POC for resident injury

[JEMartin6452]

I've been asked to ask all of you what you would do in this situation that our home now finds ourselves in.  Over the weekend a resident who has had a CVA was propelling herself down the hallway in a Broda chair using the hand rails along the hallway.  At some point she grabbed a hold of a door jam to a resident's room wrapping her fingers around the jam and just in the space between the door on the side the hinges are on.  The resident who lives in the room saw her coming into her room and shut the door.  Unfortunately the resident who had her fingers in the door jam almost completely severed two finger tips off.  She was taken to the hospital and her injuries were sutured.  This was such a freak accident that we are at a loss as to how to prevent this from reoccurring.  You can't put stoppers on the doors.  We had the resident in the hallway so that she could be more easily observed but you can't have someone in the hall monitoring constantly.  Any suggestions for a POC because the family has already informed us that they are reporting the incident to the state.  Even if they weren't, obviously we want to prevent this type of incident from ever happening again. Thank you, Janice Martin, RN MDS Coordinator