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Woburn teen dies in I-93 crash

Joseph Briere, 19, of Woburn, was killed last night when the SUV in which he was a passenger rolled over on southbound I-93 near Exit 3 in New Hampshire, New Hampshire State Police have confirmed.

He was taken by medical helicopter to Massachusetts General Hospital, where he was later pronounced dead.

Briere was one of five young people from Woburn who were riding in the 1998 Isuzu Trooper, which police said was driven by Kyle Ahearn, 19. Ahearn and the other three passengers, Shshank Samual, 20, Ethan Ahearn, 15, and Patrick Raistrick, 18, were first treated by Derry Fire and Rescue, then taken by ambulance to area hospitals with what police described as non-life-threatening injuries.

Police said they responded to a call about a single-car rollover about 5:15 p.m. and found the SUV rolled over on its driver’s side, blocking both southbound lanes.

The investigation is ongoing; however it appears that the Isuzu Trooper left the right side of the roadway and struck the beginning portion of a guard rail  causing the vehicle to roll back into the roadway, police said..

Interstate 93 south was closed for over an hour and rush-hour traffic was diverted off Exit 4 in Londonderry and rerouted to the north by way of an emergency crossover north of the collision scene.  One lane remained closed for about two hours while troopers reconstructed the accident, gathered evidence and removed the vehicle and debris from the roadway.  Troopers were assisted with traffic and clean up at the scene by Department of Transportation.

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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7 days ago  ·  

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