reconstruction Section and the State Police Crime Scene Services Section.

No other information was available.


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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