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Nursing Home Litigation


Motor Vehicle Trauma Workers’ Comp Injuries Assaults


Temporomandibular Disorders Anxiety


HEADACHES


If your clients have headaches, a negative C.A.T. scan, and negative neurological findings, they may be at high risk for an undiagnosed temporomandibular disorder.


• Non-Surgical treatment of traumatic TMD’s and related post-traumatic headaches.


• Extensive expert witness experience • Independent medical evaluations • Impairment ratings


Symptoms of Temporomandibular Disorders


• Headaches • Pain in the Temples, Face, or Neck • Pain or Clicking from the Jaw Joint • Difficulty Opening and Closing Mouth • Clogged Ears • Ringing in the Ears • Ear Pain • Dizziness • Sore Throat


Dr. Stephen H. Gamerman, D.D.S., P.A.


107 W. Saratoga Street Baltimore, 21201 (410)539-1155


9811 Mallard Drive, Ste. 112 Laurel, MD 20708 (301)523-1470


Visit us at www.tmjdoctorofmaryland.com Email us: tmjdoctorofmaryland@gmail.com


a form document entitled Incident/Accident or Change in Condition (or similar description), which documents the relevant circumstances with some narrative detail. Te MDS form provides for assessments, among others,


of long and short term memory, cognitive deficits, mood, the ability of the resident to perform activities of daily living (including transfers, locomotion, hygiene, etc.), continence, the number of medications being taken and any history of accidents.


The Resident Assessment Protocol (RAP) Document


Te RAP is another valuable record that provides


detailed information about the resident and is helpful because it includes more narrative information than the MDS. Te RAP contains a listing of various problem areas, including whether the resident has any cognitive losses, is taking any psychoactive drugs, has fallen, has behavioral symptoms, etc., and if a particular issue is identified (“triggered”), then a written explanation is generated. Te information on the RAP may affect the specific plan of care for the resident and, if so, it will be documented as such in the resident’s chart.


38 Trial Reporter / Fall 2011


Other Sources of Information Physical and Occupational Terapy records document


the resident’s mobility, gait, strength and any specific


recommendation made to accommodate any limitations. If assistive devices are recommended, were they provided? Were they of proper size? Were they readily within the resident’s reach?


Certainly, the nursing and CNA notes must be reviewed


to make sure that the interventions that would have been suggested by the MDS or RAP documents were, in fact, implemented. Tese notes may also contain important clinical information that was not adequately documented in the other assessments, but which should have been included. Physician orders and progress notes should be reviewed to determine if orders were followed. Medication administration records should be reviewed to ensure compliance with any orders for changes in medications, dosages or the timing of medications. Te fall protocol and policy documents of the Nursing


Home must be obtained and reviewed. Are they up-to- date and consistent with current research and literature as to fall prevention? Does it appear that they were followed concerning the resident whose case you are investigating? Were staff adequately trained to recognize and implement fall prevention measures?


Extrinsic Factors Extrinsic factors may also influence the risk for falling.


Certain times of the day may be associated with increased risks for falling. Residents with dementia or Alzheimer’s may experience Sundowner’s syndrome which produces confusion, anxiety, restlessness and agitation after sundown. In this type of state, residents are more likely to fall. Te facility should find effective interventions -- reducing noise and stimulation as the evening approaches or giving appropriate medications -- that can mitigate these symptoms.


Fall Risk Assessment Te Fall Risk Assessment is an evaluation that is done


upon admission and quarterly, at a minimum, from there on. Depending upon what the initial assessment reveals, more frequent evaluations are done. Eight clinical conditions, including, among others, gait/balance status, whether the resident uses any assistive devices, gradations in systolic blood pressure readings (lying versus standing), continence, as well as predisposing disease processes are addressed and a score assigned to each. If a certain, total score is achieved, then appropriate preventive steps should be implemented by the facility.


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