Chase County Community Hospital

“PATIENT CARE POLICIES CFR(s): (1) The CAH’s health care services are furnished in accordance with appropriate written policies that are consistent with applicable State law. This Standard is not met as evidenced by: 52353 Based on observation, policy and procedure review, medical record review and staff interview, the Critical Access Hospital (CAH) failed to follow policy and procedure for hand hygiene for 1 of 1 (Patient 41) observed. The CAH also failed to follow policy and procedure for Foley Catheter care for 1 of 1 (Patient 9) records reviewed. This failed practice had the potential to affect all patients of the CAH with a reported a census of 140 patients and 723 emergency room (ED) visits for the fiscal year ending 6/30/24. Findings are: A. Observation (6/10/25 at 10:18) RN-G obtained albuterol (medication to improve breathing) to administer to patient 20. Without performing hand hygiene and without putting on gloves, opened nebulizer (dispenses fine mist medication) packaging and placed albuterol in medication cup. RN-G then entered patients 20’s room without performing hand hygiene and without wearing gloves, handed the nebulizer with mouthpiece (allows direct delivery of medication to the lungs) to the patient. RN-G attached the tubing to the oxygen flowmeter (measures amount of oxygen), at this time the tubing to the mouthpiece became disconnected. RN-G reattached the nebulizer tubing without wearing gloves. Once the nebulizer treatment was completed, RN-G took used nebulizer tubing and used mouthpiece from patient without using gloves or performing hand hygiene. With bare hands carried used equipment to the sink in patients room. RN-G without performing hand hygiene or without putting on gloves, disassembled nebulizer mouthpiece, medication cup and tubing. RN-G rinsed used equipment in the sink under running water with bare hands. After rinsing RN-G placed items on a paper towel on the edge of the sink to dry. Without washing hands with soap and water, RN-G dried both hands off with a paper towel. RN-G exited patient 20’s room without performing hand hygiene and began charting on a computer outside of the room. - Review of policy and procedure titled Hand Hygiene Policy (Effective 10/5/19) stated ...”staff ...wash their hands during ...before and after any patient contact ...before entering a patients room and exiting a patients room ...any contact with mucus membranes ...any contact with inanimate objects including medical equipment.” B. Review of patient 9’s medical record (6/11/25 at 1:50PM) revealed the patient was admitted as an inpatient from the Critical Access Hospital (CAH) swing bed (12/5-12/11/25) with a diagnosis of anemia (low red blood cell count) and leukopenia (low white blood cell count making it difficult to fight infection) secondary to receiving chemotherapy for chronic lymphocytic leukemia (cancer involving white blood cells). The patient had a Foley catheter (flexible tube to help urinate) in place for a history of urine retention (not being able to fully urinate) and chronic kidney failure. On 12/10/25 review of nursing documentation lacks evidence of documentation of cleaning the Foley catheter site on am cares. -Review of policy and procedure titled Indwelling Urinary Catheter (Effective 4/1/24) stated ...” Catheters will be routinely cleansed ...with soap and water with am and pm cares.” C. Interview (6/10/25 at 10:35) with RN-G confirmed lack of hand hygiene as outlined above. RN-G stated “I should wear gloves”, I should “wash hands in the sink or with gel.” -Interview with CNO (6/12/25 at 10:00AM) confirmed lack of documented am catheter care.”

