Passaic woman among 3 killed in Route 3 crash

NORTH BERGEN — A Passaic woman and two men from Massachusetts were killed in a single-car, high-speed accident around 5:40 a.m. Thursday on the Route 3 eastbound ramp that merges into Route 495 and the approach to the Lincoln Tunnel, authorities said.

Margarita Santiago, 32, of Passaic, was on her way to visit family in Massachusetts when she was killed along with her cousin, Miguel A. Barreto Jr., 34, of Leominister, Mass., who had traveled to New Jersey to pick her up, according to family members.

Authorities identified Santiago and Barreto as victims after notifying their next of kin but declined to reveal the identity of the third victim, saying they had not yet contacted his family. He also was from Massachusetts, they said. They did not immediately say who was driving.

Authorities believe speed contributed to the crash, said the Hudson County Sheriff’s Office spokesman, Michael Makarski. The car, a white Mercedes station wagon with Massachusetts license plates, struck a guardrail and slid 153 feet before breaking into pieces when it struck a light pole, authorities said.

The Sheriff’s Office’s accident reconstruction team has determined that the car went airborne after hitting the guardrail and landed on the driver’s side before sliding along the roadway, Sheriff Frank X. Schillari said in a news release.

All eastbound lanes were reopened at 11:20 a.m. after lanes were closed for the morning commute, causing delays of an hour and backups as far west as Route 21 in Clifton.

Bareto’s sister, Vivian Bareto, said her brother had taken their mother’s car to New Jersey to pick up their cousin, Santiago, and bring her to Massachusetts for a visit. She said that her brother wanted Santiago to meet his two daughters. She said she did not know the identity of the third victim.

There were two fatal crashes in the same area last year.

In August 2013, three men died and two were injured in a one-car crash when the vehicle struck a curb on Route 3 and veered off the roadway onto a grassy area. The car then struck a concrete pillar and rolled over several times, coming to a stop near an overpass.

Weeks later, a 25-year-old East Windsor man was killed and his passenger critically injured when the SUV he was driving overturned there.


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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