A2cl Aurora Health Center - Menomonee Falls

CLIA Laboratory Citation Details

3
Total Citations
14
Total Deficiencyies
7
Unique D-Tags
CMS Certification Number 52D0388478
Address N84 W16889 Menomonee Ave, Menomonee Falls, WI, 53051
City Menomonee Falls
State WI
Zip Code53051
Phone(262) 251-7500

Citation History (3 surveys)

Survey - May 31, 2023

Survey Type: Standard

Survey Event ID: SC8L11

Deficiency Tags: D6177 D6177

Summary:

Summary Statement of Deficiencies D6177 TESTING PERSONNEL RESPONSIBILITIES CFR(s): 493.1495(b)(3) Each individual performing high complexity testing must adhere to the laboratory's quality control policies, document all quality control activities, instrument and procedural calibrations and maintenance performed. This STANDARD is not met as evidenced by: Based on surveyor observations, review of procedures and records, and interview with staff, testing personnel did not follow the laboratory's quality control policies and did not document maintenance performed on the cryostat in the dermatology laboratory in twelve of the last twelve months. Findings include: 1. Observation of equipment in the dermatology laboratory on May 31, 2023, at 9:00 AM revealed a Leica CM1950 cryostat used for processing dermatology tissue samples. 2. Review of the procedure, 'WI - MOHS Dermatology Cryostat Decontamination and Maintenance', showed the procedure required documentation of maintenance using the 'WI - Mohs Cryostat Maintenance and Disinfection/Decontamination Sheet' and required documented review of the completed forms. 3. Review of laboratory records from the last twelve months showed no evidence of use of the Mohs Cryostat Maintenance and Disinfection/Decontamination Sheet or other documentation of maintenance of the cryostat. 4. Interview with staff A on May 31, 2023, at 10:00 AM confirmed staff did not document maintenance performed on the cryostat and confirmed staff did not follow the 'WI-Mohs Cryostat Decontamination and Maintenance' procedure. Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 1 --

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Survey - September 1, 2021

Survey Type: Standard

Survey Event ID: YF9Q11

Deficiency Tags: D5215 D5401 D5439 D5215 D5401 D5439

Summary:

Summary Statement of Deficiencies D5215 EVALUATION OF PROFICIENCY TESTING PERFORMANCE CFR(s): 493.1236(b)(2) The laboratory must verify the accuracy of any analyte, specialty or subspecialty assigned a proficiency testing score that does not reflect laboratory test performance (that is, when the proficiency testing program does not obtain the agreement required for scoring as specified in subpart I of this part, or the laboratory receives a zero score for nonparticipation, or late return or results). This STANDARD is not met as evidenced by: Based on surveyor review of Wisconsin State Laboratory of Hygience (WSLH) proficiency testing (PT) records and interview with the technical consultant, the laboratory did not evaluate the accuracy for twenty-five of twenty-five "Not scored- insufficient peer group" "Hematolgy-Comprehensive-AF5" PT results for 2020. Findings include: 1. Review of Wisconsin State Laboratory of Hygiene (WSLH) PT records showed the laboratory did not evaluate the accuracy of the following "Hematology-Comprehensive-AF5" PT results in 2020. a. 2020-HemeReg1: Five of five "Not scored-insufficient peer group" "Monocyte %" results. b. 2020-HemeReg2: Five of five "Not scored-insufficient peer group" "Lymphocytes%" results, five of five "Not scored-insufficient peer group" "Basophils%" results. c. 2020-HemeReg3: Five of five "Not scored-insufficient peer group" "Lymphocytes%" results, five of five "Not scored-insufficient peer group" "Basophils%" results 2. Interview with the technical consultant on September 1, 2021 at 9:35 AM confirmed the laboratory did not evaluate the accuracy for twenty-five of twenty-five "Not scored-insufficient peer group" "Hematolgy-Comprehensive-AF5" PT results for 2020. D5401 PROCEDURE MANUAL CFR(s): 493.1251(a) Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 3 -- A written procedures manual for all tests, assays, and examinations performed by the laboratory must be available to, and followed by, laboratory personnel. Textbooks may supplement but not replace the laboratory's written procedures for testing or examining specimens. This STANDARD is not met as evidenced by: Based on surveyor review of laboratory procedures and records and interview with the general supervisor, testing personnel did not follow the laboratory's procedure for "Bi- Annual Automated and Manual Differential Comparisons" for hematology differentials in 2020 and 2021. Findings include: 1. Review of the "Bi-Annual Automated and Manual Differential Comparisons" procedure revealed comparisons between automated and manual differential "must be performed at a minimum of twice per year". 2. Review of hematology records showed differential method comparison performed February 28, 2020. Further review showed no additional method comparison in 2020 or 2021. 3. Interview with the general supervisor on September 1, 2021 at 1:30 PM confirmed the testing personnel did not follow the laboratory's procedure "Bi-Annual Automated and Manual Differential Comparisons" for hematology differentials in 2020 and 2021. D5439 CALIBRATION AND CALIBRATION VERIFICATION CFR(s): 493.1255(b) Unless otherwise specified in this subpart, for each applicable test system the laboratory must do the following: Perform and document calibration verification procedure - (b)(1) Following the manufacturer's calibration verification instructions; (b)(2) Using the criteria verified or established by the laboratory under 493.1253(b)(3) -- (b)(2)(i) Including the number, type, and concentration of the materials, as well as acceptable limits for calibration verification; and (b)(2)(ii) Including at least a minimal (or zero) value, a mid-point value, and a maximum value near the upper limit of the range to verify the laboratory's reportable range of test results for the test system; and (b)(3) At least once every 6 months and whenever any of the following occur: (b)(3)(i) A complete change of reagents for a procedure is introduced, unless the laboratory can demonstrate that changing reagent lot numbers does not affect the range used to report patient test results, and control values are not adversely affected by reagent lot number changes. (b)(3)(ii) There is major preventive maintenance or replacement of critical parts that may influence test performance. (b)(3)(iii) Control materials reflect an unusual trend or shift, or are outside of the laboratory's acceptable limits, and other means of assessing and correcting unacceptable control values fail to identify and correct the problem. (b)(3)(iv) The laboratory's established schedule for verifying the reportable range for patient test results requires more frequent calibration verification. This STANDARD is not met as evidenced by: Based on surveyor review of calibration verification records and interview with the general supervisor, the laboratory did not perform calibration verification every six months for the Siemens Xpand chemistry analyzer in 2021. Findings include: 1. Review of calibration verification records showed calibration verification performed on February 13, 2020 and September 1, 2020 for electrolytes, calcium and aspartate aminotransferase (AST). Further review showed no documentation of calibration verification for the Siemens Xpand chemistry analyzer in 2021. 2. Interview with the general supervisor on September 1, 2021 at 12:10 PM confirmed the laboratory did -- 2 of 3 -- not perform calibration verification every six months for the Siemens Xpand chemistry analyzer in 2021. -- 3 of 3 --