“PATIENT CARE POLICIES CFR(s): [The policies include the following:] (ii) Policies and procedures for emergency medical services. This Standard is not met as evidenced by: 52353 Based on review of emergency medication count log, review of crash cart checklists, policy and procedure review and staff interview, the Critical Access Hospital (CAH) failed to ensure the emergency department (ED) count of controlled substances were completed on 1 of 1 ED crash carts. The CAH failed to ensure the crash cart defibrillator log was completed on 1 of 1 (ED) crash carts and 1 of 1 nursing unit crash carts. The CAH also failed to ensure the pediatric crash cart log was completed on 1 of 1 pediatric crash carts. This failed practice had the potential to affect all patients of the CAH. The CAH reported a census of 140 patients, 223 Surgical patients, 71 procedural patients and 723 ED visits for the fiscal year ending 6/30/24. Findings are: A. Review of (ED) crash cart count of controlled substances (medications used for pain and relaxation) on (6/11/25 at 10:00 AM) dated (1/1/-6/10/25) revealed lack of documentation of crash cart count of controlled substances being completed on the following dates: 1/12/25, 1/18/25, 1/19/25, 1/31/25, 2/15/25, 3/25/25, 4/23/25, 4/29/25, and 5/4/25. B. Review of the (ED) defibrillator log (6/11/25 at 10:00 AM) dated (1/1/-6/10/25) revealed lack of documentation of defibrillator log being completed on the following dates: 1/8/25, 1/16/25, 1/17/25, 1/18/25, 1/27/25, 1/31/25, 3/1/25, 3/25/25, 4/23/25, 4/29/25, 4/31/25, 5/3/25, 5/3/25, 5/4/25, 6/1/25, and 6/7/25. -Review of nursing unit defibrillator log (6/11/25 at 10:30AM) dated (1/1/-6/9/25) revealed lack of documentation of defibrillator log being completed on the following dates:1/25/25, 1/26/25, 2/2/25, 2/3/25, 2/7/25, 3/19/25, 4/4/25, and 5/4/25. C. Review of pediatric crash cart log (6/11/25 at 10:00 AM) dated (12/24-5/25) revealed a lack of documentation of being completed for April 2025. E. Policy and procedure titled Medication Carts-Monitoring (last revision 5/5/25) stated “...All crash carts shall be checked by a licensed nurse on routine schedule.” F. Interview with CNO (6/11/25 at 11:00 AM) confirmed the above crash cart count of controlled substances, (ED) crash cart log, nursing unit crash cart log, and pediatric crash cart log lacked doumentation of being completed.”

“PATIENT CARE POLICIES CFR(s): [The policies include the following:] (iv) Rules for the storage, handling, dispensation, and administration of drugs and biologicals. These rules must provide that there is a drug storage area that is administered in accordance with accepted professional principles, that current and accurate records are kept of the receipt and disposition of all scheduled drugs, and that outdated, mislabeled, or otherwise unusable drugs are not available for patient use. This Standard is not met as evidenced by: 52353 Based on observation of emergency medications and supplies, review of policy and procedure, and staff interview, the Critical Access Hospital (CAH) failed to ensure outdated emergency medications were not available for patient use on 2 of 2 crash carts. The CAH also failed to ensure outdated supplies were not available for patient use in 3 of 3 patient rooms (Patient Rooms 7, 8 and 9) observed, and for 5 of 5 of random sample supplies in the central supply room. These failed practices had the potential to affect all patients of the CAH. The CAH reported a census of 140 patients, 223 Surgical patients, 71 procedural patients and 723 emergency room (ED) visits for the fiscal year ending 6/30/24. Findings are: A. Observation of emergency medications located in the ED crash cart (6/10/25 at 11:55PM) revealed the following expired medications: -Norepinephrine (medication used to increase blood pressure) 4 milligrams (mg) in 4 milliliter (ml) vial, 1 of 1 vial expired 4/25. -Amiodarone (medication used to return the heart to a normal rhythm) 450 mg in 9 ml vial, 2 of 2 vials expired 5/25. B. Observation of emergency medications located in the patient floor crash cart (6/10/25 at 12:00PM) revealed the following expired medications: -Norepinephrine 4mg mixed in 250 ml IV bag expired 5/21/25 C. Observation of facility central supply room (6/11/25 at 8:50 AM) revealed the following expired medications: -5 IV Dextrose (energy for body cells) 10% concentration 500 ml volume bags expired 1/25. D. Random observation of patient rooms revealed the following expired supplies in 3 patient rooms available for use: -Room 7 (6/10/25 at 9:08 AM) adult aerosol (fine medication mist) mask expired 5/6/24, adult aerosol mask with opened packaging and exposed mask. -Room 8 (6/10/25 at 9:10 AM) adult oxygen mask (used to deliver oxygen over nose and mouth) expired 5/6/24 for 2 of 2 masks. -Room 9 (6/10/25 at 9:15 AM) adult oxygen mask expired 5/6/24. . E. Review of policy and procedure titled Medication Carts-Monitoring (Revision 5/25/25) stated “ ...all crash carts/medication carts shall be checked by a licensed nurse on a routine basis ...any outdated items should be removed.” -Review of policy and procedure titled Medications-Management of Expired Drugs (last review 3/17/25) ...”Outdated medications shall be managed by ...qualified individuals within the departments. Outdates shall be checked on at least a monthly basis.” F. Interview with the CNO (6/11/25 at 12:30 PM) confirmed the above medications and supplies were expired and available for patient use.”

