Pedestrian who died is identified

LAWRENCE – The pedestrian struck and killed Monday evening on Parker Street was identified yesterday as Earle Baker Jr., 54, police said.

Baker was crossing Parker Street, but was not in a crosswalk, when he was hit by a black 2006 Chrysler Pacifica driven by Yordana Gil, 37, of 10 Stevens St., apt. 1, Lawrence, according to a police report.

When officers arrived at about 5:15 p.m., Baker was found “lying on his back with heavy facial trauma,” according to a police report.

Gil was standing outside her car and was “visibly shaken” and “crying,” according to the report, written by officer Thomas Murphy.

She told police she was stopped on Market Street facing west and when the light turned green, she went to to make a left turn onto Parker Street heading north.

Gil said Baker was dressed in black clothing and after she struck him she stopped immediately and called police, Murphy said.

Baker was taken to Lawrence General Hospital where he died approximately an hour later. He had most recently lived on the second floor at 209 Prospect St., police said.

Patriot Ambulance workers also checked out Gil as a precaution, Murphy said.

Baker’s next of kin, a sister living in Harwich, Mass., was notified of his death later Monday night, Police Chief James Fitzgerald said.

The accident remains under investigation by Lawrence police and a Massachusetts State Police accident reconstruction team.

Fitzgerald neither alcohol nor speed appear to be factors in the crash. Gil is believed to be traveling between 15 to 20 miles per hour when the accident occurred, he said.

“She has not been cited for anything,” Fitzpatrick said.

Once the accident report is completed, the results will be given to District Attorney Jonathan Blodgett’s office to see if charges are warranted, he said.

The Pacifica was towed to Coady’s garage on Marston Street and is being held there pending the state police investigation.


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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5 days ago  ·  

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