Two workers injured in construction accident; OSHA to investigate

Three men were injured Thursday when a roof collapsed inside a 33-story building under construction at the edge of Chinatown and Downtown Crossing, causing a “pancake” reaction with floors falling atop one another, the Boston Fire Department said.

Two of the victims were taken to nearby Tufts Medical Center. Their injuries were not considered life-threatening. One had minor injuries; the other had a serious head wound, said Fire Department spokesman Steve MacDonald.

A third man hurt his wrist and walked to the hospital for treatment, MacDonald said.

The accident happened about 8 a.m. when 120 iron workers, laborers, and carpenters were inside the structure at 45 Stuart St., MacDonald said.

“The roof collapsed from the 12th floor to the fifth,’’ said MacDonald. “It did what we call pancake,’’ with one floor flattening the other below. He said he was unsure on which floor the injured laborers were working. He said inspectors from the Occupational Safety and Health Administration, the city, and the state were examining the building. OSHA will investigate the incident, he said.

At a morning event Thursday, Mayor Martin J. Walsh expressed concern for the laborers. “There are a lot of construction workers, men and women, in the trade very shaken up over this,” the mayor said.

The owner of the building was identified as AvalonBay Communities Inc., and an AvalonBay representative said the construction company is John Moriarty & Associates.

The building, a residential tower, was expected to be completed by mid-2015.

At the site early Thursday, a massive crane towered over the building an hour after the incident. Two Fire Department aerial ladders extended up the side of the building on the LaGrange Street side.

Michael Roberts, senior vice president of development for AvalonBay, said the company was hopeful the injured workers “will make full recoveries.’’

“We are fully cooperating with the Fire Department investigation and are in contact with representatives of OSHA,’’ Roberts said.

Martin Finucane of the Globe staff and Globe correspondent Catalina Gaitan contributed to this report.

Source: Boston Globe

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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6 days ago  ·  

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