“COMP ASSESSMENT, CARE PLAN & DISCHARGE CFR(s): §485.645(d)(5) Comprehensive assessment, comprehensive care plan, and discharge planning (§483.20(b), and §483.21(b) and (c)(2) of this chapter), except that the CAH is not required to use the resident assessment instrument (RAI) specified by the State that is required under §483.20(b), or to comply with the requirements for frequency, scope, and number of assessments prescribed in §413.343(b) of this chapter). “ §483.20(b) Comprehensive assessments- (1) Resident assessment instrument. A facility must make a comprehensive assessment of a resident’s needs, strengths, goals, life history and preferences, using the resident assessment instrument (RAI) specified by CMS. The assessment must include at least the following: (i) Identification and demographic information. (ii) Customary routine. (iii) Cognitive patterns. (iv) Communication. (v) Vision. (vi) Mood and behavior patterns. (vii) Psychosocial well-being. (viii) Physical functioning and structural problems. (ix) Continence. (x) Disease diagnoses and health conditions. (xi) Dental and nutritional status. (xii) Skin condition. (xiii) Activity pursuit. (xiv) Medications. (xv) Special treatments and procedures. (xvi) Discharge planning. (xvii) Documentation of summary information regarding the additional assessment performed on the care areas triggered by the completion of the Minimum Data Set (MDS). (xviii) Documentation of participation in assessment. The assessment process must include direct observation and communication with the resident, as well as communication with licensed and nonlicensed direct care staff members on all shifts. (2) When required. Subject to the timeframes prescribed in §413.343(b) of this chapter, a facility must conduct a comprehensive assessment of a resident in accordance with the timeframes specified in paragraphs (b)(2) (i) through (iii) of this section. The timeframes prescribed in §413.343(b) of this chapter do not apply to CAHs. (i) Within 14 calendar days after admission, excluding readmissions in which there is no significant change in the resident’s physical or mental condition. (For purposes of this section, “readmission” means a return to the facility following a temporary absence for hospitalization or for therapeutic leave.) (ii) Within 14 calendar days after the facility determines, or should have determined, that there has been a significant change in the resident’s physical or mental condition. (For purposes of this section, a “significant change” means a major decline or improvement in the resident’s status that will not normally resolve itself without further intervention by staff or by implementing standard disease-related clinical interventions, that has an impact on more than one area of the resident’s health status, and requires interdisciplinary review or revision of the care plan, or both.) (iii) Not less often than once every 12 months. “ §483.21(b) Comprehensive care plans. (1) The facility must develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth at §483.10(c)(2) and §483.10(c)(3), that includes measurable objectives and timeframes to meet a resident’s medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. The comprehensive care plan must describe the following: (i) The services that are to be furnished to attain or maintain the resident’s highest practicable physical, mental, and psychosocial well-being as required under §483.24, §483.25, or §483.40; and (ii) Any services that would otherwise be required under §483.24, §483.25, or §483.40 but are not provided due to the resident’s exercise of rights under §483.10, including the right to refuse treatment under §483.10(c)(6). (i) Any specialized services or specialized rehabilitative services the nursing facility will provide as a result of PASARR recommendations. If a facility disagrees with the findings of the PASARR, it must indicate its rationale in the resident’s medical record. (ii) In consultation with the resident and the resident’s representative(s)- (A) The resident’s goals for admission and desired outcomes. (B) The resident’s preference and potential for future discharge. Facilities must document whether the resident’s desire to return to the community was assessed and any referrals to local contact agencies and/or other appropriate entities, for this purpose. (C) Discharge plans in the comprehensive care plan, as appropriate, in accordance with the requirements set forth in paragraph (c) of this section. (2) A comprehensive care plan must be- (i) Developed within 7 days after completion of the comprehensive assessment. (ii) Prepared by an interdisciplinary team, that includes but is not limited to- (A) The attending physician. (B) A registered nurse with responsibility for the resident. (C) A nurse aide with responsibility for the resident. (D) A member of food and nutrition services staff. (E) To the extent practicable, the participation of the resident and the resident’s representative(s). An explanation must be included in a resident’s medical record if the participation of the