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Survey - May 24, 2019

Survey Type: Standard

Survey Event ID: V95X11

Deficiency Tags: D5413 D5417 D6069 D5413 D5417 D6069

Summary:

Summary Statement of Deficiencies D5413 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(b) The laboratory must define criteria for those conditions that are essential for proper storage of reagents and specimens, accurate and reliable test system operation, and test result reporting. The criteria must be consistent with the manufacturer's instructions, if provided. These conditions must be monitored and documented and, if applicable, include the following: (1) Water quality. (2) Temperature. (3) Humidity. (4) Protection of equipment and instruments from fluctuations and interruptions in electrical current that adversely affect patient test results and test reports. This STANDARD is not met as evidenced by: Based on surveyor review of laboratory temperature records and patient logs, and interview with the technical supervisor, the laboratory did not document the temperature of the cryostats two of four days of use in May 2019. Findings include: 1. Review of cryostat temperature records for May 2019 showed documented temperatures for cryostat number 1 and number 2 on only two days, May 1 and May 8, 2019. 2. Review of Mohs patient logs from May 2019 showed the physician, Staff A, performed Mohs procedures on May 1, 8, 15, and 22, 2019. 3. Interview with the technical supervisor, staff A, on May 24, 2019 at 9:50 AM confirmed Mohs procedures were performed on May 15 and May 22, 2019 and confirmed staff did not document the temperatures of the cryostat. D5417 TEST SYSTEMS, EQUIPMENT, INSTRUMENTS, REAGENT CFR(s): 493.1252(d) Reagents, solutions, culture media, control materials, calibration materials, and other supplies must not be used when they have exceeded their expiration date, have deteriorated, or are of substandard quality. Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 2 -- This STANDARD is not met as evidenced by: Based on surveyor observation of reagents in use in the laboratory and interview with the technical supervisor, the laboratory used Surgipath Scott's Tap Water Substitute Working Solution from February 27, 2019 through May 22, 2019 after the expiration date of January 20, 2019. Findings include: 1. Observation of the staining reagents currently in use in the laboratory revealed one bottle of Surgipath Scott's Tap Water Substitute Working Solution (Reference number 3802901). The bottle showed an opened date of February 27, 2019 and showed the manufacturer's expiration date of January 20, 2019. 2. Interview with the technical supervisor, staff A, on May 24, 2019 at 9:50 AM confirmed laboratory staff used the reagent after the expiration date. D6069 TESTING PERSONNEL RESPONSIBILITIES CFR(s): 493.1425(a) Each individual performs only those moderate complexity tests that are authorized by the laboratory director and require a degree of skill commensurate with the individual's education, training or experience, and technical abilities. This STANDARD is not met as evidenced by: Based on surveyor observation of testing supplies and interview with the dermatology manager and the technical consultant, three physicians in the dermatology area performed microscopy procedures that the laboratory director had not authorized. Findings include: 1. Observation of testing supplies in the dermatology area on May 24, 2019 at 10:05 AM revealed a microscope, slides, potassium hydroxide (KOH) reagent, and Chlorazol Black and Toluidine Blue stains. 2. Interview with the dermatology manager, staff B, on May 24, 2019 at 10:05 AM revealed three physicians perform microscopy procedures in the department including KOH and scabies examinations. Further interview revealed procedures were not available for these tests in the department. 3. Interview with the technical consultant, staff C, on May 24, 2019 at 10:30 AM revealed the director had not authorized the performance of microscopy procedures using KOH, Chlorazol Black, or Toluidine Blue in the dermatology area. Further interview confirmed the technical consultant had not been aware of the testing and had not evaluated competency of the staff performing these microscopy procedures. -- 2 of 2 --

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