resident and their resident representative is determined not practicable for the development of the resident’s care plan. (F) Other appropriate staff or professionals in disciplines as determined by the resident’s needs or as requested by the resident. (iii) Reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments. (3) The services provided or arranged by the facility, as outlined by the comprehensive care plan, must- (i) Meet professional standards of quality. (ii) Be provided by qualified persons in accordance with each resident’s written plan of care. (iii) Be culturally-competent and trauma-informed. “ §483.21(c)(2) Discharge summary. When the facility anticipates discharge a resident must have a discharge summary that includes, but is not limited to, the following: (i) A recapitulation of the resident’s stay that includes, but is not limited to, diagnoses, course of illness/treatment or therapy, and pertinent lab, radiology, and consultation results. (ii) A final summary of the resident’s status to include items in paragraph (b)(1) of §483.20, at the time of the discharge that is available for release to authorized persons and agencies, with the consent of the resident or resident’s representative. (iii) Reconciliation of all pre-discharge medications with the resident’s post-discharge medications (both prescribed and over-the-counter). (iv) A post-discharge plan of care that is developed with the participation of the resident and, with the resident’s consent, the resident representative(s), which will assist the resident to adjust to his or her new living environment. The post-discharge plan of care must indicate where the individual plans to reside, any arrangements that have been made for the resident’s follow up care and any post-discharge medical and non-medical services. This Standard is not met as evidenced by: 46123 Based on medical record review, facility policy review and staff interview the Critical Access Hospital (CAH) failed to ensure a discharge summary that included a recapitulation of the patients stay for 5 of 5 swing bed patients (Patients 32, 33, 34, 35 and 36). This failed practice had the potential to affect all swing bed patients at the CAH. The number of swing bed patients at the CAH for Fiscal Year 24 was 47 swing bed patients. Findings are: A. Review of Patient 32’s medical record (6/11/25 at 4:00PM) revealed a swing bed admission of 11/22/24 - 12/18/24 for a left hip joint replacement. Review of the entire medical record revealed a lack of evidence of a discharge summary that included a recapitulation of the patients stay. - Review of Patient 33’s medical record (6/11/25 at 4:30PM) revealed a swing bed admission of 1/13/25 -2/3/25 for pinning of a right hip fracture. Review of the entire medical record revealed a lack of evidence of a discharge summary that included a recapitulation of the patients stay. - Review of Patient 34’s medical record (6/12/25 at 8:30AM) revealed a swing bed admission of 1/8/25 - 2/6/25 for osteomyelitis (an infection of the bone). Review of the entire medical record revealed a lack of evidence of a discharge summary that included a recapitulation of the patients stay. - Review of Patient 35’s medical record (6/12/25 at 8:55AM) revealed a swing bed admission of 2/27/25 - 3/3/25 for congestive heart failure (CHF - the heart is unable to pump enough blood to meet the body’s needs). Review of the entire medical record revealed a lack of evidence of a discharge summary that included a recapitulation of the patients stay - Review of Patient 36’s medical record (6/12/25 at 9:15AM) revealed a swing bed admission of 4/19/25-4/28/25 for encephalopathy (a brain disorder that affects the function). Review of the entire medical record revealed a lack of evidence of a discharge summary that included a recapitulation of the patients stay. B. The facility lacked evidence of a policy for the discharge summary with recapitulation of the patients stay. C. Interview with Chief Nursing Officer (CNO) (6/12/25 at 10:00AM) confirmed, 5 of 5 swing bed records lacked the document type discharge summary with recapitulation.”

“42 CFR 483.90(a) (b) The facility must meet the applicable provisions of the 2012 Edition of the Life Safety Code of the National Fire Protection Association. This facility is governed by Chapter 19, Existing Health Care Occupancies of the 2012 Edition of the National Fire Protection Association [NFPA], Chapter 101: Life Safety Code. Chase County Community Hospital is a one story building, of Type II(111) construction that was built in 1977 with an addition in 1992 with the addition having automatic supervised sprinkler system. There is supervised smoke detection located in the corridors and all open areas to the corridor. The facility has 15 beds. At the time of the survey the census was 0. Chase County Community Hospital was found not to be in compliance with the requirements for participation in Medicare/Medicaid at 42 CFR 483.90(a), Life Safety from Fire, and the related National Fire Protection Association (NFPA) Standard 101 - 2012 edition.”

“Fire Drills CFR(s): NFPA 101 Fire Drills Fire drills include the transmission of a fire alarm signal and simulation of emergency fire conditions. Fire drills are held at expected and unexpected times under varying conditions, at least quarterly on each shift. The staff is familiar with procedures and is aware that drills are part of established routine. Where drills are conducted between 9:00 PM and 6:00 AM, a coded announcement may be used instead of audible alarms. 19.7.1.4 through 19.7.1.7 This Standard is not met as evidenced by: 15537 Based on observation and record review, the facility failed to conduct fire drills at one per shift per quarter. This deficient practice has the potential of affecting all occupants in two of two smoke zones. This deficient practice has the potential to affect the readiness of the staff in the case of fire emergency. This facility has a capacity of 15 and census of 0 patients at the time of the survey. Finding are: On 6/10/2025/2025 at 1200 P.M., record review, the facility failed to conduct a fire drill for the second shift in the third quarter of 2024. During interview conducted on 6/10/2025 at 12:00 P.M., Maintenance personnel stated that they were unaware of the missing drill.”

“COMPLIANCE WITH 489.24 CFR(s): 489.20(l) [The provider agrees,] in the case of a hospital as defined in §489.24(b), to comply with §489.24. This Standard is not met as evidenced by: 46123 Based on record review, review of facility policies and staff interviews. The facility failed to follow their policy regarding providing stabilizing treatment within the facilities capabilities for 1 patient (P) (P2) of 20 sampled medical records. This failed practice has the potential to cause permanent harm or even death to all patients that present to the Emergency Department (ED) for evaluation of an emergency medical condition (EMC). According to facility provided information the ED treats on average 79 patients per month. See citation C2407, that also resulted in C2400 to not be met.”

“STABILIZING TREATMENT CFR(s): 489.24(d)(1-3) (1) General. Subject to the provisions of paragraph (d)(2) of this section, if any individual (whether or not eligible for Medicare benefits) comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either- (i) within the capabilities of the staff and facilities available at the hospital, for further medical examination and treatment as required to stabilize the medical condition. (ii) For for transfer of the individual to another medical facility in accordance with paragraph (e) of this section. (2) Exception: Application to inpatients. (i) If a hospital has screened an individual under paragraph (a) of this section and found the individual to have an emergency medical condition, and admits that individual as an inpatient in good faith in order to stabilize the emergency medical condition, the hospital has satisfied its special responsibilities under this section with respect to that individual (ii) This section is not applicable to an inpatient who was admitted for elective (nonemergency) diagnosis or treatment. (iii) A hospital is required by the conditions of participation for hospitals under Part 482 of this chapter to provide care to its inpatients in accordance with those conditions of participation. (3) Refusal to consent to treatment. A hospital meets the requirements of paragraph (d)(1)(i) of this section with respect to an individual if the hospital offers the individual the further medical examination and treatment described in that paragraph and informs the individual (or a person acting on the individual’s behalf) of the risks and benefits to the individual of the examination and treatment, but the individual (or a person acting on the individual’s behalf) does not consent to the examination or treatment. The medical record must contain a description of the examination, treatment, or both if applicable, that was refused by or on behalf of the individual. The hospital must take all reasonable steps to secure the individual’s written informed refusal (or that of the person acting on his or her behalf). The written document should indicate that the person has been informed of the risks and benefits of the examination or treatment, or both. This Standard is not met as evidenced by: 46123 Based on review of CAH-A’s medical records, ACF-B medical record reviews, facility policy review and CAH-A’s database information the CAH failed to provide stabilizing care to 1 (P2) of 20 medical records sampled that were treated for an EMC in the ED. This failed practice has the potential to cause permanent harm or even death to all patients that present for treatment to the ED. According to facility provided information the ED treats around 79 patients per month. Also see C2400 and C2406 that resulted in C2407 not being met. Findings include: A. Review of facility policy “EMTALA - Medical Evaluation and Patient Transfers”, approved 7/18/23 revealed, an emergency medical condition (EMC) is a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbance and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in: - Placing the health of the individual in serious jeopardy - Serious impairment to bodily function, or - Serious dysfunction of any bodily organ or part Stabilize: To provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during transfer of the individual from a facility. Further Examination and Treatment: If the individual has an EMC, further medical examination, and stabilizing treatment within the capabilities of the staff and facilities must be provided. B. Review of the facility database completed by the Chief Executive Officer (CEO) of CAH-A and reviewed with surveyor revealed, CAH-A is a 15-bed licensed facility. Certified as a Basic Trauma Facility (level 4). To be certified as a Basic Trauma Facility all ED Registered Nurses (RNs) must have current Trauma Nurse Core Course (TNCC) certification and ED medical providers must have current Advanced Trauma Life Support class (ATLS) certification. The facility employs 13 full time RNs, 1 full time physician, 2 full time physician assistants (PAs), and 2 Nurse Practitioners (NP) all who provide ED coverage. The CAH is also contracted with a telehealth emergency service that is available 24 hours a day, 7 days a week. Any provider or nurse can connect with the service when needed. C. Review of CAH-A’s medical record revealed, P2 presented to the ED on 7/16/23 at 4:23PM via EMS following a SUV versus semi MVC. P2’s SUV was traveling at a speed of 50 miles per hour when it ran into the back of a parked semi. The SUV was noted to have significant damage to the front end. P2 was the unrestrained (not wearing seatbelt) driver, the windshield was starred (indicates passenger impact) on the driver’s side. EMS had P2 in a c-collar, K.E.D, backboard and headblocks for spinal immobilization. Upon arrival to ED EMS reported that P2 had complaints of bilateral upper extremities tingling and unable to move them at scene prior to extrication of the vehicle. Upon arrival to the primary and secondary trauma assessments were completed with it noted that P2 did not have purposeful extremity movements and was unable to move bilateral upper extremities, normal sensation distal to spinal cord injury and diminished motor distal to spinal cord injury. With hand grasps being unable to obtain due to patient condition. At 4:48 PM MD-A removed immobilization (K.E.D and backboard) with log roll and posterior inspection with no abnormalities noted. CT of head, c-spine, neck, chest, abdomen, and pelvis were completed. CT results were reviewed with P2 and spouse at 6:07 PM. MD-A then removed the c-collar. RN-B noted that CMS intact in lower extremities and not change in movement of bilateral arms, sensory and pulses good in upper extremities intact after removal of c-collar. At 6:55 PM MD-A at bedside discussing the plan of care. Plan was to observe P2 in the ED for a period of time to ensure P2 could void (urinate) after being straight cathed for urine sample and be able to get up and ambulate. After P2 failed to be able to urinate (could indicate a possible spinal injury) and was also unable to stand without leaning to the left and needing an assist of 3 to stand and transfer to a bedside commode. P2 also had a change in CMS assessment of being unable to walk, difficulty moving bilateral legs, unable to move bilateral upper extremities decision to transfer was made. RN-B documented P2’s pain through out the shift. Initial pain assessment was completed with initial vital signs at 4:35 PM with pain rating 8/10. Pain rating at 5:19 PM 10/10. P2 was given IV Tylenol at 5:23 PM. At 6:00 PM pain rating 9/10. MD-A was notified of pain rating and stated that he would not be giving any additional pain medication until the CT results were back. Results of CT were reviewed with P2 at 6:07 PM. The record lacks documentation of pain medication being ordered after CT results were received. At 7:00PM pain rating is documented as 10/10. RN-B again notified MD-A of pain being uncontrolled. MD-A stated that he wanted to hold off on pain medication at this time. RN-C took over care at 7:25 PM. At 9:50 PM RN-C documented pain as 8/10. Oral Tylenol 650mg was given at 9:00PM. P2’s pain was reassessed after Tylenol at 10:15PM pain ratine 8/10. At this time P2 was given oral Percocet 5/325milligrams (mg) 2 tablets. P2’s pain rating at 12:20AM prior to transfer continued to be 8/10. D. Review of ACH-B’s medical records revealed P2 was transferred from CAH-A to ACH-B for increased changes in P2’s neurological exam after MVC. P2’s CT’s done at CAH-A were noted to have no acute findings. P2 endorsed fentanyl given during air transport made a big difference in decreasing P2’s pain. P2 had an MRI done after arrival to ACH-B. Neurosurgery reviewed MRI and recommended transfer to a higher level of care for decompressive surgery and postoperative physical therapy. ACH-B transferred P2 to ACF-D for further treatment.”